A third of women with atypical endometrial hyperplasia have concurrent endometrial cancer, suggests a systematic review and meta-analysis published in PLoS One.
A team led by Queen's University Belfast identified studies published up to September 2018 that reported on the prevalence of concurrent cancer (within three months of endometrial hyperplasia diagnosis) or the incidence of cancer identified three or more months after hyperplasia diagnosis. A total of 36 articles were identified; 15 investigating concurrent endometrial cancer and 21 investigating progression to cancer.
In 11 studies of atypical hyperplasia, the pooled prevalence of concurrent endometrial cancer was 32.6 per cent (95% CI, 24.1%-42.4%), whereas no studies evaluated concurrent cancer in non-atypical hyperplasia.
The risk for progression to cancer was high in atypical hyperplasia (five studies) with an annual incidence rate of 8.2 per cent (95% CI, 3.9%-17.3%). Only one study reported on non-atypical hyperplasia found an annual incidence rate of 2.6 per cent (95% CI, 0.6%-10.6%).
Overall, a third of women with atypical hyperplasia had concurrent endometrial cancer, although the number of studies, especially population-based, is small.
Progression to cancer in atypical hyperplasia was high, but few studies were identified.
The authors say population-based estimates are required, in both atypical and non-atypical hyperplasia patients, to better inform treatment strategies.
