Having the facts is key to successfully managing your health. Recent research may let women facing the threat of endometrial cancer gain the upper hand on the disease.

Endometrial hyperplasia is a condition that sometimes develops into cancer. It is marked by abnormal growth and spread of cells in the lining of the uterus. Physicians diagnose hyperplasia based on an endometrial biopsy, which uses a thin tube to collect a few cells from the endometrial lining.

James V. Lacey Jr. (Photo by Darrin S. Joy)

Pathologists then group the condition into three categories — simple, complex or atypical — based on how the cells appear under a microscope.

Doctors often recommend removal of the uterus, called hysterectomy, for women with the atypical version because up to half of them actually have endometrial cancer when atypical hyperplasia is found.

But for women who do not undergo hysterectomy — and for the many more with simple or complex hyperplasia — the question of what to do is unclear.

Results from a 20-year study provided much-needed information that may help.

Led by James V. Lacey Jr., Ph.D., associate professor in City of Hope’s Division of Cancer Etiology, researchers selected 138 women with endometrial hyperplasia who developed cancer at least 1 year, and on average 6 years, after their diagnosis of endometrial hyperplasia, and then compared them over time to 241 similar women with hyperplasia who were still cancer-free after a year. The scientists found that:

• About 28 percent of women with atypical hyperplasia who did not undergo hysterectomy developed endometrial cancer within the next 20 years — even if they were treated through hormone therapy and had follow-up biopsies done.
• Women with either simple or complex hyperplasia had only a 5 percent risk of progressing to endometrial cancer within 20 years.

“For physicians and their patients, knowing absolute risks may help decide whether to pursue definitive treatment — a hysterectomy — or decide on nonsurgical management, including [hormone]-based therapy and regular observation,” Lacey said.

The findings may help clear uncertainty about how to treat complex hyperplasia in particular, especially among postmenopausal women. The study suggests that hormone therapy and routine follow-up tests were enough for most women with this diagnosis, which means many could avoid hysterectomy.

Lacey noted that scientists now must try to find ways to identify the 5 percent of women with simple or complex hyperplasia who go on to develop cancer. They also hope to better identify early signs of atypical hyperplasia to catch these cases earlier.

Finally, researchers hope to develop tools or strategies pathologists can use to more quickly and accurately classify abnormal findings from endometrial biopsies. This would let physicians and their patients make treatment decisions based on more reliable information.