Endometrial cancer has long been considered a disease that affects older women.
The typical patient is in her 60s and post-menopausal. However, in the past few years, experts have noticed a troubling trend: younger patients. Matthew Schlumbrecht, M.D., M.P.H., is seeing more women in their 30s and 40s with this cancer. At one point, he treated a 19-year-old. All these cases exhibited a common — and preventable — condition.
"Obesity," says Dr. Schlumbrecht, a gynecologic oncologist at the Sylvester Comprehensive Cancer Center. "It's definitely playing a factor. The younger women who present with these tumors are overweight or obese."
Global cases of endometrial cancer have been inching up for the past two decades.
The American Cancer Society calls obesity a "strong risk factor." In fact, certain endometrial tumors are twice as common in overweight women as in women of a healthy weight — and more than three times as common in obese women. It is estimated that about 40% of endometrial cancer cases may be due to excess pounds.
That's because aromatase, an enzyme found in fatty tissue, converts testosterone into estrogen.
And one of the most common causes of low-grade endometrial cancer is an imbalance of too much estrogen compared to progesterone. This imbalance allows the lining of the uterus to get thicker, where malignant cells can grow.
While cancer can be a frightening experience at any age, young women with endometrial cancer face an added worry. Still, in their childbearing years, they may not want to undergo a hysterectomy – a standard treatment for some endometrial cancers - thus limiting their therapies. There are, of course, other fertility-sparing options, including a progesterone-delivering IUD, but early detection and treatment remain key to their success.
Cancers of the uterus, including endometrial cancer, are the most common cancer of the female reproductive organs.
According to the American Cancer Society, an estimated 66,570 new cases will be diagnosed this year, and about 12,940 women will die from these malignancies.
Endometrial cancer is also known as uterine cancer because the abnormal cells grow in the lining of the uterus or the endometrium. The uterus is best known as the organ that houses the fetus when a woman is pregnant, but it is quite a complex hormone factory. The endometrium changes during a woman's menstrual cycle, with estrogen causing it to thicken and progesterone causing it to ripen in preparation for an embryo. If a woman doesn't get pregnant, however, both hormone levels fall. This, in turn, causes a shedding of the endometrial lining, which is what we know as menstrual flow.
The estrogen-progesterone hormonal imbalance is a leading cause of low-grade endometrial cancer. There are other risk factors as well. In younger women, polycystic ovary syndrome, a condition marked by irregular periods, can be a factor. In older women, certain types of hormone replacement therapy after menopause also play a role. Dr. Schlumbrecht and colleagues recommend that most menopausal women on HRT take a combination of estrogen and progestin to reduce this risk.
Symptoms of endometrial cancer are easy to recognize.
They include pelvic pain, vaginal bleeding after menopause, and bleeding between periods for younger women. The good news is that this cancer is treatable when found early. There are more than 600,000 survivors of endometrial cancer in the U.S. today.
"Two-thirds [of the tumors] are found in the early stage when still confined to the uterus, so it's important that women go to their doctors when they notice any symptoms," Dr. Schlumbrecht says.
But not all endometrial cancer cases have such favorable outcomes. These include high-grade tumors that form "independent of an estrogen pathway," Dr. Schlumbrecht adds. "Their rates are going up, regardless of race and ethnicity."
These aggressive subtypes are particularly problematic for women of African-descent, who have worse survival rates, even though they actually have a lower overall incident rate than white women. Even within racial and ethnic groups, incidence and outcomes can vary depending on where the woman was born. For example, in their research, Dr. Schlumbrecht and UHealth molecular geneticist Sophia George, Ph.D., have found that Haitian and Jamaican women in South Florida have a higher incidence of uterine serous carcinoma (USC). This is a highly aggressive variant that typically represents less than 10% of all cases but accounts for a disproportionate number of deaths.
"There are a number of factors that can come into play," Dr. Schlumbrecht says.
He adds that genes and the interaction of environment and genes are identifiable targets of study. "The research is ongoing."
His team has just received funding to conduct focus groups with potentially affected communities. Understanding the molecular profiles of tumors and how to treat these differences are essential steps to optimizing care.
In the meantime, he suggests women stay in tune with their bodies. Post-menopausal bleeding is "never normal," he says, and should immediately be checked by a physician. Regardless of age, all women should strive to maintain a healthy weight. If help is needed, consult a nutritionist or consider bariatric surgery.
"Even a diagnosis can be a teachable moment for good habits," he says.
Ana Veciana-Suarez, Guest Columnist
Ana is a regular contributor to the University of Miami Health System. She is a renowned journalist and author who has worked at The Miami Herald, The Miami News, and The Palm Beach Post. Visit her website at anavecianasuarez.com or follow @AnaVeciana on Twitter.
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