Endometrial Cancer on the Rise—Again

Abstract

Denise G. Link, PhD, WHNP-BC The Journal for Nurse Practitioners would like to thank Susan Wysocki for her past service as department editor and welcome the new department editor, Dr. Denise Link. Estrogenwas first approved by the Food and Drug Administration for the management of menopausal symptoms in 1942. Estrogen replacement was touted to relieve the disruptive symptoms of menopause and keep women young and feminine. This last goal is evident in the advertising that was used to encourage women to start estrogen therapy whether or not they were experiencing perimenopausal symptoms. Based on findings from large studies, physicians were recommending that women well beyond menopause start estrogen to benefit from protection from heart disease and osteoporosis. In 2 decades, as the widespread use of exogenous estrogen took hold, state vital statistics reviewers began to note a steady increase in the number of hysterectomies for endometrial cancer, particularly on the West Coast of the United States where the popularity of estrogen use was much stronger than elsewhere in the country. The rate of endometrial cancer in Alameda County, CA, alone doubled between 1970 and 1975. Similar increases began to be noticed elsewhere in the US but not in other countries. Then, in late 1975, 2 articles were published in the New England Journal of Medicine that reported findings of an association between the use of exogenous estrogens and the development of endometrial cancer. Within 3 years of the publication of these studies, a rapid decline in the sale and use of unopposed estrogen was credited with a dramatic reduction in the incidence of endometrial cancer. Researchers who reflected on what they considered at the time to be “one of the largest epidemics of serious iatrogenic disease that has ever occurred in this country” noted that it took a long time for the problem to be noticed. They made some recommendations that could be clustered under the general categories of careful patient assessment and remaining aware of the