Bariatric surgery an opportunity to screen for endometrial cancer


AT IGCS 2014


MELBOURNE – Bariatric surgery may provide a useful opportunity to screen morbidly obese women for endometrial cancer, according to the presenter of a study showing a 15% prevalence of occult endometrial cancer or atypical hyperplasia in this population.

Speaking at the biennial meeting of the International Gynecologic Cancer Society, Dr. Michelle MacKintosh, clinical research fellow at the Institute of Cancer Sciences at the University of Manchester (England), presented data from a prospective cohort study examining the endometrial effects of weight loss in morbidly obese women.

Among the 67 women so far enrolled and assessed via a regional weight management service, Dr. MacKintosh and her colleagues detected endometrial cancer or atypical endometrial hyperplasia in 10 women; 1 woman presented symptoms suggestive of an underlying endometrial abnormality.

Endometrial biopsies were conducted while the women were under general anesthesia for bariatric surgery, and the researchers also took blood and cervical cytology samples.

Three-quarters of the women were premenopausal, and among those undergoing bariatric surgery, as opposed to a medically-supervised weight management program, the median body mass index was 52.5 kg/m2.

Twelve-month follow-up data showed bariatric surgery–induced weight loss led to a significant reduction in insulin resistance and significant improvements in reproductive function, as measured by sex hormone binding globulin, follicle-stimulating hormone and luteinizing hormone.

The researchers examined the impact of weight loss on levels of Ki67 – a marker of endometrial proliferation that can be used to generate a proliferation index.

“We know that proliferation is a feature of cancer development and we know it increases along that spectrum, so what we wanted to see was if that process appeared to be reversed by weight loss and we thought that looking at the proliferation index would be a way of quantifying that,” Dr. MacKintosh said in an interview.

These analyses are ongoing but Dr. MacKintosh said initial data look promising, with suggestions that endometrial Ki67 expression drops with weight loss.

“The 15% baseline prevalence of endometrial cancer and atypical hyperplasia, which we found in these women, is clinically significant and is far in excess of anything previously been reported,” Dr. MacKintosh said at the conference.

“Ours is the first prospective cohort study to assess blood and endometrial change with weight loss and in answer to the question we posed, we do believe that we can support endometrial screening of such high risk women.”

There were no conflicts of interest declared.

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