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Epidemiologie, Risikofaktoren und Genetik des Endometriumkarzinoms

Epidemiology, risk factors, and genetics of endometrial cancer

  • Leitthema
  • Published:
Die Gynäkologie Aims and scope

Zusammenfassung

Hintergrund

Das Endometriumkarzinom (EC) ist das fünfthäufigste Malignom der Frau und das häufigste weibliche Beckenmalignom. Kenntnisse der Epidemiologie, Genetik und Risikofaktoren dieses Malignoms sind die Voraussetzung für eine effiziente Beratung, Früherkennung und Prävention.

Ziel

Darstellung der aktuellen Literatur mit einer Übersicht über die Epidemiologie, Genetik und Risikofaktoren.

Material und Methoden

Diese Arbeit basiert auf der aktuellen S3-Leitlinie Diagnostik, Therapie und Nachsorge der Patientinnen mit Endometriumkarzinom. Die aktuelle Literatur für diese Kapitel wurde zum Teil auf Basis von Expert*innenwissen zusammengestellt. Es erfolgten systematische Recherchen in der Datenbank Medline und in Cochrane Reviews (2015–2021). Die Evidenzklassifikation erfolgte nach Oxford 2011. Die Empfehlungen bzw. Statements wurden von einer repräsentativen Gruppe mit strukturiertem Konsensverfahren formuliert.

Ergebnisse

Bezogen auf die krebsspezifische Mortalität der Frau nimmt das EC mit 2,7 % aller krebsbedingten Todesfälle in Deutschland die neunte Stelle ein. Die Erkrankungshäufigkeit nimmt mit steigendem Alter kontinuierlich zu. ECs werden am häufigsten zwischen dem 75. und dem 79. Lebensjahr diagnostiziert, das Lebenszeitrisiko beträgt 1,9 %. Wichtige risikosteigernde ätiologische Faktoren sind die Langzeiteinnahme von Östrogenen, eine Gestagentherapie, ein hoher Body-Mass-Index sowie ein gestörter Glukosemetabolismus. Risikoreduzierende bzw. -modifizierende Faktoren sind orale Kontrazeptiva, körperliche Bewegung, diätetische Faktoren, wie Fett- und Fleischanteil, Soja, Ballaststoffe, Vitamine und Genussmittel. Ein immunhistochemisches bzw. molekulargenetisches Screening ist bei allen EC-Patientinnen indiziert und beeinflusst die genetische Beratung der betroffenen Familien sowie die Therapieplanung.

Abstract

Background

Endometrial cancer (EC) is the fifth most common female malignancy and the most common pelvic malignancy. Effective strategies for early detection, prevention, and genetic assessment are discussed in this article.

Aim

To review the literature on epidemiology, risk factors, and genetics.

Materials and Methods

This article is based on the current recommendations of the German Society of Obstetrics and Gynecology for the diagnosis and treatment of women with EC. The current literature was summarized based on expert knowledge. Systematic searches in the Medline database and in Cochrane Reviews were performed. The quality of the evidence was rated according to the 2011 Oxford classification. Recommendations and statements were formulated by a representative group using structured consensus methods.

Results

In Germany, 2.7% of cancer-specific deaths are due to EC. The incidence of EC increases with age and the disease is most often diagnosed in the age group of 75- to 79-year-old women. The lifetime risk of EC is 1.9%. Risk-modulating factors of EC include long-term use of estrogens, progestogen therapy, oral contraceptives, high body mass index, and impaired glucose metabolism. In addition, physical activity and dietary aspects, such as the amount of fat and red meat consumed, as well as soja foods, dietary fibers, vitamins, and specific beverages such as tea and coffee, play an important etiological role. EC also has a genetic component. Immunohistochemical and/or molecular screening is warranted for all patients with EC and has a significant impact on the genetic counselling of affected families as well as on treatment decisions.

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Literatur

  1. Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): Diagnostik, Therapie und Nachsorge der Patientinnen mit Endometriumkarzinom, Langversion 2.0, 2022, AWMF Registernummer: 032/034-OLKF; Konsultationsfassung; Mai 2022

  2. ICD-10-GM 2018 Systematisches Verzeichnis: Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme, 2017.

  3. Robert K‑I (2021) Gesellschaft der epidemiologischen Krebsregister in Deutschland e, V., Krebs in Deutschland 2017/2018 (13. Ausgabe)

    Google Scholar 

  4. Beral V, Bull D, Reeves G (2005) Endometrial cancer and hormone-replacement therapy in the Million Women Study. Lancet 365:1543–1551

    Article  Google Scholar 

  5. Tempfer CB, Hilal Z, Kern P, Juhasz-Boess I, Rezniczek GA (2020) Menopausal hormone therapy and risk of endometrial cancer: a systematic review. Cancers 12(8):2195

    Article  CAS  Google Scholar 

  6. Chlebowski RT, Anderson GL, Sarto GE, Haque R, Runowicz CD, Aragaki AK et al (2015) Continuous combined estrogen plus progestin and endometrial cancer: the women’s health initiative randomized trial. J Natl Cancer Inst 108(3):djv350.https://doi.org/10.1093/jnci/djv350

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Fournier A, Dossus L, Mesrine S, Vilier A, Boutron-Ruault MC, Clavel-Chapelon F et al (2014) Risks of endometrial cancer associated with different hormone replacement therapies in the E3N cohort, 1992–2008. Am J Epidemiol 180:508–517

    Article  Google Scholar 

  8. The Writing Group for the PEPI Trial (1996) Effects of hormone replacement therapy on endometrial histology in postmenopausal women. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. JAMA 275(5):370–375

    Article  Google Scholar 

  9. Crosbie EJ, Zwahlen M, Kitchener HC, Egger M, Renehan AG (2010) Body mass index, hormone replacement therapy, and endometrial cancer risk: a meta-analysis. Cancer Epidemiol Biomarkers Prev 19:3119–3130

    Article  CAS  Google Scholar 

  10. Mørch LS, Kjaer SK, Keiding N, Løkkegaard E, Lidegaard Ø (2016) The influence of hormone therapies on type I and II endometrial cancer: a nationwide cohort study. Int J Cancer 138(6):1506–1515

    Article  Google Scholar 

  11. Braithwaite RS, Chlebowski RT, Lau J, George S, Hess R, Col NF (2003) Meta-analysis of vascular and neoplastic events associated with tamoxifen. J Gen Intern Med 18:937–947

    Article  Google Scholar 

  12. Nelson HD, Smith ME, Griffin JC, Fu R (2013) Use of medications to reduce risk for primary breast cancer: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 158:604–614

    Article  Google Scholar 

  13. Emons G, Mustea A, Tempfer C (2020) Tamoxifen and endometrial cancer: a Janus-headed drug. Cancers 12(9):2535

    Article  CAS  Google Scholar 

  14. DeMichele A, Troxel AB, Berlin JA, Weber AL, Bunin GR, Turzo E et al (2008) Impact of raloxifene or tamoxifen use on endometrial cancer risk: a population-based case-control study. J Clin Oncol 26:4151–4159

    Article  Google Scholar 

  15. Ignatov A, Ortmann O (2020) Endocrine risk factors of endometrial cancer: polycystic ovary syndrome, oral contraceptives, infertility, tamoxifen. Cancers 12(7):1766

    Article  CAS  Google Scholar 

  16. Siristatidis C, Sergentanis TN, Kanavidis P, Trivella M, Sotiraki M, Mavromatis I, Psaltopoulou T, Skalkidou A, Petridou ET (2013) Controlled ovarian hyperstimulation for IVF: impact on ovarian, endometrial and cervical cancer—a systematic review and meta-analysis. Hum Reprod Update 19(2):105–123

    Article  CAS  Google Scholar 

  17. Skalkidou A, Sergentanis TN, Gialamas SP, Georgakis MK, Psaltopoulou T, Trivella M, Siristatidis CS, Evangelou E, Petridou E (2017) Risk of endometrial cancer in women treated with ovary-stimulating drugs for subfertility. Cochrane Database Syst Rev 3(3):CD010931. https://doi.org/10.1002/14651858.CD010931.pub2

    Article  PubMed  Google Scholar 

  18. Setiawan VW, Pike MC, Karageorgi S, Deming SL, Anderson K, Bernstein L et al (2012) Age at last birth in relation to risk of endometrial cancer: pooled analysis in the epidemiology of endometrial cancer consortium. Am J Epidemiol 176:269–278

    Article  Google Scholar 

  19. Karageorgi S, Hankinson SE, Kraft P, De Vivo I (2009) Reproductive factors and postmenopausal hormone use in relation to endometrial cancer risk in the Nurses’ Health Study cohort 1976–2004. Int J Cancer 126:208–216

    Article  Google Scholar 

  20. Friberg E, Orsini N, Mantzoros CS, Wolk A (2007) Diabetes mellitus and risk of endometrial cancer: a meta-analysis. Diabetologia 50:1365–1374

    Article  CAS  Google Scholar 

  21. Barone BB, Yeh HC, Snyder CF, Peairs KS, Stein KB, Derr RL et al (2008) Long-term all-cause mortality in cancer patients with preexisting diabetes mellitus: a systematic review and meta-analysis. JAMA 300:2754–2764

    Article  CAS  Google Scholar 

  22. Huang Y, Cai X, Qiu M, Chen P, Tang H, Hu Y et al (2014) Prediabetes and the risk of cancer: a meta-analysis. Diabetologia 57:2261–2269

    Article  CAS  Google Scholar 

  23. Liao C, Zhang D, Mungo C, Tompkins AD, Zeidan AM (2014) Is diabetes mellitus associated with increased incidence and disease-specific mortality in endometrial cancer? A systematic review and meta-analysis of cohort studies. Gynecol Oncol 135:163–171

    Article  Google Scholar 

  24. Bjorge T, Stocks T, Lukanova A, Tretli S, Selmer R, Manjer J et al (2010) Metabolic syndrome and endometrial carcinoma. Am J Epidemiol 171:892–902

    Article  Google Scholar 

  25. Chittenden BG, Fullerton G, Maheshwari A, Bhattacharya S (2009) Polycystic ovary syndrome and the risk of gynaecological cancer: a systematic review. Reprod Biomed Online 19:398–405

    Article  CAS  Google Scholar 

  26. Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M (2008) Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 371:569–578

    Article  Google Scholar 

  27. Dobbins M, Decorby K, Choi BC (2013) The Association between Obesity and Cancer Risk: A Meta-Analysis of Observational Studies from 1985 to 2011. ISRN Prev Med 2013:680536. https://doi.org/10.5402/2013/680536

    Article  Google Scholar 

  28. Bandera EV, Kushi LH, Moore DF, Gifkins DM, McCullough ML (2007) Association between dietary fiber and endometrial cancer: a dose-response meta-analysis. Am J Clin Nutr 86:1730–1737

    Article  CAS  Google Scholar 

  29. Myung SK, Ju W, Choi HJ, Kim SC (2009) Soy intake and risk of endocrine-related gynaecological cancer: a meta-analysis. BJOG 116:1697–1705

    Article  Google Scholar 

  30. Ollberding NJ, Lim U, Wilkens LR, Setiawan VW, Shvetsov YB, Henderson BE, Kolonel LN, Goodman MT (2012) Legume, soy, tofu, and isoflavone intake and endometrial cancer risk in postmenopausal women in the multiethnic cohort study. J Natl Cancer Inst 104(1):67–76. https://doi.org/10.1093/jnci/djr475

    Article  CAS  PubMed  Google Scholar 

  31. Raglan O, Kalliala I, Markozannes G, Cividini S, Gunter MJ, Nautiyal J et al (2019) Risk factors for endometrial cancer: an umbrella review of the literature. Int J Cancer 145(7):1719–1730

    Article  CAS  Google Scholar 

  32. Keum N, Greenwood DC, Lee DH, Kim R, Aune D, Ju W, Hu FB, Giovannucci EL (2015) Adult weight gain and adiposity-related cancers: a dose-response meta-analysis of prospective observational studies. J Natl Cancer Inst 107(3):dju428

    PubMed  Google Scholar 

  33. Gierach GL, Chang SC, Brinton LA, Lacey JV Jr, Hollenbeck AR, Schatzkin A, Leitzmann MF (2009) Physical activity, sedentary behavior, and endometrial cancer risk in the NIH-AARP Diet and Health Study. Int J Cancer 124(9):2139–2147

    Article  CAS  Google Scholar 

  34. Moore SC, Lee IM, Weiderpass E, Campbell PT, Sampson JN, Kitahara CM, Keadle SK, Arem H, Berrington de Gonzalez A, Hartge P, Adami HO, Blair CK, Borch KB, Boyd E, Check DP, Fournier A, Freedman ND, Gunter M, Johannson M, Khaw KT, Linet MS, Orsini N, Park Y, Riboli E, Robien K, Schairer C, Sesso H, Spriggs M, Van Dusen R, Wolk A, Matthews CE, Patel AV (2016) Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA Intern Med 176(6):816–825

    Article  Google Scholar 

  35. Voskuil DW, Monninkhof EM, Elias SG, Vlems FA, van Leeuwen FE, Task Force Physical Activity and Cancer (2007) Physical activity and endometrial cancer risk, a systematic review of current evidence. Cancer Epidemiol Biomarkers Prev 16(4):639–648

    Article  Google Scholar 

  36. Soini T, Hurskainen R, Grénman S, Mäenpää J, Paavonen J, Pukkala E (2014) Cancer risk in women using the levonorgestrel-releasing intrauterine system in Finland. Obstet Gynecol 124(2 Pt 1):292–299

    Article  CAS  Google Scholar 

  37. Beining RM, Dennis LK, Smith EM, Dokras A (2008) Meta-analysis of intrauterine device use and risk of endometrial cancer. Ann Epidemiol 18(6):492–499

    Article  Google Scholar 

  38. Ward KK, Roncancio AM, Shah NR, Davis MA, Saenz CC, McHale MT, Plaxe SC (2014) Bariatric surgery decreases the risk of uterine malignancy. Gynecol Oncol 133(1):63–66

    Article  Google Scholar 

  39. Ishihara BP, Farah D, Fonseca MCM, Nazario A (2020) The risk of developing breast, ovarian, and endometrial cancer in obese women submitted to bariatric surgery: a meta-analysis. Surg Obes Relat Dis 16(10):1596–1602

    Article  Google Scholar 

  40. Buchanan DD, Tan YY, Walsh MD, Clendenning M, Metcalf AM, Ferguson K et al (2013) Tumor mismatch repair immunohistochemistry and DNA MLH1 methylation testing of patients with endometrial cancer diagnosed at age younger than 60 years optimizes triage for population-level germline mismatch repair gene mutation testing. J Clin Oncol 32:90–100

    Article  Google Scholar 

  41. Egoavil C, Alenda C, Castillejo A, Paya A, Peiro G, Sanchez-Heras AB et al (2013) Prevalence of Lynch syndrome among patients with newly diagnosed endometrial cancers. Plos One 8:e79737

    Article  CAS  Google Scholar 

  42. Lu KH, Schorge JO, Rodabaugh KJ, Daniels MS, Sun CC, Soliman PT et al (2007) Prospective determination of prevalence of lynch syndrome in young women with endometrial cancer. J Clin Oncol 25:5158–5164

    Article  CAS  Google Scholar 

  43. Lu KH, Dinh M, Kohlmann W, Watson P, Green J, Syngal S et al (2005) Gynecologic cancer as a “sentinel cancer” for women with hereditary nonpolyposis colorectal cancer syndrome. Obstet Gynecol 105:569–574

    Article  Google Scholar 

  44. Carcangiu ML, Radice P, Casalini P, Bertario L, Merola M, Sala P (2010) Lynch syndrome-related endometrial carcinomas show a high frequency of nonendometrioid types and of high FIGO grade endometrioid types. Int J Surg Pathol 18(1):21–26

    Article  Google Scholar 

  45. Burn J, Sheth H, Elliott F, Reed L, Macrae F, Mecklin JP, Möslein G, McRonald FE, Bertario L, Evans DG, Gerdes AM, Ho JWC, Lindblom A, Morrison PJ, Rashbass J, Ramesar R, Seppälä T, Thomas HJW, Pylvänäinen K, Borthwick GM, Mathers JC, Bishop DT, CAPP2 Investigators (2020) Cancer prevention with aspirin in hereditary colorectal cancer (Lynch syndrome), 10-year follow-up and registry-based 20-year data in the CAPP2 study: a double-blind, randomised, placebo-controlled trial. Lancet 395(10240):1855–1863

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Universitätsfrauenklinik der Ruhr-Universität Bochum, Marienhospital Herne, Hölkeskampring 40, 44625, Herne, Deutschland

    Clemens Tempfer MBA

  2. Medizinisch Genetisches Zentrum München, München, Deutschland

    Verena Steinke-Lange

  3. MVZ Venusberg, Bonn, Deutschland

    Stefan Aretz

  4. Universitätsfrauenklinik Köln, Köln, Deutschland

    Rita Schmutzler

  5. Universitätsfrauenklinik Regensburg, Regensburg, Deutschland

    Olaf Ortmann

  6. Frauenklinik, Evangelisches Klinikum Köln-Weyertal, Köln, Deutschland

    Thomas Römer

  7. Frauenklinik, Klinikum Fürth, Fürth, Deutschland

    Volker Hanf

  8. Semicolon, Mönchengladbach, Deutschland

    Simone Widhalm & Nicola Reents

  9. Gynäkologie/Geburtshilfe, Klinikum Mutterhaus der Borromäerinnen, Trier, Deutschland

    Sebastian Jud

  10. Medizinische Fakultät, Lehrstuhl für Gynäkologie und Geburtshilfe, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland

    Sebastian Jud

  11. Universitäts-Frauenklinik, Universitätsklinikum Tübingen, Tübingen, Deutschland

    Stefan Kommoss

  12. AWMF – Institut für Medizinisches Wissensmanagement (AWMF-IMWi), c/o Philipps Universität Marburg/AWMF Berlin, Berlin, Deutschland

    Monika Nothacker & Susanne Blödt

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  1. Clemens Tempfer MBA
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  2. Verena Steinke-Lange
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Corresponding author

Correspondence to Clemens Tempfer MBA.

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Interessenkonflikt

C. Tempfer, V. Steinke-Lange, S. Aretz, R. Schmutzler, O. Ortmann, T. Römer, V. Hanf, S. Widhalm, N. Reents, S. Jud, S. Kommoss, M. Nothacker und S. Blödt geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Günter Emons, Göttingen

Teile dieses Beitrags entstammen wörtlich aus dem Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF) (2022) Diagnostik, Therapie und Nachsorge der Patientinnen mit Endometriumkarzinom [1].

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Tempfer, C., Steinke-Lange, V., Aretz, S. et al. Epidemiologie, Risikofaktoren und Genetik des Endometriumkarzinoms. Gynäkologie 55, 470–480 (2022). https://doi.org/10.1007/s00129-022-04956-z

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