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Hum. Reprod. Advance Access published online on January 23, 2006
Human Reproduction, doi:10.1093/humrep/dei462
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received September 26, 2005
Revised November 17, 2005
Accepted November 25, 2005

Article

Endometriosis and the risk of cancer with special emphasis on ovarian cancer

A. Melin 1 *, P. Sparén 2, I. Persson 2, and A. Bergqvist 3

1 Department of Obstetrics & Gynaecology, Karolinska University Hospital Huddinge, Stockholm, Sweden
2 Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
3 Department of Obstetrics & Gynaecology, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden; Present address: Pfizer AB, Täby, Sweden

* To whom correspondence should be addressed.
A. Melin, E-mail: anna-sofia.melin{at}karolinska.se


  Abstract

BACKGROUND: Several observations of the coexistence of endometriosis and cancer have been published. One study concerning endometriosis patients from 1969 to 1986 showed an overall relative cancer risk of 1.2 and relative risks for breast cancer, ovarian cancer and non-Hodgkin’s lymphoma to be 1.3, 1.9 and 1.8, respectively. The aim of this study was to see whether these risk ratios stand in an extended study with longer follow-up. METHODS: Women discharged from a hospital, with a diagnosis of endome-triosis from 1969 to 2000, were identified using the National Swedish Inpatient Register. Data were linked to the National Swedish Cancer Register to identify cases of cancer. Data on hysterectomies and oophorectomies were available. Standardized incidence ratios (SIR) were calculated. RESULTS: 64 492 women entered the study. First year of follow-up was excluded, leaving 3349 cases of cancer. There was no increased overall risk of cancer [SIR 1.04, 95% CI 1.00-1.07]. Elevated risks were found for ovarian cancer (SIR 1.43, 95% CI 1.19-1.71), endocrine tumours (SIR 1.36, 95% CI 1.15-1.61), non-Hodgkin’s lymphoma (SIR 1.24, 95% CI 1.02-1.49) and brain tumours (SIR 1.22, 95% CI 1.04-1.41). Women with early diagnosed and long-standing endometriosis had a higher risk of ovarian cancer, with SIR of 2.01 and 2.23, respectively. The average age at endometriosis diagnosis was 39.4, indicating that there are the moderate/severe cases that are included in this study. Women who had a hysterectomy before or at the time of the endometriosis diagnosis did not show an increased risk of ovarian cancer. CONCLUSION: Women with endometrio-sis have an increased risk of some malignancies, particularly ovarian cancer, and the risk increases with early diagnosed or long-standing disease. Hysterectomy may have a preventive effect against ovarian cancer.

Keywords: cancer/endometriosis/standardized incidence ratio/Sweden.
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