Study shows younger women with endometrial cancer can safely keep ovaries, avoid early menopause

In this New Digest:

• Summary of study being published online January 26, 2009 in the Journal of Clinical Oncology,showing no survival difference between premenopausal women with early-stage endometrial cancer whose ovaries were left intact during cancer surgery compared with those whose ovaries were surgically removed.
• Quote for attribution from Beth Karlan, MD, American Society of Clinical Oncology gynecologic cancer expert and Director, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center
• Links to additional information on Cancer.Net, ASCO's patient Web site

Study Summary

In the largest study to date on the safety of ovarian preservation in women aged 45 and younger who were surgically treated for early-stage endometrial cancer, researchers have found that there is no survival benefit associated with surgical removal of the ovaries, compared to women whose ovaries were left intact. Leaving the ovaries in place could spare many women from the side effects of surgery-induced early menopause, such as hot flashes and vaginal dryness, as well as the long-term increased risk of heart disease, osteoporosis and hip fractures.

"Our research suggests that oncologists may no longer need to remove the ovaries during surgery in younger women with early-stage endometrial cancer, which has been the standard approach for many years. Leaving the ovaries intact appears to be a safe option that offers women a range of important short- and long-term health and quality of life benefits," said lead author Jason D. Wright, MD, assistant professor of obstetrics and gynecology in the Division of Gynecologic Oncology at Columbia University College of Physicians & Surgeons.

Surgical removal of the uterus (hysterectomy) is the standard of care for endometrial cancer. During the procedure, surgeons usually remove the ovaries as well, a procedure called oophorectomy. Oophorectomy is usually performed to reduce the risk of cancer spreading to the ovaries and also to lower estrogen levels that may fuel the growth of any remaining endometrial cancer cells. However, studies have shown that these risks are small, and the benefits of oophorectomy have not been established by research.

In this study, Dr. Wright and his colleagues compared five-year survival between 402 women aged 45 and younger who were diagnosed with stage I endometrial cancer (cancer confined to the uterus) whose ovaries were preserved, and 3,269 similar women whose ovaries were removed. All patients had a hysterectomy and were diagnosed between 1988 and 2004. Data were derived from the Surveillance, Epidemiology and End Results (SEER) Database, a collection of cancer data on one-quarter of the U.S. population.

Five-year overall survival was similar between the two groups: Among women who had oophorectomy, 98 percent of those with stage IA disease, 96 percent of those with stage IB disease and 89 percent of those with stage IC disease were still alive. The corresponding figures for women whose ovaries were preserved were 98, 100 and 86 percent, respectively.

The investigators also noted that women were more likely to have had ovarian preservation if they were younger (under age 30), were diagnosed later in the study period, lived in the eastern United States and had a low tumor grade and earlier tumor stage.

About Endometrial Cancer

The American Cancer Society estimates that approximately 40,100 women were diagnosed with endometrial cancer in the U.S. in 2008, and that 7,470 died from the disease. According to SEER data, about 8 percent of women diagnosed with endometrial cancer are under age 45.

ASCO Perspective

Beth Karlan, MD, Director, Division of Gynecologic Oncology at Cedars-Sinai Medical Center and Professor of Obstetrics and Gynecology at Geffen School of Medicine at UCLA

"Increasing attention is rightly being paid to improving the quality of life of cancer survivors. These findings are good news for younger women with early-stage endometrial cancer, who may be able to safely keep their ovaries, avoiding adverse health effects and maintaining quality of life."

Information from Cancer.Net, ASCO's Patient Web site

Cancer.Net Guide to Uterine Cancer

Fertility and Cancer Treatment

Managing Menopausal Symptoms

Information on These Studies for Patients

Link to JCO Cancer Advances

The Journal of Clinical Oncology is the tri-monthly peer-reviewed journal of the American Society of Clinical Oncology (ASCO), the world's leading professional society representing physicians who treat people with cancer.

ATTRIBUTION TO THE JOURNAL OF CLINICAL ONCOLOGY IS REQUESTED IN ALL NEWS COVERAGE.