Serial endometrial thickness and risk of non-endometrial hormone-dependent cancers in postmenopausal women in UK Collaborative Trial of Ovarian Cancer Screening.

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  • Additional Information
    • Affiliation:
      MRC CTU, Institute of Clinical Trials and Methodology, University College London, London, UK
      Department of Occupational and Environmental Medicine, Frederiksberg‐Bispebjerg University Hospital, Copenhagen NV,, Denmark
      Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
      Create Fertility, London, UK
      University of New South Wales, Sydney, Australia
      MRC CTU, Institute of Clinical Trials and Methodology, University College London, UK
      Department of Occupational and Environmental Medicine, Frederiksberg-Bispebjerg University Hospital, Bispebjerg Bakke 23, DK-2400, Copenhagen, NV, Denmark
      Department of Women's Cancer, Institute for Women's Health, University College London, UK
    • Abstract:
      Objective: Estrogen is a well-established risk factor for various cancers. It causes endometrial proliferation, which is assessed routinely as endometrial thickness (ET) using transvaginal ultrasound (TVS). Only one previous study, restricted to endometrial and breast cancer, has considered ET and the risk of non-endometrial cancer. The aim of this study was to explore the association between baseline and serial ET measurements and nine non-endometrial hormone-sensitive cancers, in postmenopausal women, using contemporary statistical methodology that attempts to minimize the biases typical of endogenous serial data.Methods: This was a cohort study nested within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). In the ultrasound arm of UKCTOCS, 50639 postmenopausal women, aged 50-74, underwent annual TVS examination, of whom 38 105 had a valid ET measurement, no prior hysterectomy and complete covariate data, and were included in this study. All women were followed up through linkage to national cancer registries. The effect of ET on the risk of six estrogen-dependent cancers (breast, ovarian, colorectal, bladder, lung and pancreatic) was assessed using joint models for longitudinal biomarker and time-to-event data, and Cox models were used to assess the association between baseline ET measurement and these six cancers in addition to liver cancer, gastric cancer and non-Hodgkin's lymphoma (NHL). All models were adjusted for current hormone-replacement therapy (HRT) use, body mass index, age at last menstrual period, parity and oral contraceptive pill use.Results: The 38 105 included women had a combined total of 267 567 (median, 8; interquartile range, 5-9) valid ET measurements. During a combined total of 407 838 (median, 10.9) years of follow-up, 1398 breast, 351 endometrial, 381 lung, 495 colorectal, 222 ovarian, 94 pancreatic, 79 bladder, 62 gastric, 38 liver cancers and 52 NHLs were registered. Using joint models, a doubling of ET increased significantly the risk of breast (hazard ratio (HR), 1.21; 95% CI, 1.09-1.36; P = 0.001), ovarian (HR, 1.39; 95% CI, 1.06-1.82; P = 0.018) and lung (HR, 1.25; 95% CI, 1.02-1.54; P = 0.036) cancers. There were no statistically significant associations between ET and the remaining six cancers.Conclusion: Postmenopausal women with high/increasing ET on TVS are at increased risk of breast, ovarian and lung cancer. It is important that clinicians are aware of these risks, as TVS is a common investigation. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
    • Journal Subset:
      Biomedical; Europe; Peer Reviewed; UK & Ireland
    • ISSN:
      0960-7692
    • MEDLINE Info:
      PMID: NLM31614036 NLM UID: 9108340
    • Grant Information:
      16/46/01//National Institute for Health Research (NIHR) HTA grant/; HTA/16/46/01/DH_/Department of Health/United Kingdom; MC_UU_12023/28/MRC_/Medical Research Council/United Kingdom; MC_UU_12023/20/MRC_/Medical Research Council/United Kingdom
    • Publication Date:
      In Process
    • Publication Date:
      20201002
    • DOI:
      10.1002/uog.21894
    • Accession Number:
      144885564
  • Citations
    • ABNT:
      BURNELL, M. et al. Serial endometrial thickness and risk of non-endometrial hormone-dependent cancers in postmenopausal women in UK Collaborative Trial of Ovarian Cancer Screening. Ultrasound in Obstetrics & Gynecology, [s. l.], v. 56, n. 2, p. 267–275, 2020. DOI 10.1002/uog.21894. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=144885564. Acesso em: 1 nov. 2020.
    • AMA:
      Burnell M, Gentry MA, Glazer C, et al. Serial endometrial thickness and risk of non-endometrial hormone-dependent cancers in postmenopausal women in UK Collaborative Trial of Ovarian Cancer Screening. Ultrasound in Obstetrics & Gynecology. 2020;56(2):267-275. doi:10.1002/uog.21894
    • APA:
      Burnell, M., Gentry, M. A., Glazer, C., Karpinskyj, C., Ryan, A., Apostolidou, S., Kalsi, J., Parmar, M., Campbell, S., Jacobs, I., Menon, U., Burnell, M., Gentry-Maharaj, A., Glazer, C., Karpinskyj, C., Ryan, A., Apostolidou, S., Kalsi, J., Parmar, M., & Campbell, S. (2020). Serial endometrial thickness and risk of non-endometrial hormone-dependent cancers in postmenopausal women in UK Collaborative Trial of Ovarian Cancer Screening. Ultrasound in Obstetrics & Gynecology, 56(2), 267–275. https://doi.org/10.1002/uog.21894
    • Chicago/Turabian: Author-Date:
      Burnell, M., Maharaj, A. Gentry, C. Glazer, C. Karpinskyj, A. Ryan, S. Apostolidou, J. Kalsi, et al. 2020. “Serial Endometrial Thickness and Risk of Non-Endometrial Hormone-Dependent Cancers in Postmenopausal Women in UK Collaborative Trial of Ovarian Cancer Screening.” Ultrasound in Obstetrics & Gynecology 56 (2): 267–75. doi:10.1002/uog.21894.
    • Harvard:
      Burnell, M. et al. (2020) ‘Serial endometrial thickness and risk of non-endometrial hormone-dependent cancers in postmenopausal women in UK Collaborative Trial of Ovarian Cancer Screening’, Ultrasound in Obstetrics & Gynecology, 56(2), pp. 267–275. doi: 10.1002/uog.21894.
    • Harvard: Australian:
      Burnell, M., Gentry, MA, Glazer, C., Karpinskyj, C., Ryan, A., Apostolidou, S., Kalsi, J., Parmar, M., Campbell, S., Jacobs, I, Menon, U, Burnell, Matthew, Gentry-Maharaj, A, Glazer, Clara, Karpinskyj, Chloe, Ryan, Andy, Apostolidou, Sophia, Kalsi, Jatinderpal, Parmar, Mahesh & Campbell, Stuart 2020, ‘Serial endometrial thickness and risk of non-endometrial hormone-dependent cancers in postmenopausal women in UK Collaborative Trial of Ovarian Cancer Screening’, Ultrasound in Obstetrics & Gynecology, vol. 56, no. 2, pp. 267–275, viewed 1 November 2020, .
    • MLA:
      Burnell, M., et al. “Serial Endometrial Thickness and Risk of Non-Endometrial Hormone-Dependent Cancers in Postmenopausal Women in UK Collaborative Trial of Ovarian Cancer Screening.” Ultrasound in Obstetrics & Gynecology, vol. 56, no. 2, Aug. 2020, pp. 267–275. EBSCOhost, doi:10.1002/uog.21894.
    • Chicago/Turabian: Humanities:
      Burnell, M., Maharaj, A. Gentry, C. Glazer, C. Karpinskyj, A. Ryan, S. Apostolidou, J. Kalsi, et al. “Serial Endometrial Thickness and Risk of Non-Endometrial Hormone-Dependent Cancers in Postmenopausal Women in UK Collaborative Trial of Ovarian Cancer Screening.” Ultrasound in Obstetrics & Gynecology 56, no. 2 (August 15, 2020): 267–75. doi:10.1002/uog.21894.
    • Vancouver/ICMJE:
      Burnell M, Gentry MA, Glazer C, Karpinskyj C, Ryan A, Apostolidou S, et al. Serial endometrial thickness and risk of non-endometrial hormone-dependent cancers in postmenopausal women in UK Collaborative Trial of Ovarian Cancer Screening. Ultrasound in Obstetrics & Gynecology [Internet]. 2020 Aug 15 [cited 2020 Nov 1];56(2):267–75. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=144885564