Knowing Your Risk for Endometrial Cancer
- Did you know that polycystic ovary syndrome, known as PCOS, is a risk factor for endometrial cancer? And a recent study says it’s “significantly associated with higher risk” of this most common type of gynecological cancer.
- Fashion designer Victoria Beckham, 50, has previously shared about her PCOS condition which she was reportedly diagnosed with while having difficulty conceiving her fourth child with soccer star David Beckham, daughter Harper, now 12.
- In addition to PCOS, there are certain risk factors associated with endometrial cancer, like family history and genetic abnormalities, that you can’t change.However, you have control over many other risk factors such as maintaining a healthy healthy weight, exercise, and diet.
- Many of the health factors that increase the risk of endometrial cancer lead to an excess of the female hormone estrogen that stimulate cell growth in the uterus. If you are considered high-risk, regular monitoring and paying attention to symptoms such as abnormal bleeding can help you stay healthy and catch problems early.
And a recent study says it’s “significantly associated with higher risk” of this most common type of gynecological cancer.
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“PCOS can also cause anxiety, depression and a negative body image. Some symptoms such as infertility, obesity and unwanted hair growth can lead to social stigma. This can affect other life areas such as family, relationships, work and involvement in the community,” the WHO explains.
What Is PCOS?
PCOS is a condition with symptoms such as:
- Irregular menstrual periods
- Excess androgens (acne, excess facial hair, and scalp hair loss),
- Ovaries that appear on an ultrasound to be “polycystic” meaning they have many cysts
- Women with PCOS face a higher risk of endometrial cancer because of female hormone imbalances. Because PCOS results in too much estrogen and not enough progesterone, it stimulates excess growth of cells in the uterus that can become cancerous.
“PCOS is a condition that involves irregular menses, meaning women with PCOS have anovulatory bleeding. They don’t ovulate every month,” Dr. Dana Chase, a gynecologic oncologist at the David Geffen School of Medicine at UCLA to SurvivorNet. “So anovulatory bleeding is a risk factor for endometrial cancer, and it’s one of the characteristics of a patient that has PCOS. ”
Dr. Dana Chase explains what would be considered irregular bleeding
Additionally, PCOS increases insulin resistance so that the body’s cells don’t respond normally to insulin. This further over stimulates cell growth.
If you have PCOS, this does not necessarily mean you will get endometrial cancer, Dr. Chase noted. Your doctor will recommend regular monitoring and management strategies, to both treat the disease and watch for endometrial cancer. Recommendations usually include lifestyle changes to maintain a healthy weight and medications to regulate the menstrual cycle and reduce insulin resistance.
Learning More About Endometrial Cancer
There are some factors that affect your chances of getting endometrial cancer — like family history or certain genetic abnormalities — that you can’t do anything about. But you do have control over many aspects of your health that influence your risk.
Endometrial cancer risk factors can be divided up into two categories — inherent and modifiable.
- Inherent risks are aspects of your health that you can’t change because they are part of your health history like genetics, family history, or another medical diagnosis. You can’t erase these factors entirely, but you can still take steps to minimize their impact on your endometrial cancer risk.
- Modifiable risks are aspects of your health that you can proactively change, often through small adjustments in lifestyle habits. Keeping an eye on these factors ensures you catch any problems as early as possible.
By making some changes to your lifestyle, paying attention to your health, and staying on top of your medical check ups, you may be able to prevent endometrial cancer, or at least catch it as early as possible when treatment is easier.
There are still treatment options when endometrial cancer is diagnosed at later stages, but prognosis is often better when the disease is caught early.
“There are a lot of new exciting treatments for advanced endometrial cancer that we’ve just discovered over the last couple years,” Dr. Chase explained. “So even if you’re diagnosed with an advanced stage, ask your treating doctor what are the latest treatments or even potentially is there a clinical trial I can participate in for my endometrial cancer.”
Aside from PCOS, What Are My Risks?
Along with PCOS, genetics, family history, age, race and other reproductive factors can up your risk for endometrial cancer.
Genetics and Family History
Inherited genetic mutations, particularly Lynch syndrome, can increase the risk of endometrial cancer. So can having a close family member like a mother, sister, cousin or aunt who has had endometrial or colorectal cancer.
- Lynch Syndrome: Sometimes referred to as Hereditary Nonpolyposis Colorectal Cancer (HNPCC), is caused by inherited mutations in genes responsible for repairing DNA, leading to a higher chance of cells growing uncontrollably and becoming cancerous. Women with Lynch syndrome, determined by special genetic testing, may be at higher risk for getting endometrial cancer at a younger age.
- Family History: A family history of endometrial cancer increases your risk because it may indicate an inherited genetic predisposition to the disease, especially if your close relative was diagnosed at a young age. This shared genetic background is why doctors often ask about your family’s health history.
“The one patient that you might be able to screen for endometrial cancer with endometrial biopsies is a patient that has known Lynch syndrome,” said Dr. Chase. “So if you are known to have Lynch syndrome … you’ve been tested for it and you have Lynch syndrome … you could be eligible for this screening protocol, which I would discuss with your doctor.”
She added that, while you can’t change your DNA, if you have genetic risks in your background, there are steps you can take to make sure you stay on top of your health, including:
- Scheduling regular check-ins with your doctor
- Starting regular screenings at age 35 in the form of endometrial biopsies
- Seeking genetic counseling and testing to assess your risk and come up with a personal plan to manage it
Age
Your chance of being diagnosed with endometrial cancer increases with each year of age. “Now we are seeing a rise potentially in premenopausal cases, but age is one of the biggest risk factors for endometrial cancer,” Dr. Chase said.
The likelihood of genetic changes in the cells of the uterus lining grows over time. With more years, there’s a greater chance for DNA damage in these cells, which can lead to cancer. Additionally, hormonal changes associated with menopause can also contribute to the risk.
Here again, regular health screenings and discussions with your doctor can help you carefully monitor for any signs and symptoms to help catch the disease early. Staying as healthy as possible for as long as possible by eating right, exercising, and practicing other smart health habits can also help.
Race and Ethnicity
Endometrial cancer is more common in white women compared to women of other racial and ethnic groups. Although experts still aren’t sure why white woman have higher rates of endometrial cancer, it could be due to a combination of genetic, environmental, and lifestyle factors.
Reproductive Factors
Your period, any other unusual vaginal bleeding, and your fertility contribute to your endometrial cancer risk.
Women who have an increased risk of endometrial cancer include those who:
- Started menstruation before age 12
- Went through menopause after the age of 55
- Have never given birth
- Experienced problems with fertility
- Have any unusual vaginal bleeding either before or after menopause
These sort of “reproductive factors” may not be modifiable for all individuals, but they are something you should pay attention to and discus with your doctor.
Dr. Chase stressed that any irregular bleeding, even if you think it’s not serious, could indicate something is off.
“So it’s very, very important to spread the word that if you have irregular bleeding, even a pink discharge, it doesn’t have to be bright red blood, even a pink discharge, don’t hesitate or don’t be afraid to get that checked out,” she advised.
What Risk Factors Can I Control?
There are several endometrial cancer risk factors that are more in your control. Making meaningful changes to them can lower your chances of getting endometrial cancer.
Obesity
“If your BMI is in the obese range, you could be at increased risk for endometrial cancer,” warns Dr. Chase.
Excess body fat can lead to increased estrogen production, which in turn may promote the growth of endometrial cells. Achieving and maintaining a healthy weight through a balanced diet and regular exercise and movement can help reduce endometrial cancer risk.
Compared to women at a healthy weight, women who are overweight have double the risk of endometrial cancer, and women who have obesity have three times the risk.
Even modest weight loss can have a beneficial effect on lowering risk.
Hormone Therapy
Estrogen-only hormone replacement therapy (HRT) without progesterone is commonly used to manage menopausal symptoms but it has been associated with an increased risk of endometrial cancer. Here again, it comes down to too much estrogen causing excess cell growth.
If your doctor tells you that hormone therapy is necessary, you should discuss a combined estrogen and progesterone therapy or other alternative treatments that can lower endometrial cancer risk. If you and your doctor determine that estrogen-only therapy is right for you, you and your doctor will put a plan in place to monitor for endometrial cancer.
Alcohol Consumption
Heavy alcohol consumption has been associated with a higher risk of endometrial cancer, potentially because it stimulates estrogen production.
Limiting alcohol intake to moderate levels (defined as up to one drink per day for women) or refraining from drinking alcohol altogether can help reduce endometrial cancer risk.
Dietary Factor
Diets high in red meat, processed meats, saturated fats, and refined carbohydrates have been linked to an increased risk of endometrial cancer, while diets rich in fruits, vegetables, whole grains, and lean proteins may be protective.
Adopting a healthy eating pattern that emphasizes plant-based foods, whole grains, lean proteins, and healthy fats can help lower endometrial cancer risk. Additionally, reducing intake of processed and sugary foods may further mitigate risk.
By addressing these modifiable risk factors through lifestyle changes and proactive health management, individuals can significantly reduce their risk of developing endometrial cancer and improve their overall health and well-being.
Questions to Ask Your Doctor
If you are concerned about your risk of endometrial cancer, discuss it with your health care provider team. You can consider asking them the following questions:
- What steps should I take to lower my chance of developing endometrial cancer?
- Am I considered high-risk?
- What are my options for cancer screening?
- Should I meet with a genetic counselor?
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