title: Endometrial thickness and risk of breast and endometrial carcinomas in the prostate, lung, colorectal and ovarian cancer screening trial.
abstract: Postmenopausal women with higher circulating estrogen levels are at increased risk of developing breast and endometrial carcinomas. In the endometrium, excess estrogen relative to progesterone produces a net proliferative stimulus, which may result in endometrial thickening. Therefore, the hypothesis that endometrial thickness is a biological marker of excess estrogen stimulation that is associated with risk of breast and endometrial carcinomas was tested. Endometrial thickness was measured in 1,272 postmenopausal women, aged 55-74 years, who underwent transvaginal ultrasound (TVU) screening as part of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Serial endometrial thickness measurements were available for a subset of women at 1 year (n = 1,018), 2 years (n = 869) and 3 years (n = 641) after baseline. The associations between endometrial thickness and breast (n = 91) and endometrial (n = 14) carcinoma were evaluated by estimating relative risks (RRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression with age as the time metric. Models incorporating baseline endometrial thickness and as a time-varying covariate using all measurements were examined. Median follow-up among study participants was 12.5 years (range: 0.3-13.8 years). Compared to baseline endometrial thickness of 1.0-2.99 mm, women with baseline endometrial thickness greater than or equal to 5.0 mm had an increased risk of breast (RR = 2.00, 95% CI = 1.15-3.48) and endometrial (RR = 5.02, 95% CI = 0.96-26.36) carcinomas in models adjusted for menopausal hormone use and BMI. These data suggest that increased endometrial thickness as assessed by TVU was associated with increased risk of breast and endometrial carcinomas.
authors.affiliation: Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD; Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD.
authors.forename: Ashley S
authors.initials: AS
authors.lastname: Felix
authors.forename: Joel L
authors.initials: JL
authors.lastname: Weissfeld
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Pfeiffer
authors.forename: Francesmary
authors.initials: F
authors.lastname: Modugno
authors.forename: Amanda
authors.initials: A
authors.lastname: Black
authors.forename: Lyndon M
authors.initials: LM
authors.lastname: Hill
authors.forename: Jerry
authors.initials: J
authors.lastname: Martin
authors.forename: Anita S
authors.initials: AS
authors.lastname: Sit
authors.forename: Mark E
authors.initials: ME
authors.lastname: Sherman
authors.forename: Louise A
authors.initials: LA
authors.lastname: Brinton
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000209:etiology* / Q000473:pathology; D002986:Clinical Trials as Topic; D016889:Endometrial Neoplasms / Q000209:etiology* / Q000473:pathology; D004717:Endometrium / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate
keywords: cancer risk; endometrial thickness; etiology; screening; transvaginal ultrasound
references.citation: Endocr Rev. 1990 May;11(2):266-301
references.pmid: 2114281
references.citation: Lancet Oncol. 2009 Apr;10(4):327-40
references.pmid: 19282241
references.citation: JAMA. 1998 Nov 4;280(17):1510-7
references.pmid: 9809732
references.citation: Ultrasound Obstet Gynecol. 2012 Dec;40(6):621-9
references.pmid: 23001905
references.citation: Br J Cancer. 2011 Aug 23;105(5):709-22
references.pmid: 21772329
references.citation: Acta Obstet Gynecol Scand. 1996 Feb;75(2):181-2
references.pmid: 8604609
references.citation: Eur J Obstet Gynecol Reprod Biol. 2006 Aug;127(2):218-21
references.pmid: 16517043
references.citation: Control Clin Trials. 2000 Dec;21(6 Suppl):273S-309S
references.pmid: 11189684
references.citation: Obstet Gynecol. 1993 Dec;82(6):936-40
references.pmid: 8233268
references.citation: J Ultrasound Med. 2001 Oct;20(10):1025-36
references.pmid: 11587008
references.citation: JAMA. 2011 Jun 8;305(22):2295-303
references.pmid: 21642681
references.citation: Maturitas. 2004 Jul 15;48(3):219-23
references.pmid: 15207887
references.citation: Adv Exp Med Biol. 2008;630:148-65
references.pmid: 18637490
references.citation: J Clin Endocrinol Metab. 2011 Feb;96(2):E330-9
references.pmid: 21147881
references.citation: Lancet Oncol. 2011 Jan;12(1):38-48
references.pmid: 21147030
references.citation: Acta Obstet Gynecol Scand. 1998 Oct;77(9):905-8
references.pmid: 9808378
references.citation: Cancer Epidemiol Biomarkers Prev. 2004 Sep;13(9):1459-65
references.pmid: 15342446
references.citation: J Obstet Gynaecol Can. 2010 Oct;32(10):990-9
references.pmid: 21176311