Early detection, risk factors, and prevention of endometrial cancer

BackgroundEndometrial cancer (EC) is the fourth most common female malignancy and the most common pelvic malignancy.AimTo review the current literature on early detection, risk factors, and prevention of EC.Materials and methodsThis article is based on the current, S3 Guideline of the German Society of Obstetrics and Gynecology for the "Diagnosis and treatment of women with endometrial cancer " (AWMF Registry Number: 032/034-OL; May 2022). The current literature was summarized based on systematic searches in the database Medline and Cochrane Central Register of Controlled Trials. The quality of the evidence was rated according to the 2011 Oxford classification. Recommendations and statements were formulated by a representative group using structured consensus.ResultsIn Germany, 10,860 cases of EC were diagnosed in 2018. The incidence of EC increases with age and EC is most often diagnosed in the age group of 75- to 79-year-old women. The life-time risk of EC is 2.1%. Endometrioid adenocarcinoma is the most common histological subtype of EC, characterized by its hormone-dependency. Risk-increasing factors of EC are early age at menarche, late age at menopause, long-term use of estrogens without progestogen opposition, long-term estrogen-progestogen hormone replacement therapy, tamoxifen, controlled ovarian stimulation during assisted reproduction, obesity, impaired glucose metabolism, and polycystic ovary syndrome (PCOS). There is no evidence-based screening for the early detection of EC. The most common clinical symptom of EC is abnormal uterine bleeding. Risk-reducing factors are oral contraceptives, intrauterine devices, physical activity, diet, and bariatric surgery in morbidly obese women. In addition, preventive hysterectomy may be discussed with women who have a hereditary tumor predisposition syndrome such as Lynch syndrome or Cowden syndrome, which are both associated with an increased risk of EC.