Úna C. McMenamin

Metabolic Syndrome and the Risk of Breast, Endometrial, and Ovarian Cancer among Postmenopausal Women in the UK Biobank

Abstract Background: There is some evidence that metabolic syndrome (MetS) is associated with postmenopausal breast and gynecologic cancer. However, results from previous studies have been inconsistent and varied by the definition of MetS used. Methods: Using data from the UK Biobank, the association between MetS, according to three definitions, and the risk of breast, endometrial, and ovarian cancer was assessed among postmenopausal women with serologic biomarker data. Cox proportional hazards regression was used to calculate HRs with 95% confidence intervals (CI), adjusting for a range of confounders. Results: In total, 4,791 breast cancers, 820 endometrial cancers, and 582 ovarian cancers were diagnosed. For all definitions, MetS was associated with a higher risk of breast cancer (harmonized definition; HR, 1.11; 95% CI, 1.04–1.19) and endometrial cancer (harmonized definition; HR, 2.18; 95% CI, 1.86–2.55) but not ovarian cancer (harmonized definition; HR, 1.08; 95% CI, 0.88–1.31). Assessment of the individual MetS components revealed that only abdominal obesity was consistently associated with breast cancer, whereas all components were associated with a higher risk of endometrial cancer. Conclusions: In this cohort, MetS and all MetS components were individually associated with a higher risk of endometrial cancer, but only abdominal obesity was consistently associated with an increased risk of breast cancer. No associations were observed between MetS and ovarian cancer risk. Impact: These findings underline the need for further mechanistic research to clarify potential causal relationships and to better inform public health strategies to address the increasing obesity-related cancer burden, particularly endometrial cancer in postmenopausal women.

Concurrent and future risk of endometrial cancer in women with endometrial hyperplasia: A systematic review and meta-analysis

To inform treatment decisions in women diagnosed with endometrial hyperplasia, quantification of the potential for concurrent endometrial cancer and the future risk of progression to cancer is required. We identified studies up to September 2018 that reported on the prevalence of concurrent cancer (within three months of endometrial hyperplasia diagnosis), or the incidence of cancer, identified at least three months after hyperplasia diagnosis. Random-effects meta-analyses produced pooled estimates and 95% confidence intervals (CIs). A total of 36 articles were identified; 15 investigating concurrent and 21 progression to cancer. In pooled analysis of 11 studies of atypical hyperplasia, the pooled prevalence of concurrent endometrial cancer was 32.6% (95% CI: 24.1%, 42.4%) while no studies evaluated concurrent cancer in non-atypical hyperplasia. The risk of progression to cancer was high in atypical hyperplasia (n = 5 studies, annual incidence rate = 8.2%, 95% CI 3.9%, 17.3%) and only one study reported on non-atypical hyperplasia (annual incidence rate = 2.6%, 95% CI: 0.6%, 10.6%). Overall, a third of women with atypical hyperplasia had concurrent endometrial cancer, although the number of studies, especially population-based, is small. Progression to cancer in atypical hyperplasia was high, but few studies were identified. Population-based estimates are required, in both atypical and non-atypical hyperplasia patients to better inform treatment strategies.