Endometriosis can bring severe pelvic and menstrual pain, and now research suggests a significant increase in the risk of ovarian cancer.
For years, scientists have warned about the connection between these two conditions. However, a study published in THE PAYMENT last summer it was found that the risk of developing ovarian cancer is almost 10 times higher in women with severe endometriosis compared to those without the condition. For those with endometriosis overall, the risk of ovarian cancer is 4.2 times higher.
“The magnitude of risk associated with endometriosis is much greater than previously estimated,” Sarah Adams, MDsaid a professor of obstetrics and gynecology at the University of New Mexico Cancer Center Health.
About 11% of Americans between the ages of 15 and 44, who were assigned female at birth, have endometriosis. With this condition, cells that are similar to tissue in the uterus grow outside the uterus, causing pain, bleeding, and other problems.
There are several different types of endometriosis — deep infiltrating endometriosis is the rarest and most severe, but it appears to significantly increase a woman’s risk of ovarian cancer, he explained. Tamer Seckin, MDendometriosis surgeon at Lenox Hill Hospital and co-founder of the Endometriosis Foundation of America.
“We know that ovarian cancer affects a small amount (of people), but it’s deadly,” Sekin said Health.
About 1.1% of women in the US develop ovarian cancer.
Previous research has shown a link between the two conditions, including a 2021 meta-analysis that found endometriosis may put women at a slightly higher risk of ovarian cancer. However, the authors emphasized that most of the studies they reviewed were biased.
To further explore the connection, a new THE PAYMENT the study looked at nearly 451,000 women in the Utah Population database, all of whom were between the ages of 18 and 55. About 78,500 women had endometriosis, and about 372,400 did not. The researchers also used the Utah Cancer Registry to determine that 597 of these women developed ovarian cancer between 1992 and 2019.
From there, they further dissected the data to discover associations between different types of ovarian cancer and different types of endometriosis.
“This study differs from previous studies because they further categorized patients based on their type of endometriosis and their type of ovarian cancer,” Christine Metz, Ph.Dprofessor and endometriosis researcher at Northwell Health Feinstein Institute for Medical Research, said Health.
Overall, the data showed that women with endometriosis have a higher risk of ovarian cancer.
For type I ovarian cancer – which usually grows locally, more slowly and has better outcomes – the risk was 7.48 times higher in those with endometriosis.
People with deep infiltrating endometriosis and/or ovarian endometrioma – more severe forms of the condition – had an 18.96 times increased risk of type I ovarian cancer. They had a 3.72 times higher risk of type II ovarian cancer, which is more aggressive.
“There we found a 19 times greater risk, compared to the link between smoking and lung cancer,” Dr. Karen Schlipauthor and associate professor at the University of Utah in Salt Lake City, Utah, said in a news release. “As an epidemiologist, seeing such numbers is really impressive.
There are several limitations to the study, Metz noted. First, data were missing on whether participants used oral contraceptives or gonadotropin-releasing hormone (GnRH) agonists, which are sometimes used to treat endometriosis. Although more evidence is needed on how GnRH agonists affect cancer risk, evidence suggests that contraceptive use may reduce risk.
However, experts agree that endometriosis is probably somehow involved in the development of ovarian cancer.
The authors of this study suggest that ovarian cancer may be derived from endometriosis lesions, Metz said.
Another theory is that the genetic factors associated with the development of endometriosis somehow overlap with ovarian cancer, she explained.
“The genes are there,” Sekin said. “They are ready to be provoked.”
Endometriosis does not necessarily cause cancer, Sekin explained. However, “endometriosis probably opens the door wide to cancer-causing situations.”
Although the study found a significantly higher risk of ovarian cancer in people with severe endometriosis, Schliep said Health that “our results should in no way alarm women” because “ovarian cancer is rare.”
However, even if it’s a little scary, it’s important for people with endometriosis to be aware of this connection, Mary Lou Ballwaysaid the author and president and CEO of the Endometriosis Association Health.
There is currently a lack of reliable screening tests for ovarian cancer, and people are usually not screened for ovarian cancer unless they have a genetic condition or family history that puts them at very high risk. But doctors can use pelvic exams, blood tests, and transvaginal ultrasound if needed to check for signs of cancer.
According to THE PAYMENT Study, findings show that people with endometriosis “may benefit from ovarian cancer risk and prevention counseling.”
To that end, this type of research could be helpful in alerting clinicians to this link and encouraging better diagnosis and treatment of endometriosis, Sekin said.
“People underestimate how important it is,” he said. “I think this (study) will really get attention.”
In general, the symptoms of endometriosis — which include painful periods and cramping — are often dismissed, and many women go undiagnosed as a result, Ballweg explained.
“People don’t pay attention because they think it doesn’t affect young women,” she said.
Endometriosis cannot necessarily be prevented, but there is evidence that regular exercise, avoiding large amounts of alcohol and caffeine, and using hormonal birth control can reduce a person’s risk.