Risk Of Atypical Hyperplasia Research Articles

Risk of atypical hyperplasia and endometrial carcinoma after initial diagnosis of non-atypical endometrial hyperplasia: A long-term follow-up study

ObjectivesThe strong association between atypical endometrial hyperplasia and endometrial carcinoma is well established, but data on the risk of atypical hyperplasia and carcinoma in Danish women with non-atypical endometrial hyperplasia are almost non-existent. This study aimed to investigate the prevalence of atypical hyperplasia and endometrial carcinoma diagnosed within 3 months of initial diagnosis (defined as concurrent disease) and the risk of atypical hyperplasia and carcinoma more than 3 months after initial diagnosis (classified as progressive disease) in Danish women initially diagnosed with non-atypical endometrial hyperplasia.DesignThis cohort study recruited 102 women diagnosed with non-atypical endometrial hyperplasia at Randers Regional Hospital in Randers, Denmark, between 2000 and 2015.MethodsThe endometrium was evaluated by transvaginal ultrasound examination and office mini-hysteroscopy with biopsies in all non-hysterectomized women. Data regarding subsequent hysterectomy or endometrial sampling were obtained from medical records and the Danish Pathology Registry (Patobank).ResultsA total of 15 women were diagnosed with atypical hyperplasia or carcinoma during follow-up. Concurrent atypical hyperplasia or carcinoma was seen in 2.9% (3/102), and among women who remained at risk for more than 3 months after initial diagnosis of non-atypical endometrial hyperplasia (n = 94), progression to atypical hyperplasia or carcinoma was seen in 13% (median follow-up 5.2 years, range 3.6 months to 15.1 years). Sixty-six percent of the women with progressive disease were diagnosed with atypical hyperplasia or carcinoma more than 1 year after initial diagnosis, but only two were diagnosed later than 5 years (5.2 and 9 years).ConclusionsThe risk of being diagnosed with atypical endometrial hyperplasia or endometrial carcinoma more than 5 years after an initial diagnosis of non-atypical endometrial hyperplasia seems to be low in Danish women. Specialized follow-up more than 5 years after diagnosis of non-atypical endometrial hyperplasia may not be warranted.

Serum IGFBP-2 and Risk of Atypical Hyperplasia of the Breast.

Atypical hyperplasia of the breast (AH) is associated with increased risk of subsequent invasive breast cancer, yet little is known about the etiology of AH. Insulin-like growth factor binding protein 2 (IGFBP-2) may contribute to the development of AH due to its proliferative effects on mammary tissue. We conducted a nested case-control study of postmenopausal women enrolled in Women's Health Initiative-Clinical Trial. Cases were 275 women who developed incident AH during follow-up, individually (1 : 1) matched to controls. Levels of IGFBP-2 were determined from fasting serum collected at baseline. Multivariable conditional logistic regression models were used to estimate odds ratios for the association of IGFBP-2 with risk of AH. Serum IGFBP-2 was associated with a nonsignificant decrease in risk for AH, when comparing the highest quartile to lowest quartile (OR = 0.65; 95% CI = 0.32–1.31). This decrease in risk was most evident when analyses were restricted to nondiabetic, nonusers of hormone therapy (OR = 0.33, 95% CI = 0.13–0.86, p trend = 0.06) and nondiabetic women who were overweight or obese (OR = 0.43, 95% CI = 0.18–1.03, p trend = 0.05). Results from this study provide some support for an inverse association between serum IGFBP2 levels and risk of AH, particularly in nondiabetic women who are overweight or obese. Further studies are required to confirm these results.

A Prospective Study of Diet and Benign Breast Disease

Abstract Much attention has been paid to the relation between diet and breast cancer risk. Because benign breast disease (BBD), particularly atypical hyperplasia (AH), is a marker of increased breast cancer risk, studies of diet and BBD may provide evidence about the effect of diet at an early stage in the process of breast carcinogenesis. We evaluated the relationship between fat, fiber, antioxidant and caffeine intake and incidence of non-proliferative BBD, proliferative BBD without atypia and AH in the Nurses' Health Study II. We calculated rate ratios (RR) and 95% confidence intervals (95% CI) for each quartile of energy-adjusted intake using the lowest quartile as reference. There was no increase in risk of BBD with increasing fat intake, rather increasing vegetable fat was associated with a significant reduction in the rate of proliferative BBD without atypia. There was no significant association between any type of BBD and micronutrient intake. High caffeine consumption was positively associated (RR = 2.46, 95% CI 1.11-5.49 for the highest quartile), and use of multivitamin supplements inversely associated (RR = 0.57, 95% CI 0.33-0.98) with risk of AH although these analyses were based on small numbers. These data do not support the hypothesis that higher fat consumption increases risk of BBD, with or without atypia, and also provide little evidence for a major role of antioxidants in the development of breast disease. They do, however, raise the possibility that high caffeine intake may increase, and use of vitamin supplements may decrease risk of developing AH.

Does hormone replacement therapy increase the frequency of breast atypical hyperplasia in postmenopausal women? Results from the Bouches du Rhone district screening campaign

It is thought that the risk of atypical hyperplasia (AH) increases with age, particularly among postmenopausal women. Three hypotheses were investigated to try to explain this phenomena: use of hormone replacement therapy (HRT), increased breast cancer screening and improvements in radiological quality. Data were collected from the Bouches du Rhône breast cancer screening programme database and from the pathological registry of all women operated on for breast diseases in the district. The AH incidence rate was studied using a Poisson regression analysis. The change in the profile of breast diseases was explored through studying changes in the proportion of AH among benign lesions and malignant diseases. The AH incidence rate significantly increased over time (13.6% per year). The proportion of AH among the benign diseases increased with time and was significantly higher for HRT users (Odds Ratio (OR)=2.05; 95% Confidence Interval (CI): 1.43–2.93). While AH decreased with age among HRT non-users, it increased among users as a proportion of both benign and malignant lesions. The AH incidence rate significantly increased among pre- and postmenopausal women. Our study suggests that this increase is partly explained by the incidental discovery of these lesions by mammography and partly by a real increase of the disease among HRT users.

A longitudinal evaluation of postmenopausal bleeding and transvaginal sonographic measurement of the endometrium as predictors of endometrial cancer

Objective: To evaluate postmenopausal bleeding (PMB) and transvaginal sonographic (TVS) measurement of endometrial thickness (ET) as predictors of endometrial cancer (EC) and atypical hyperplasia (AH) in women during a >10‐year period following a PMB.Study design: Women presented with a PMB from November 1987 to October 1990 were included in this study (n = 394). The women underwent TVS with measurement of ET and a dilation and curettage (D & C). It was possible to assess the medical records of 339 of the 394 women (86%) >10 years after referral for PMB. During the follow up period the recurrence of a PMB, the development of EC and mortality were assessed.Results: After the primary investigation, 39 of the 339 women were diagnosed as having EC (11.5%) and 5 women had AH (1.5%). The relative risk (RR) of diagnosing an EC in women referred for a PMB was 63.9 (CI 46.0 Ð 88.8) and the corresponding RR for EC and AH together was 72.1 (CI 52.8 Ð 98.5) compared to women of the same age from the same region of Sweden. The reliability of PMB as a diagnostic test for EC was assessed: sensitivity 18%; specificity 100%; positive predictive value 12%; and negative predictive value 100%. None of the women with an ET of 2 × 4 mm were diagnosed as having EC. The reliability of ET (cut‐off 2 × 4 mm) as a diagnostic test for EC was assessed: sensitivity 100%; specificity 60%; positive predictive value 25% and negative predictive value 100%. The incidence of EC or AH in women with an intact uterus followed 3 × 10 years was 5.8%. The corresponding figure for women who had 3 × 1 recurrent bleeding during follow up was 22.7%. No EC was diagnosed in women with a recurrent PMB who had an ET of 2 × 4 mm at the initial scan. No EC was diagnosed in the absence of a recurrent bleeding.Conclusion: PMB incurs a 64‐fold increase risk for EC. No EC was missed when ET measurement (cut‐off 2 × 4 mm) was used even if the women were followed 3 × 10 years. About 5.8% of the women referred for a PMB later developed EC or atypia during the 10‐year observation period. There was no increased risk of EC or AH in women who did not have recurrent bleedings whereas women with a recurrent bleeding were a high risk group. A thick endometrium, with histopathological diagnosis of atrophy or insufficient for diagnosis, should be taken seriously and a guided biopsy should be taken or saline instillation sonography performed with ultrasound‐guided biopsy.