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Chapter 20 - Cancer and Polycystic Ovary Syndrome

Published online by Cambridge University Press:  13 May 2022

Gabor T. Kovacs
Affiliation:
Monash University, Melbourne, Australia
Bart Fauser
Affiliation:
University Medical Center, Utrecht, Netherlands
Richard S. Legro
Affiliation:
Penn State Medical Center, Hershey, PA, USA
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Summary

The possibility that women with polycystic ovary syndrome (PCOS) could be at increased risk of cancer was first suggested 14 years after the description of the syndrome by Stein and Leventhal in 1935.[1] This report was related to endometrial cancer, an association that could have some basis, at least in women with anovulatory PCOS, who are exposed to estrogen unopposed by progesterone, which when used as menopausal therapy was shown to increase the risk of endometrial cancer.[2] Based on the same mechanism, there could theoretically be an association between PCOS and cancers of breast and ovary.

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Publisher: Cambridge University Press
Print publication year: 2022

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References

Azziz, R. and Adashi, E. Y. Stein and Leventhal: 80 years on. Am J Obstet Gynecol 2016; 214(2): 247.e241–247.e211.CrossRefGoogle Scholar
Ziel, H. K. and Finkle, W. D. Increased risk of endometrial carcinoma among users of conjugated estrogens. N Engl J Med 1975; 293(23): 11671170.Google Scholar
Speert, H. Carcinoma of the endometrium in young women. Surg Gynecol Obstet 1949; 88(3): 332336.Google Scholar
Dockerty, M. B., Lovelady, S. B. and Foust, G. T., Jr. Carcinoma of the corpus uteri in young women. Am J Obstet Gynecol 1951;61(5):966–81.CrossRefGoogle ScholarPubMed
Jackson, R. L. and Dockerty, M. B. The Stein-Leventhal syndrome: Analysis of 43 cases with special reference to association with endometrial carcinoma. Am J Obstet Gynecol 1957; 73(1): 161–73.CrossRefGoogle Scholar
Ramzy, I. and Nisker, J. A. Histologic study of ovaries from young women with endometrial adenocarcinoma. Am J Clin Pathol 1979; 71: 253256.Google Scholar
Coulam, C. B., Annegers, J. F. and Kranz, J. S. Chronic anovulation syndrome and associated neoplasia. Obstet Gynecol 1983; 61(4): 403407.Google ScholarPubMed
Gallup, D. G. and Stock, R. J. Adenocarcinoma of the endometrium in women 40 years of age or younger. Obstet Gynecol 1984; 64(3): 417420.Google Scholar
Dahlgren, E., Friberg, L. G., Johansson, S. et al. Endometrial carcinoma; ovarian dysfunction: A risk factor in young women. Eur J Obstet Gynecol Reprod Biol 1991; 41(2): 143150.Google Scholar
Escobedo, L. G., Lee, N. C., Peterson, H. B. and Wingo, P. A. Infertility-associated endometrial cancer risk may be limited to specific subgroups of infertile women. Obstet Gynecol 1991; 77(1): 124128.Google Scholar
Ho, S. P., Tan, K. T., Pang, M. W. and Ho, T. H. Endometrial hyperplasia and the risk of endometrial carcinoma. Singapore Med J 1997; 38(1): 1115.Google Scholar
Wild, S., Pierpoint, T., Jacobs, H. and McKeigue, P. Long-term consequences of polycystic ovary syndrome: Results of a 31 year follow-up study. Hum Fertil (Camb) 2000; 3: 101105.Google Scholar
Niwa, K., Imai, A., Hashimoto, M. et al. A case-control study of uterine endometrial cancer of pre- and post-menopausal women. Oncol Rep 2000; 7(1): 8993.Google ScholarPubMed
Iatrakis, G., Zervoudis, S., Saviolakis, A. et al. Women younger than 50 years with endometrial cancer. Eur J Gynaecol Oncol 2006; 27(4): 399400.Google ScholarPubMed
Zucchetto, A., Serraino, D., Polesel, J. et al. Hormone-related factors and gynecological conditions in relation to endometrial cancer risk. Eur J Cancer Prev 2009; 18(4): 316321.Google Scholar
Fearnley, E. J., Marquart, L., Spurdle, A. B., Weinstein, P. and Webb, P. M. Polycystic ovary syndrome increases the risk of endometrial cancer in women aged less than 50 years: An Australian case-control study. Cancer Causes Control 2010; 21(12): 23032308.Google Scholar
Holm, N. S., Glintborg, D., Andersen, M. S., Schledermann, D. and Ravn, P. The prevalence of endometrial hyperplasia and endometrial cancer in women with polycystic ovary syndrome or hyperandrogenism. Acta Obstet Gynecol Scand 2012; 91(10): 11731176.Google Scholar
Hart, R. and Doherty, D. A. The potential implications of a PCOS diagnosis on a woman’s long-term health using data linkage. J Clin Endocrinol Metab 2015; 100(3): 911919.Google Scholar
Gottschau, M., Kjaer, S. K., Jensen, A., Munk, C. and Mellemkjaer, L. Risk of cancer among women with polycystic ovary syndrome: A Danish cohort study. Gynecol Oncol 2015; 136(1): 99103.Google Scholar
Ding, D. C., Chen, W., Wang, J. H. and Lin, S. Z. Association between polycystic ovarian syndrome and endometrial, ovarian, and breast cancer: A population-based cohort study in Taiwan. Medicine 2018; 97(39): e12608.Google Scholar
Soliman, P. T., Oh, J. C., Schmeler, K. M. et al. Risk factors for young premenopausal women with endometrial cancer. Obstet Gynecol 2005; 105(3): 575580.Google Scholar
Pillay, O. C., Wong Te Fong, L. F. and Crow, J. C. The association between polycystic ovaries and endometrial cancer. Hum Reprod 2006; 21(4): 924929.Google Scholar
Brinton, L. A., Moghissi, K. S., Westhoff, C. L., Lamb, E. J. and Scoccia, B. Cancer risk among infertile women with androgen excess or menstrual disorders (including polycystic ovary syndrome). Fertil Steril 2010; 94(5): 17871792.Google Scholar
Yin, W., Falconer, H., Yin, L., Xu, L. and Ye, W. Association between polycystic ovary syndrome and cancer risk. JAMA Oncol 2019; 5(1): 106107.Google Scholar
Pierpoint, T., McKeigue, P. M., Isaacs, A. J., Wild, S. H. and Jacobs, H. S. Mortality of women with polycystic ovary syndrome at long-term followup. J Clin Epidemiol 1998, 51(7): 581–86.CrossRefGoogle Scholar
Chittenden, B. G., Fullerton, G., Maheshwari, A. and Bhattacharya, S. Polycystic ovary syndrome and the risk of gynaecological cancer: A systematic review. Reprod Biomed Online 2009; 19(3): 398405.Google Scholar
Barry, J. A., Azizia, M. M. and Hardiman, P. J. Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: A systematic review and meta-analysis. Hum Reprod Update 2014; 20(5): 748758.Google Scholar
Shobeiri, F. and Jenabi, E. The association between polycystic ovary syndrome and breast cancer: A meta-analysis. Obstet Gynecol Sci 2016; 59(5): 367372.Google Scholar
Olsen, C. M., Green, A. C., Nagle, C. M. et al. Epithelial ovarian cancer: Testing the “androgens hypothesis.” Endocr Relat Cancer 2008; 15(4): 10611068.Google Scholar
Bodmer, M., Becker, C., Meier, C, Jick, S. S. and Meier, C. R. Use of metformin and the risk of ovarian cancer: A case-control analysis. Gynecol Oncol 2011; 123(2): 200204.Google Scholar
Shen, C. C., Yang, A. C., Hung, J. H., Hu, L. Y. and Tsai, S. J. A nationwide population-based retrospective cohort study of the risk of uterine, ovarian and breast cancer in women with polycystic ovary syndrome. Oncologist 2015; 20(1): 4549.Google Scholar
Harris, H. R., Titus, L. J., Cramer, D. W. and Terry, K. L. Long and irregular menstrual cycles, polycystic ovary syndrome, and ovarian cancer risk in a population-based case-control study. Int J Cancer 2017; 140(2): 285291.Google Scholar
Ehrmann, D. A. Polycystic ovary syndrome. New Engl J Med 2005, 352(12): 12231236.Google Scholar
Lim, S. S., Davies, M. J., Norman, R. J. and Moran, L. J. Overweight, obesity and central obesity in women with polycystic ovary syndrome: A systematic review and meta-analysis. Hum Reprod Update 2012; 18(6): 618637.CrossRefGoogle ScholarPubMed
Onstad, M. A., Schmandt, R. E. and Lu, K. H. Addressing the role of obesity in endometrial cancer risk, prevention, and treatment. J Clin Oncol 2016; 34(35): 42254230.Google Scholar
Calle, E. E. and Kaaks, R. Overweight, obesity and cancer: Epidemiological evidence and proposed mechanisms. Nat Rev Cancer 2004; 4(8): 579591.CrossRefGoogle ScholarPubMed
Renehan, A. G., Tyson, M., Egger, M., Heller, R. F. and Zwahlen, M. Body-mass index and incidence of cancer: A systematic review and meta-analysis of prospective observational studies. Lancet 2008; 371(9612): 569578.Google Scholar
World Cancer Research Fund and American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Endometrial Cancer. Continuous Update Project Report, 2013.Google Scholar
Kristensen, A. B., Hare-Bruun, H., Høgdall, C. K. and Rudnicki, M. Influence of body mass index on tumor pathology and survival in uterine cancer: A Danish register study. Int J Gynecol Cancer 2017; 27(2): 281288.Google Scholar
McCullough, M. L., Patel, A. V., Patel, R. et al. Body mass and endometrial cancer risk by hormone replacement therapy and cancer subtype. Cancer Epidemiol Biomarkers Prev 2008; 17(1): 7379.Google Scholar
Simó, R., Sáez-López, C., Barbosa-Desongles, A., Hernández, C. and Selva, D. M. Novel insights in SHBG regulation and clinical implications. Trends Endocrinol Metab 2015; 26(7): 376383.CrossRefGoogle ScholarPubMed
Simó, R., Saez-Lopez, C., Lecube, A., Hernandez, C., Fort, J. M. and Selva, D. M. Adiponectin upregulates SHBG production: Molecular mechanisms and potential implications. Endocrinology 2014; 155(8): 28202830.Google Scholar
Deng, L., Feng, J. and Broaddus, R. R. The novel estrogen-induced gene EIG121 regulates autophagy and promotes cell survival under stress. Cell Death Dis 2010; 1(4): e32.Google Scholar
Thomas, C. and Gustafsson, J. The different roles of ER subtypes in cancer biology and therapy. Nat Rev Cancer 2011; 11(8): 597608.Google Scholar
Cavalieri, E., Chakravarti, D., Guttenplan, J. et al. Catechol estrogen quinones as initiators of breast and other human cancers: Implications for biomarkers of susceptibility and cancer prevention. Biochim Biophys Acta 2006; 1766(1): 6378.Google Scholar
Cavalieri, E. and Rogan, E. The molecular etiology and prevention of estrogen-initiated cancers: Ockham’s Razor: Pluralitas non est ponenda sine necessitate. Plurality should not be posited without necessity. Mol Aspects Med 2014; 36: 155.Google Scholar
Cavalieri, E. L. and Rogan, E. G. Depurinating estrogen-DNA adducts, generators of cancer initiation: Their minimization leads to cancer prevention. Clin Transl Med 2016; 5(1): 12.Google Scholar
Stepto, N. K., Cassar, S., Joham, A. E. et al. Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic-hyperinsulaemic clamp. Hum Reprod 2013; 28(3): 777784.CrossRefGoogle ScholarPubMed
Hernandez, A. V., Pasupuleti, V., Benites-Zapata, V. A., Thota, P., Deshpande, A. and Perez-Lopez, F. R. Insulin resistance and endometrial cancer risk: A systematic review and meta-analysis. Eur J Cancer 2015; 51(18): 27472758.Google Scholar
Burzawa, J. K., Schmeler, K. M., Soliman, P. T. et al. Prospective evaluation of insulin resistance among endometrial cancer patients. Am J Obstet Gynecol 2011; 204: 355.e351357.Google Scholar
Shan, W., Ning, C., Luo, X. et al. Hyperinsulinemia is associated with endometrial hyperplasia and disordered proliferative endometrium: A prospective cross-sectional study. Gynecol Oncol 2014; 132(3): 606610.Google Scholar
Mu, N., Zhu, Y., Wang, Y., Zhang, H. and Xue, F. Insulin resistance: A significant risk factor of endometrial cancer. Gynecol Oncol 2012; 125(3): 751757.CrossRefGoogle ScholarPubMed
Giovannucci, E. Insulin, insulin-like growth factors and colon cancer: A review of the evidence. J Nutr 2001; 131(11): 3109s3120s.Google Scholar
Carlson, M. J., Thiel, K. W., Yang, S. and Leslie, K. K. Catch it before it kills: Progesterone, obesity, and the prevention of endometrial cancer. Discov Med 2012; 14(76): 215222.Google Scholar
Hoeben, A., Landuyt, B., Highley, M. S. et al. Vascular endothelial growth factor and angiogenesis. Pharmacol Rev 2004; 56(4): 549580.Google Scholar
Ibrahim, Y. H. and Yee, D. Insulin-like growth factor-I and cancer risk. Growth Horm IGF Res 2004; 14(4): 261269.Google Scholar
Mihm, M., Gangooly, S. and Muttukrishna, S. The normal menstrual cycle in women. Anim Reprod Sci 2011; 124(3–4): 229236.Google Scholar
Davis, S. R., Lambrinoudaki, I., Lumsden, M. et al. Menopause. Nature Rev Dis Primers 2015; 23(1): 15004.CrossRefGoogle Scholar
Konishi, I., Koshiyama, M., Mandai, M. et al. Increased expression of LH/hCG receptors in endometrial hyperplasia and carcinoma in anovulatory women. Gynecol Oncol 1997; 65(2): 273280.CrossRefGoogle ScholarPubMed
Dabizzi, S., Noci, I., Borri, P. et al. Luteinizing hormone increases human endometrial cancer cells invasiveness through activation of protein kinase A. Cancer Res 2003; 63(14): 42814286.Google Scholar
Apparao, K. B., Lovely, L. P., Gui, Y., Lininger, R. A. and Lessey, B. A. Elevated endometrial androgen receptor expression in women with polycystic ovarian syndrome. Biol Reprod 2002; 66(2): 297304.Google Scholar
Tada, A., Sasaki, H., Nakamura, J., Yoshihama, M. and Terashima, Y. Aromatase activity and the effect of estradiol and testosterone on DNA synthesis in endometrial carcinoma cell lines. J Steroid Biochem Mol Biol 1993; 44(4–6): 661666.Google Scholar
Li, X., Pishdari, B., Cui, P. et al. Regulation of androgen receptor expression alters AMPK phosphorylation in the endometrium: In vivo and in vitro studies in women with polycystic ovary syndrome. Int J Biol Sci 2015; 11(12): 13761389.Google Scholar
Currie, E., Schulze, A., Zechner, R., Walther, T. C. and Farese, R. V., Jr. Cellular fatty acid metabolism and cancer. Cell Metab 2013; 18(2): 153161.CrossRefGoogle ScholarPubMed
Swinnen, J. V., Brusselmans, K. and Verhoeven, G. Increased lipogenesis in cancer cells: New players, novel targets. Curr Opin Clin Nutr Metabol Care 2006; 9(4): 358365.Google Scholar
Hirasawa, A., Makita, K., Akahane, T. et al. Hypertriglyceridemia is frequent in endometrial cancer survivors. Jpn J Clin Oncol 2013; 43(11): 10871092.Google Scholar
Swanson, C. A., Potischman, N., Barrett, R. J. et al. Endometrial cancer risk in relation to serum lipids and lipoprotein levels. Cancer Epidemiol Biomarkers Prev 1994; 3(7): 575581.Google Scholar
Pillay, O. C., Sharkey, L. A., Catalano, R. and Hardiman, P. Endometrial gene expression in women with PCOS. Human Reprod 2005; 20: 20.Google Scholar
Chen, Y., Wang, Y. and Li, M. Expression of apoptosis regulatory protein bcl-2 and bax in endometrium of polycystic ovary syndrome [Article in Chinese]. Zhonghua fu chan ke za zhi 1999; 34(11): 652654.Google Scholar
MacLaughlan, S. D., Palomino, W. A., Mo, B., Lewis, T. D., Lininger, R. A. and Lessey, B. A. Endometrial expression of Cyr61: A marker of estrogenic activity in normal and abnormal endometrium. Obstet Gynecol 2007; 110(1): 146154.Google Scholar
Birks, S., Peeters, A., Backholer, K., O’Brien, P. and Brown, W. A systematic review of the impact of weight loss on cancer incidence and mortality. Obes Rev 2012; 13(10): 868891.Google Scholar
Perez-Lopez, F. R., Pasupuleti, V., Gianuzzi, X., Palma-Ardiles, G., Hernandez-Fernandez, W. and Hernandez, A. V. Systematic review and meta-analysis of the effect of metformin treatment on overall mortality rates in women with endometrial cancer and type 2 diabetes mellitus. Maturitas 2017; 101: 611.Google Scholar

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