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Cancer risk and PCOS.
Steroids 2013; 78(8):782-5S

Abstract

Women with polycystic ovary syndrome (PCOS) have a 2.7-fold increased risk for developing endometrial cancer. A major factor for this increased malignancy risk is prolonged exposure of the endometrium to unopposed estrogen that results from anovulation. Additionally, secretory endometrium of some women with PCOS undergoing ovulation induction or receiving exogenous progestin exhibits progesterone resistance accompanied by dysregulation of gene expression controlling steroid action and cell proliferation. Endometrial surveillance includes transvaginal ultrasound and/or endometrial biopsy to assess thickened endometrium, prolonged amenorrhea, unopposed estrogen exposure or abnormal vaginal bleeding. Medical management for abnormal vaginal bleeding or endometrial hyperplasia consists of estrogen-progestin oral contraceptives, cyclic or continuous progestins or a levonorgestrel-releasing (Mirena) intrauterine device. Lifestyle modification with caloric restriction and exercise is appropriate to treat obesity as a concomitant risk factor for developing endometrial disease. An increased risk of ovarian cancer may also exist in some women with PCOS. There are strong data to suggest that oral contraceptive use is protective against ovarian cancer and increases with the duration of therapy. The mechanism of this protection may be through suppression of gonadotropin secretion rather than the prevention of "incessant ovulation". There is no apparent association of PCOS with breast cancer, although the high prevalence of metabolic dysfunction from obesity is a common denominator for both conditions. Recent data suggest that the use of metformin may be protective for both endometrial and breast cancer. There are insufficient data to evaluate any association between PCOS and vaginal, vulvar and cervical cancer or uterine leiomyosarcoma.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States. ddumesic@mednet.ucla.edu

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23624028

Citation

Dumesic, Daniel A., and Rogerio A. Lobo. "Cancer Risk and PCOS." Steroids, vol. 78, no. 8, 2013, pp. 782-5.
Dumesic DA, Lobo RA. Cancer risk and PCOS. Steroids. 2013;78(8):782-5.
Dumesic, D. A., & Lobo, R. A. (2013). Cancer risk and PCOS. Steroids, 78(8), pp. 782-5. doi:10.1016/j.steroids.2013.04.004.
Dumesic DA, Lobo RA. Cancer Risk and PCOS. Steroids. 2013;78(8):782-5. PubMed PMID: 23624028.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cancer risk and PCOS. AU - Dumesic,Daniel A, AU - Lobo,Rogerio A, Y1 - 2013/04/24/ PY - 2013/03/31/received PY - 2013/04/09/revised PY - 2013/04/09/accepted PY - 2013/4/30/entrez PY - 2013/4/30/pubmed PY - 2014/1/25/medline SP - 782 EP - 5 JF - Steroids JO - Steroids VL - 78 IS - 8 N2 - Women with polycystic ovary syndrome (PCOS) have a 2.7-fold increased risk for developing endometrial cancer. A major factor for this increased malignancy risk is prolonged exposure of the endometrium to unopposed estrogen that results from anovulation. Additionally, secretory endometrium of some women with PCOS undergoing ovulation induction or receiving exogenous progestin exhibits progesterone resistance accompanied by dysregulation of gene expression controlling steroid action and cell proliferation. Endometrial surveillance includes transvaginal ultrasound and/or endometrial biopsy to assess thickened endometrium, prolonged amenorrhea, unopposed estrogen exposure or abnormal vaginal bleeding. Medical management for abnormal vaginal bleeding or endometrial hyperplasia consists of estrogen-progestin oral contraceptives, cyclic or continuous progestins or a levonorgestrel-releasing (Mirena) intrauterine device. Lifestyle modification with caloric restriction and exercise is appropriate to treat obesity as a concomitant risk factor for developing endometrial disease. An increased risk of ovarian cancer may also exist in some women with PCOS. There are strong data to suggest that oral contraceptive use is protective against ovarian cancer and increases with the duration of therapy. The mechanism of this protection may be through suppression of gonadotropin secretion rather than the prevention of "incessant ovulation". There is no apparent association of PCOS with breast cancer, although the high prevalence of metabolic dysfunction from obesity is a common denominator for both conditions. Recent data suggest that the use of metformin may be protective for both endometrial and breast cancer. There are insufficient data to evaluate any association between PCOS and vaginal, vulvar and cervical cancer or uterine leiomyosarcoma. SN - 1878-5867 UR - https://www.unboundmedicine.com/medline/citation/23624028/Cancer_risk_and_PCOS_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0039-128X(13)00086-X DB - PRIME DP - Unbound Medicine ER -