 Polycystic ovary syndrome and endometrial carcinoma
Polycystic ovary syndrome and endometrial carcinoma
Paul Hardiman; Ouama S Pillay; William Atiomo
196 words
24 May 2003
The Lancet
Volume 361, Issue 9371; ISSN: 0140-6736
English
Copyright (c) 2003 ProQuest Information and Learning. All rights reserved. Copyright Lancet Ltd. May 24, 2003
Diabetes mellitus is well recognised as a risk factor for endometrial cancer. In part this association may relate to obesity but there is evidence for a specific effect of hyperinsulinaemia. Nagamani et al19 found insulin binding sites in the endometrial stroma of premenopausal women and women with endometrial cancer, and Bershtein et al20 found increased concentrations of plasma insulin in patients with endometrial cancer.
Because insulin upregulates aromatase activity in endometrial glands and stroma, endogenous oestrogen production is enhanced in women with high circulating insulin.21 As expected, therefore, insulin (and insulin-like growth factor-1), concentrations of which are raised in PCOS, accelerate the growth of endometrial cancer cells in vitro.22 By contrast, the argument linking hyperinsulinaemia with endometrial cancer is not supported by a study which shows that the risk of endometrial cancer is greater with type 1 diabetes than with type 2 diabetes.23 On the basis of the available evidence, it is reasonable to conclude that the interaction between endocrine and metabolic factors and endometrial neoplasia in women with PCOS is more complex than originally believed.
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