Endometriosis Typology and Ovarian Cancer Risk

Mollie E Barnard; Leslie V Farland; Bin Yan; Jing Wang; Britton Trabert; Jennifer A Doherty; Huong D Meeks; Myke Madsen; Emily Guinto; Lindsay J Collin; Kathryn A Maurer; Jessica M Page; Amber C Kiser; Michael W Varner; Kristina Allen-Brady; Anna Z Pollack; Kurt R Peterson; C Matthew Peterson; Karen C Schliep

doi:10.1001/jama.2024.9210

Endometriosis Typology and Ovarian Cancer Risk

Barnard ME, Farland LV, Yan B, Wang J, Trabert B, Doherty JA, Meeks HD, Madsen M, Guinto E, Collin LJ, Maurer KA, Page JM, Kiser AC, Varner MW, Allen-Brady K, Pollack AZ, Peterson KR, Peterson CM, Schliep KC

Published August 13, 2024 JAMA, 332(6), 482-489

DOI 10.1001/jama.2024.9210 PMID 39018030 PMC PMC11255975

RRM Academy Synopsis

Ovarian cancer risk is highest with endometrioma or deep endometriosis

A Utah cohort of 450 906 women found that women with endometriosis had 4.20 times the risk of ovarian cancer. Risk was highest with ovarian endometriomas or deep infiltrating endometriosis.

Key Findings

Ovarian cancer risk was higher with endometriosis (aHR, 4.20 [95% CI, 3.59-4.91]): 9.90 excess cases per 10 000 women (95% CI, 7.22-12.57) over a mean of 12 years.
Type I ovarian cancer risk was higher with endometriosis (aHR, 7.48 [95% CI, 5.80-9.65]) and type II risk was higher (aHR, 2.70 [95% CI, 2.09-3.49]).
With deep infiltrating endometriosis and/or ovarian endometriomas, the aHR was 9.66 (95% CI, 7.77-12.00) overall, 18.96 (95% CI, 13.78-26.08) for type I and 3.72 (95% CI, 2.31-5.98) for type II.
Superficial peritoneal endometriosis was associated with 2.82-fold higher ovarian cancer risk (95% CI, 2.27-3.51), and other endometriosis with 2.62-fold higher risk (95% CI, 1.72-3.99).

Interpretation

This cohort study followed 450 906 women in Utah for a mean of 12 years, using medical records linked to the state cancer registry. Doctors identified endometriosis type from diagnosis codes. Checked against surgery records for 412 women, these codes matched the true type most of the time. A statistical check by the authors suggested the real risk links may be even stronger than reported. Risk rose and fell in a U-shaped pattern over the study period. The authors note that information on birth control pill and GnRH agonist use was not available for this analysis. The findings support larger studies into why endometriosis type affects ovarian cancer risk this way.

RRM Context

Restorative reproductive medicine starts with a cause-based diagnosis. For endometriosis, that means naming the lesion type and its location. This cohort shows that lesion type carries real information about future risk. A precise diagnosis matters for long-term care as well as symptom relief.

Our editorial summary of this paper, not the article's abstract.

Abstract

Importance

Endometriosis has been associated with an increased risk of ovarian cancer; however, the associations between endometriosis subtypes and ovarian cancer histotypes have not been well-described.

Objective

To evaluate the associations of endometriosis subtypes with incidence of ovarian cancer, both overall and by histotype.

Design, Setting, and Participants

Population-based cohort study using data from the Utah Population Database. The cohort was assembled by matching 78 893 women with endometriosis in a 1:5 ratio to women without endometriosis.

Exposures

Endometriosis cases were identified via electronic health records and categorized as superficial endometriosis, ovarian endometriomas, deep infiltrating endometriosis, or other.

Main Outcomes and Measures

Estimated adjusted hazard ratios (aHRs), adjusted risk differences (aRDs) per 10 000 women, and 95% CIs for overall ovarian cancer, type I ovarian cancer, and type II ovarian cancer comparing women with each type of endometriosis with women without endometriosis. Models accounted for sociodemographic factors, reproductive history, and past gynecologic operations.

Results

In this Utah-based cohort, the mean (SD) age at first endometriosis diagnosis was 36 (10) years. There were 597 women with ovarian cancer. Ovarian cancer risk was higher among women with endometriosis compared with women without endometriosis (aHR, 4.20 [95% CI, 3.59-4.91]; aRD, 9.90 [95% CI, 7.22-12.57]), and risk of type I ovarian cancer was especially high (aHR, 7.48 [95% CI, 5.80-9.65]; aRD, 7.53 [95% CI, 5.46-9.61]). Ovarian cancer risk was highest in women with deep infiltrating endometriosis and/or ovarian endometriomas for all ovarian cancers (aHR, 9.66 [95% CI, 7.77-12.00]; aRD, 26.71 [95% CI, 20.01-33.41]), type I ovarian cancer (aHR, 18.96 [95% CI, 13.78-26.08]; aRD, 19.57 [95% CI, 13.80-25.35]), and type II ovarian cancer (aHR, 3.72 [95% CI, 2.31-5.98]; aRD, 2.42 [95% CI, -0.01 to 4.85]).

Conclusions and Relevance

Ovarian cancer risk was markedly increased among women with ovarian endometriomas and/or deep infiltrating endometriosis. This population may benefit from counseling regarding ovarian cancer risk and prevention and could be an important population for targeted screening and prevention studies.

Topics

General Gynecology Gynecologic Oncology Ovarian Cancer

General Gynecology › Gynecologic Oncology › Ovarian Cancer

Mollie E Barnard, Leslie V Farland, Bin Yan, Jing Wang, Britton Trabert, Jennifer A Doherty, Huong D Meeks, Myke Madsen, Emily Guinto, Lindsay J Collin, Kathryn A Maurer, Jessica M Page, Amber C Kiser, Michael W Varner, Kristina Allen-Brady, Anna Z Pollack, Kurt R Peterson, C Matthew Peterson, Karen C Schliep

M Barnard, L Farland, B Yan, J Wang, B Trabert, Jen Doherty, Jenny Doherty, J Doherty, H Meeks, M Madsen, E Guinto, L Collin, Kathy Maurer, Kate Maurer, K Maurer, Jess Page, J Page, A Kiser, Mike Varner, M Varner, K Allen-Brady, A Pollack, K Peterson, K Schliep

PMID 39018030 39018030 DOI 10.1001/jama.2024.9210 10.1001/jama.2024.9210 Barnard et al. 2024, Barnard 2024

Endometriosis Typology and Ovarian Cancer Risk

Ovarian cancer risk is highest with endometrioma or deep endometriosis

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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