Author(s): Lacey JV Jr, Sherman ME, Rush BB, Ronnett BM, Ioffe OB,
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Abstract PURPOSE The severity of endometrial hyperplasia (EH)-simple (SH), complex (CH), or atypical (AH)-influences clinical management, but valid estimates of absolute risk of clinical progression to carcinoma are lacking. Materials and METHODS We conducted a case-control study nested in a cohort of 7,947 women diagnosed with EH (1970-2002) at one prepaid health plan who remained at risk for at least 1 year. Patient cases (N = 138) were diagnosed with carcinoma, on average, 6 years later (range, 1 to 24 years). Patient controls (N = 241) were matched to patient cases on age at EH, date of EH, and duration of follow-up, and they were counter-matched to patient cases on EH severity. After we independently reviewed original slides and medical records of patient controls and patient cases, we combined progression relative risks (AH v SH, CH, or disordered proliferative endometrium [ie, equivocal EH]) from the case-control analysis with clinical censoring information (ie, hysterectomy, death, or left the health plan) on all cohort members to estimate interval-specific (ie, 1 to 4, 5 to 9, and 10 to 19 years) and cumulative (ie, through 4, 9, and 19 years) progression risks. Results For nonatypical EH, cumulative progression risk increased from 1.2\% (95\% CI, 0.6\% to 1.9\%) through 4 years to 1.9\% (95\% CI, 1.2\% to 2.6\%) through 9 years to 4.6\% (95\% CI, 3.3\% to 5.8\%) through 19 years after EH diagnosis. For AH, cumulative risk increased from 8.2\% (95\% CI, 1.3\% to 14.6\%) through 4 years to 12.4\% (95\% CI, 3.0\% to 20.8\%) through 9 years to 27.5\% (95\% CI, 8.6\% to 42.5\%) through 19 years after AH. CONCLUSION Cumulative 20-year progression risk among women who remain at risk for at least 1 year is less than 5\% for nonatypical EH but is 28\% for AH.
This article was published in J Clin Oncol
and referenced in Epidemiology: Open Access