Hormonal suppressive therapy for endometriosis may not improve patient health.
OBJECTIVE
To critically examine the possible association between hormonal treatment of endometriosis and ovarian cancer.


RESULTS
The malignant potential of endometriosis has been suggested by several clinical studies. Although controversial, ovarian carcinoma of the endometrioid and clear cell subtypes has been associated with endometriosis, particularly among subjects with a longstanding disease. Furthermore, a significantly higher frequency of endometriosis has been found in patients undergoing surgery for endometrioid, clear cell, and mixed subtypes of ovarian carcinoma, as compared with the other subtypes. Changes in the genomic material in endometriotic implants were observed by many investigators in chromosomes 1, 5, 6, 7, 16, and 22 by several methods (fluorescent in situ hybridization, comparative genomic hybridization, and others). Because hormonal ablative treatments may suppress the normal, eukaryotic cells more than the aneuploid cells bearing chromosomal aberrations, it may increase the rate of dyskaryotic cells in the endometriotic implants, possibly augmenting the risk of malignant transformation. A recent published association between Danazol and ovarian cancer suggests that such a theoretical risk may occur.


CONCLUSIONS
The hormonal ablative treatment of endometriosis may increase the risk of malignant transformation in the endometriotic implants by causing a negative selection and increasing the rate of dyskaryosis and loss of heterozygosity.
Blumenfeld
Zeev
Z
Department of Obstetrics and Gynecology, Rambam Medical Center, and the B Rappaport Faculty of Medicine, Technion, Isreal Institute of Technology, Haifa, Israel. bzeev@techunix.technion.ac.il
D003613:Danazol / Q000009:adverse effects; D016889:Endometrial Neoplasms / Q000139:chemically induced*; D004715:Endometriosis / Q000188:drug therapy* / Q000235:genetics; D004965:Estrogen Antagonists / Q000009:adverse effects*; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000009:adverse effects / Q000031:analogs & derivatives*; D006262:Health; D006801:Humans; D019656:Loss of Heterozygosity; D010361:Patients; D011372:Progestins / Q000009:adverse effects
D004965:Estrogen Antagonists; D011372:Progestins; D007987:Gonadotropin-Releasing Hormone; C083781:LHRH, Ala(6)-Gly(10)-ethylamide-; D003613:Danazol