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Meta-Analysis
. 2014 Sep-Oct;20(5):748-58.
doi: 10.1093/humupd/dmu012. Epub 2014 Mar 30.

Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis

John A Barry  1 , Mallika M Azizia  1 , Paul J Hardiman  2
Affiliations
Meta-Analysis

Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis

John A Barry et al. Hum Reprod Update. 2014 Sep-Oct.

Abstract

Background: Polycystic ovary syndrome (PCOS) is a common condition affecting ∼8% of women. The objective of the present study was to quantify separately the risk of endometrial cancer, ovarian cancer and breast cancer in women with PCOS compared with non-PCOS controls, and quantify separately the risk to women of all ages as well as the risk to premenopausal women.

Methods: We conducted a systematic review and meta-analysis of observational studies. Studies were eligible for inclusion if they compared women with PCOS to non-PCOS groups for fatal or non-fatal gynaecological cancers. Studies listed in MEDLINE and EMBASE published up to 7 October 2013 in any language were identified, and relevant papers were also searched by hand. Relevant data (for example, study design, source of control data, diagnostic criteria) were extracted and tabulated.

Results: From 698 references, 11 studies (5 of endometrial cancer and 3 each of ovarian and breast cancer) met the inclusion criteria for the meta-analysis (919 women with PCOS and 72054 non-PCOS controls). Using the Mantel-Haenszel method, with fixed or random effects model as appropriate, women with PCOS were at a significantly increased risk of endometrial cancer (odds ratio (OR), 2.79; 95% confidence interval (CI), 1.31-5.95, P < 0.008), but the risk of ovarian and breast cancers was not significantly increased (OR, 1.41; 95% CI, 0.93-2.15, P < 0.11 and OR, 0.95; 95% CI, 0.64-1.39, P < 0.78, respectively). However when studies which included women aged over 54 years were excluded from the analysis, the risk for women with PCOS increased further for endometrial cancer (OR, 4.05; 95% CI, 2.42-6.76, P < 0.00001), became significantly increased for ovarian cancer (OR, 2.52; 95% CI, 1.08-5.89, P < 0.03), but remained non-significant for breast cancer (OR, 0.78; 95% CI, 0.46-1.32, P < 0.35).

Conclusions: This is the first meta-analysis to examine gynaecological cancers in women with PCOS younger than 54 years of age compared with controls of similar age. Current data suggest that women of all ages with PCOS are at an increased risk of endometrial cancer but the risk of ovarian and breast cancer was not significantly increased overall. These results highlight the potential risk of gynaecological cancer morbidities associated with PCOS. However, the available evidence is far from robust and variation in diagnostic criteria for PCOS, associated risk factors (particularly obesity), and selection bias in the studies may have resulted in an exaggeration of the increased risk. Furthermore, women who have PCOS should also be made aware that any increased risk for endometrial cancer must be judged in the context of its relatively low incidence in the general population. A large well-controlled prospective study is required in order to gain a more accurate estimate of the risk of gynaecological cancers in women with PCOS.

Prospero crd registration number: CRD42012003500.

Keywords: breast; endometrium; menopause; ovarian cancer; polycystic ovary syndrome.

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Figures

Figure 1
Figure 1
Flow diagram of the literature search for studies of fatal and non-fatal endometrial, ovarian, and breast cancer.
Figure 2
Figure 2
(a and b) Upper forest plot: endometrial cancer in women with polycystic ovary syndrome (PCOS) compared with controls. Lower forest plot: endometrial cancer in PCOS compared with controls in women under 54 years old.
Figure 3
Figure 3
(a and b) Upper forest plot: ovarian cancer in women with PCOS compared with controls. Lower forest plot: ovarian cancer in PCOS compared with controls in women under 54 years old.
Figure 4
Figure 4
(a and b) Upper forest plot: breast cancer in women with PCOS compared with controls. Lower forest plot: breast cancer in PCOS compared with controls in women under 54 years old.
Figure 5
Figure 5
Funnel plot of studies of endometrial cancer in women with PCOS compared with controls.
Figure 6
Figure 6
Funnel plot of studies of ovarian cancer in women with PCOS compared with controls.
Figure 7
Figure 7
Funnel plot of studies of breast cancer in women with PCOS compared with controls.
See this image and copyright information in PMC

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