Concurrent and Future risk of Endometrial Cancer in women with Endometrial Hyperplasia: A systematic review and meta-analyses.


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Úna McMenamin1,Michelle Doherty2,Omolara Sanni2,Helen Coleman2,Chris Cardwell2,Glenn McCluggage3,Declan Quinn4,James Wylie4
1Queen's University Belfast, Belfast, UK,2Queen's University Belfast,3Belfast Health and Social Care Trust,4Northern Health and Social Care Trust



There is no established screening for endometrial cancer but endometrial hyperplasia, a recognised precursor to endometrial cancer, offers an opportunity for prevention. To avoid ‘missed’ cancers in women diagnosed with endometrial hyperplasia, there is a need to quantify the potential for concurrent endometrial cancer and the future risk of progression to cancer. We aimed to systematically identify studies that evaluated concurrent and future risk of endometrial cancer in women diagnosed with endometrial hyperplasia.


EMBASE, MEDLINE and Web of Science were searched for articles published to September 2018. Random-effects meta-analyses were used to calculate pooled estimates and 95% confidence intervals (CIs) for 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.


A total of 36 articles were identified; 15 investigating concurrent and 21 investigating progression to cancer. In pooled analysis of 11 studies of atypical hyperplasia, the pooled prevalence of concurrent endometrial cancer was 33.4% (95% CI: 26.1%, 42.8%) while no studies evaluated concurrent cancer prevalence in non-atypical hyperplasia. The pooled incidence of cancer in atypical hyperplasia was 8.2% per year (n=5 studies, 95% CI 3.9%, 17.3%) and in the only study to report on progression to cancer in non-atypical hyperplasia, the pooled incidence was 2.6% per year (95% CI: 0.6%, 10.6%). High heterogeneity was observed across pooled analyses.


Over 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 women diagnosed with 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.