Can PCOS Lead to Cancer? | Chennai PCOS Clinic

Polycystic ovarian syndrome (PCOS), as a common endocrine disease, has a high prevalence in the female population. Hyperandrogenism, menstrual irregularity, and a polycystic morphology of the ovary are the symptoms of PCOS in women. The manifestation of insulin resistance, insulin secretory defects, menstrual dysfunction, and androgen excess are the high risks in women with PCOS. The irregular metabolic and hormonal status of women with PCOS could source an increased risk of some cancer types.

Can PCOS Lead to Cancer

PCOS and reproductive system cancers

Women with PCOS are at increased risk of cancer affecting the reproductive organs. Unopposed long-term hormonal exposure could possibly be the proximate risk factor. Hormonal abnormalities or menstrual cycle irregularity could be an explanation for the association observed in cases of cancer in women with PCOS. Obesity, hypertension and diabetes being the correlates of PCOS, can confound cancer risk in these women. Several carcinogenic processes are associated with PCOS, including dyslipidemia, hyperinsulinemia, and chronic inflammation. Conversely, evidence also suggests that women who ovulate less frequently, which would be expected among women with long/irregular cycles but not a case of PCOS might have protection against ovarian cancer.

PCOS association with endometrial cancer

Endometrial cancer is the form of uterine cancer that is most commonly diagnosed in women with PCOS. The risk of cancer of the endometrium which is the inside lining of the uterus may be higher for women with PCOS than it is for women without PCOS. Irregular periods or the absence of periods can cause the endometrium to build up and become thick. This occurs when cells making up the internal lining of the uterus grow out of control. This thickening can lead to endometrial cancer. The characteristic feature of prolonged anovulation in PCOS is considered to be the main mechanism responsible for the continual unopposed secretion of oestrogens and consequent increased risk of endometrial carcinoma. Associated factors which increase the risk of developing endometrial cancer are obesity, chronic use of unopposed oestrogens, nulliparity, infertility, hypertension, and diabetes.

Incidence of endometrial cancer in PCOS

Endometrial hyperplasia as seen in PCOS may act as a precursor to adenocarcinoma. It is estimated that 18% of cases of endometrial adenomatous hyperplasia will progress to cancer in the next 2 to 10 years. Intervals between menstruation of more than three months may be associated with endometrial hyperplasia leading to carcinoma in women with PCOS. It is understood that high levels of oestrogen, lower progesterone, and no regular periods in women living with PCOS ultimately cause this type of cancer.

A big study involving 1270 women with chronic anovulation is proof that the excess risk of endometrial cancer was identified to be 3.1% in PCOS. However, the true risk of endometrial carcinoma in women diagnosed with PCOS was not clearly defined in the study and hence, the association between PCOS and endometrial cancer was inconclusive.

Untreated PCOS can lead to endometrial cancer

Prevention of PCOS is not possible but knowing the risk for endometrial cancer in PCOS and following measures to minimize that risk and protect against cancer is important.  If PCOS is left untreated, hormone levels will remain abnormal and affect the body with increased cancer risk. To seek PCOS treatment early and regulate hormone levels would be the ideal step against endometrial cancer in women with PCOS.

Ovarian cancer in PCOS – conflicting

Few studies have addressed the possibility of an association between polycystic ovaries and ovarian cancer but with conflicting evidence. Studies have suggested that there is a connection between PCOS and increased risk of ovarian cancer. The risk happens to be more in nulliparous women with early menarche and late menopause. Some studies argued that inducing multiple ovulations in women with infertility in PCOS will increase the risk of ovarian cancer. Whereas, other studies suggest that infertility on its own increases the risk of borderline and invasive ovarian tumors. More recent evidence on the association between PCOS and ovarian malignancy is still conflicting but generally reassuring in favor of treatment towards symptoms of PCOS.

Breast cancer in PCOS – family history

Obesity, hyperandrogenism, and infertility are the known key features commonly associated with the development of breast cancer. But there is no significant increase in the risk of developing breast cancer in women with PCOS. However, a positive correlation between PCOS and the presence of a family history of breast cancer suggests the targeted high-risk group. Journal research indicates that higher levels of androgens and insulin may increase the risk of breast cancer in women with a family history of breast cancer. In a study of a total of 217 women, the proportion of women with a positive family history of breast cancer was significantly higher in women with PCOS compared to women without PCOS. As an association between PCOS and breast cancer is plausible, it is pertinent to be cautious about breast disease in the follow up care of all women with PCOS.

PCOS related cancer risk higher in pre-menopause

The results of a meta-analysis suggest that women with PCOS of all ages are at an increased risk of endometrial cancer, but the risk of ovarian and breast cancer was not significantly increased overall. The analysis confirmed suggestions that the risk of endometrial cancer in the women subgroup aged less than 54 years may be even higher in women with PCOS.

The risks for other specific cancers including endocrine, pancreatic, kidney, skeletal and hematopoietic cancers may also be increased in women with PCOS as compared to other women. Women who have PCOS should be made aware that the increased risk reported for cancers must be judged in the context of the relatively low incidence in the general population. Since cancer risk can be minimized with appropriate treatment for PCOS, it should not cause women to be overly concerned about their individual risk. Even though it is established that the risk for endometrial cancer is higher in PCOS, the lifetime risk of developing endometrial cancer is less. On the other hand, though most irregular menstrual cycles may not be a cause for cancer, it is important that a woman with abnormal menstrual health must reach out to a gynecologist.

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