Cancer risk and PCOS
Cancer risk and PCOS
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DOI：
10.1016/j.steroids.2013.04.004
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发表时间：
2013-08-01
期刊：
影响因子：
2.7
通讯作者：
Lobo, Rogerio A.
中科院分区：
文献类型：
--
作者：
Dumesic, Daniel A.;Lobo, Rogerio A.
患有多囊卵巢综合症 (PCOS) 的女性患子宫内膜癌的风险增加 2.7 倍。恶性肿瘤风险增加的一个主要因素是子宫内膜长时间暴露于无排卵导致的无对抗雌激素。此外，一些接受排卵诱导或接受外源孕激素的多囊卵巢综合征女性的分泌性子宫内膜表现出孕酮抵抗，并伴有控制类固醇作用和细胞增殖的基因表达失调。子宫内膜监测包括经阴道超声和/或子宫内膜活检，以评估子宫内膜增厚、闭经时间延长、雌激素暴露或异常阴道出血。异常阴道出血或子宫内膜增生的医疗治疗包括雌激素-孕激素口服避孕药、周期性或连续孕激素或左炔诺孕酮缓释（曼月乐）宫内节育器。通过限制热量和运动来改变生活方式适合治疗肥胖作为发生子宫内膜疾病的伴随危险因素。一些患有多囊卵巢综合症的女性患卵巢癌的风险也可能增加。有强有力的数据表明，口服避孕药的使用可以预防卵巢癌，并且随着治疗时间的延长而增强。这种保护机制可能是通过抑制促性腺激素分泌而不是防止“持续排卵”。多囊卵巢综合症与乳腺癌没有明显的关联，尽管肥胖引起的代谢功能障碍的高患病率是这两种疾病的共同点。最近的数据表明，使用二甲双胍可能对子宫内膜癌和乳腺癌都有保护作用。没有足够的数据来评估多囊卵巢综合症与阴道癌、外阴癌、宫颈癌或子宫平滑肌肉瘤之间的关联。 (c) 2013 Elsevier Inc. 保留所有权利。
Women with polycystic ovary syndrome (PCOS) have a 2.7-fold increased risk for developing endometrial cancer. A major factor for this increased malignancy risk is prolonged exposure of the endometrium to unopposed estrogen that results from anovulation. Additionally, secretory endometrium of some women with PCOS undergoing ovulation induction or receiving exogenous progestin exhibits progesterone resistance accompanied by dysregulation of gene expression controlling steroid action and cell proliferation. Endometrial surveillance includes transvaginal ultrasound and/or endometrial biopsy to assess thickened endometrium, prolonged amenorrhea, unopposed estrogen exposure or abnormal vaginal bleeding. Medical management for abnormal vaginal bleeding or endometrial hyperplasia consists of estrogen-progestin oral contraceptives, cyclic or continuous progestins or a levonorgestrel-releasing (Mirena) intrauterine device. Lifestyle modification with caloric restriction and exercise is appropriate to treat obesity as a concomitant risk factor for developing endometrial disease. An increased risk of ovarian cancer may also exist in some women with PCOS. There are strong data to suggest that oral contraceptive use is protective against ovarian cancer and increases with the duration of therapy. The mechanism of this protection may be through suppression of gonadotropin secretion rather than the prevention of "incessant ovulation". There is no apparent association of PCOS with breast cancer, although the high prevalence of metabolic dysfunction from obesity is a common denominator for both conditions. Recent data suggest that the use of metformin may be protective for both endometrial and breast cancer. There are insufficient data to evaluate any association between PCOS and vaginal, vulvar and cervical cancer or uterine leiomyosarcoma. (c) 2013 Elsevier Inc. All rights reserved.