Volume 20, Issue 11 (November 2022)                   IJRM 2022, 20(11): 893-914 | Back to browse issues page


XML Persian Abstract Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Amiri M, Bidhendi-Yarandi R, Fallahzadeh A, Marzban Z, Ramezani Tehrani F. Risk of endometrial, ovarian, and breast cancers in women with polycystic ovary syndrome: A systematic review and meta-analysis. IJRM 2022; 20 (11) :893-914
URL: http://ijrm.ir/article-1-2220-en.html
1- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
3- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. School of Medicine, Tehran University of Medical Science, Tehran, Iran.
4- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. , fah.tehrani@gmail.com
Abstract:   (1133 Views)
Background: Although several studies have evaluated the risk of gynecological cancers in women with polycystic ovary syndrome (PCOS), there are controversies regarding it.
Objective: This study aimed to investigate the association of PCOS with endometrial, ovarian, and breast cancers.
Materials and Methods: PubMed, Scopus, Web of Science, and Google Scholar databases based on MESH terms using the combination of the appropriate keywords were searched to retrieve observational studies on endometrial, ovarian, and breast cancers in PCOS women, published from inception to April 2020. This meta-analysis was performed to determine the pooled odds ratio (OR) of these cancers in women with PCOS. Publication bias was assessed by using Begg’s test.
Results: Of 1347 records retrieved by searching the databases, a total of 14 articles were included in the study. Overall, the pooled OR of the composite outcome, including endometrial, ovarian, and breast cancers in women with PCOS was higher than that of women with no PCOS (pooled OR: 1.4, 95% CI: 1.0-1.9). The pooled OR of endometrial (pooled OR: 2.2, 95% CI: 1.03-4.7) and ovarian (pooled OR: 1.3, 95% CI: 1.0-1.8) cancers in women with PCOS was higher than the control group, whereas the pooled OR of breast cancer was not significantly higher than that of the control group.
Conclusion: This meta-analysis indicated an increased risk of endometrial and ovarian cancers in women with PCOS.
Full-Text [PDF 1715 kb]   (689 Downloads) |   |   Full-Text (HTML)  (115 Views)  
Type of Study: Original Article | Subject: Reproductive Endocrinology

References
1. 1. March WA, Moore VM, Willson KJ, Phillips DIW, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod 2010; 25: 544-551.
2. 2. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. Positions statement: Criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: An androgen excess society guideline. J Clin Endocrinol Metab 2006; 91: 4237-4245.
3. 3. Ramezani Tehrani F, Amiri M, Behboudi-Gandevani S, Bidhendi-Yarandi R, Carmina E. Cardiovascular events among reproductive and menopausal age women with polycystic ovary syndrome: A systematic review and meta-analysis. Gynecol Endocrinol 2020; 36: 12-23.
4. 4. Burghen GA, Givens JR, Kitabchi AE. Correlation of hyperandrogenism with hyperinsulinism in polycystic ovarian disease. J Clin Endocrinol Metab 1980; 50: 113-116.
5. 5. Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes 1989; 38: 1165-1174.
6. 6. Daniilidis A, Dinas K. Long term health consequences of polycystic ovarian syndrome: A review analysis. Hippokratia 2009; 13: 90-92.
7. 7. Cheung LP, Ma RC, Lam PM, Lok IH, Haines CJ, So WY, et al. Cardiovascular risks and metabolic syndrome in Hong Kong Chinese women with polycystic ovary syndrome. Hum Reprod 2008; 23: 1431-1438.
8. 8. Balen A. Polycystic ovary syndrome and cancer. Hum Reprod Update 2001; 7: 522-525.
9. 9. Carmina E, Lobo RA. Polycystic ovary syndrome (PCOS): Arguably the most common endocrinopathy is associated with significant morbidity in women. J Clin Endocrinol Metab 1999; 84: 1897-1899.
10. 10. Gibson M. Reproductive health and polycystic ovary syndrome. Am J Med 1995; 98: 67-75.
11. 11. Ding D-Ch, Chen W, Wang J-H, Lin Sh-Z. Association between polycystic ovarian syndrome and endometrial, ovarian, and breast cancer: A population-based cohort study in Taiwan. Medicine 2018; 97: e12608.
12. 12. Risch HA. Hormonal etiology of epithelial ovarian cancer, with a hypothesis concerning the role of androgens and progesterone. J Natl Cancer Inst 1998; 90: 1774-1786.
13. 13. Schildkraut JM, Schwingl PJ, Bastos E, Evanoff A, Hughes C. Epithelial ovarian cancer risk among women with polycystic ovary syndrome. Obstet Gynecol 1996; 88: 554-559.
14. 14. Chittenden BG, Fullerton G, Maheshwari A, Bhattacharya S. Polycystic ovary syndrome and the risk of gynaecological cancer: A systematic review. Reprod Biomed Online 2009; 19: 398-405.
15. 15. Shen Ch-Ch, Yang AC, Hung J-H, Hu L-Y, Tsai Sh-J. A nationwide population-based retrospective cohort study of the risk of uterine, ovarian and breast cancer in women with polycystic ovary syndrome. Oncologist 2015; 20: 45-49.
16. 16. Kim J, Mersereau JE, Khankari N, Bradshaw PT, McCullough LE, Cleveland R, et al. Polycystic ovarian syndrome (PCOS), related symptoms/sequelae, and breast cancer risk in a population-based case-control study. Cancer Causes Control 2016; 27: 403-414.
17. 17. Anderson KE, Sellers TA, Chen PL, Rich SS, Hong CP, Folsom AR. Association of Stein-Leventhal syndrome with the incidence of postmenopausal breast carcinoma in a large prospective study of women in Iowa. Cancer 1997; 79: 494-499.
18. 18. Harris HR, Terry KL. Polycystic ovary syndrome and risk of endometrial, ovarian, and breast cancer: A systematic review. Fertil Res Pract 2016; 2: 14.
19. 19. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Int J Surg 2010; 8: 336-341.
20. 20. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25: 603-605.
21. 21. Higgins JPT, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928.
22. 22. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50: 1088-1101.
23. 23. Duval S, Tweedie R. Trim and fill: A simple funnel‐plot-based method of testing and adjusting for publication bias in meta‐analysis. Biometrics 2000; 56: 455-463.
24. 24. Mavridis D, Salanti G. How to assess publication bias: Funnel plot, trim-and-fill method and selection models. Evid Based Ment Health 2014; 17: 30.
25. 25. Nyaga VN, Arbyn M, Aerts M. Metaprop: A Stata command to perform meta-analysis of binomial data. Arch Public Health 2014; 72: 39.
26. 26. Wild S, Pierpoint T, Jacobs H, McKeigue P. Long-term consequences of polycystic ovary syndrome: Results of a 31 year follow-up study. Hum Fertil 2000; 3: 101-105.
27. 27. Harris HR, Titus LJ, Cramer DW, Terry KL. Long and irregular menstrual cycles, polycystic ovary syndrome, and ovarian cancer risk in a population-based case-control study. Int J Cancer 2017; 140: 285-291.
28. 28. Fearnley EJ, Marquart L, Spurdle AB, Weinstein P, Webb PM, Australian ovarian cancer study group and australian national endometrial cancer study group. Polycystic ovary syndrome increases the risk of endometrial cancer in women aged less than 50 years: An Australian case-control study. Cancer Causes Control 2010; 21: 2303-2308.
29. 29. Ghasemi N, Mortazavizadeh MR, Khorasani Gerdekoohi A. Frequency of poly cystic ovary syndrome in patients with premenopausal breast cancer. Iran J Reprod Med 2010; 8: 86-90.
30. 30. Olsen CM, Green AC, Nagle CM, Jordan SJ, Whiteman DC, Bain CJ, et al. Epithelial ovarian cancer: Testing the 'androgens hypothesis'. Endocr Relat Cancer 2008; 15: 1061-1068.
31. 31. Escobedo LG, Lee NC, Peterson HB, Wingo PA. Infertility-associated endometrial cancer risk may be limited to specific subgroups of infertile women. Obstet Gynecol 1991; 77: 124-128.
32. 32. Talamini R, Franceschi S, Favero A, Negri E, Parazzini F, La Vecchia C. Selected medical conditions and risk of breast cancer. Br J Cancer 1997; 75: 1699-1703.
33. 33. Bodmer M, Becker C, Meier C, Jick SS, Meier CR. Use of metformin and the risk of ovarian cancer: A case-control analysis. Gynecol Oncol 2011; 123: 200-204.
34. 34. Zucchetto A, Serraino D, Polesel J, Negri E, De Paoli A, Dal Maso L, et al. Hormone-related factors and gynecological conditions in relation to endometrial cancer risk. Eur J Cancer Prev 2009; 18: 316-321.
35. 35. Lopes IMRS, Baracat MCP, Simoes Mde J, Simoes RS, Baracat EC, Soares Jr JM. Endometrium in women with polycystic ovary syndrome during the window of implantation. Rev Assoc Med Bras 2011; 57: 702-709.
36. 36. Schindler AE. Progestogen deficiency and endometrial cancer risk. Maturitas 2009; 62: 334-337.
37. 37. Savaris RF, Groll JM, Young SL, DeMayo FJ, Jeong JW, Hamilton AE, et al. Progesterone resistance in PCOS endometrium: A microarray analysis in clomiphene citrate-treated and artificial menstrual cycles. J Clin Endocrinol Metab 2011; 96: 1737-1746.
38. 38. Nagmani M, Hannigan EV, Dillard JR EA, Dinh TV. Ovarian steroid secretion in postmenopausal women with and without endometrial cancer. J Clin Endocrinol Metab 1986; 62: 508-512.
39. 39. Apparao KBC, Lovely LP, Gui Y, Lininger RA, Lessey BA. Elevated endometrial androgen receptor expression in women with polycystic ovarian syndrome. Biol Reprod 2002; 66: 297-304.
40. 40. Goodarzi MO, Dumesic DA, Chazenbalk G, Azziz R. Polycystic ovary syndrome: Etiology, pathogenesis and diagnosis. Nat Rev Endocrinol 2011; 7: 219-231.
41. 41. Konishi I, Koshiyama M, Mandai M, Kuroda H, Yamamoto S, Nanbu K, et al. Increased expression of LH/hCG receptors in endometrial hyperplasia and carcinoma in anovulatory women. Gynecol Oncol 1997; 65: 273-280.
42. 42. Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: A systematic review and meta-analysis. Hum Reprod Update 2010; 16: 347-363.
43. 43. Saed L, Varse F, Baradaran HR, Moradi Y, Khateri S, Friberg E, et al. The effect of diabetes on the risk of endometrial cancer: An updated a systematic review and meta-analysis. BMC Cancer 2019; 19: 527.
44. 44. Haoula Z, Salman M, Atiomo W. Evaluating the association between endometrial cancer and polycystic ovary syndrome. Hum Reprod 2012; 27: 1327-1331.
45. 45. Barry JA, Azizia MM, Hardiman PJ. Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: A systematic review and meta-analysis. Hum Reprod Update 2014; 20: 748-758.
46. 46. Helzlsouer KJ, Alberg AJ, Gordon GB, Longcope C, Bush TL, Hoffman SC, et al. Serum gonadotropins and steroid hormones and the development of ovarian cancer. JAMA 1995; 274: 1926-1930.
47. 47. Schock H, Surcel H-M, Zeleniuch-Jacquotte A, Grankvist K, Lakso H-A, Fortner RT, et al. Early pregnancy sex steroids and maternal risk of epithelial ovarian cancer. Endocr Relat Cancer 2014; 21: 831-844.
48. 48. Butler M, Ricciardelli C, Tilley W, Hickey T. Androgen receptor protein levels are significantly reduced in serous ovarian carcinomas compared with benign or borderline disease but are not altered by cancer stage or metastatic progression. Horm Cancer 2013; 4: 154-164.
49. 49. Lee J-Y, Jeon I, Kim JW, Song Y-S, Yoon JM, Park SM. Diabetes mellitus and ovarian cancer risk: A systematic review and meta-analysis of observational studies. Int J Gynecol Cancer 2013; 23: 402-412.
50. 50. Terry KL, Willett WC, Rich-Edwards JW, Michels KB. A prospective study of infertility due to ovulatory disorders, ovulation induction, and incidence of breast cancer. Arch Intern Med 2006; 166: 2484-2489.
51. 51. Picon-Ruiz M, Morata-Tarifa C, Valle-Goffin JJ, Friedman ER, Slingerland JM. Obesity and adverse breast cancer risk and outcome: Mechanistic insights and strategies for intervention. CA Cancer J Clin 2017; 67: 378-397.
52. 52. Meyer JS. Cell proliferation in normal human breast ducts, fibroadenomas, and other ductal hyperplasias measured by nuclear labeling with tritiated thymidine. Effects of menstrual phase, age, and oral contraceptive hormones. Hum Pathol 1977; 8: 67-81.
53. 53. Gunter MJ, Hoover DR, Yu H, Wassertheil-Smoller S, Rohan TE, Manson JE, et al. Insulin, insulin-like growth factor-I, and risk of breast cancer in postmenopausal women. J Natl Cancer Inst 2009; 101: 48-60.
54. 54. Secreto G, Girombelli A, Krogh V. Androgen excess in breast cancer development: Implications for prevention and treatment. Endocr Relat Cancer 2019; 26: R81-R94.
55. 55. Carvalho MJ, Subtil S, Rodrigues A, Oliveira J, Figueiredo-Dias M. Controversial association between polycystic ovary syndrome and breast cancer. Eur J Obstet Gynecol Reprod Biol 2019; 243: 125-132.
56. 56. Sun Y-Sh, Zhao Zh, Yang Zh-N, Xu F, Lu H-J, Zhu Zh-Y, et al. Risk factors and preventions of breast cancer. Int J Biol Sci 2017; 13: 1387-1397.
57. 57. Shobeiri F, Jenabi E. The association between polycystic ovary syndrome and breast cancer: A meta-analysis. Obstet Gynecol Sci 2016; 59: 367-372.
58. 58. Gammon MD, Thompson WD. Polycystic ovaries and the risk of breast cancer. Am J Epidemiol 1991; 134: 818-824.
59. 59. Pillay OC, Te Fong LFW, Crow JC, Benjamin E, Mould T, Atiomo W, et al. The association between polycystic ovaries and endometrial cancer. Hum Reprod 2005; 21: 924-929.
60. 60. Baron JA, Weiderpass E, Newcomb PA, Stampfer M, Titus-Ernstoff L, Egan KM, et al. Metabolic disorders and breast cancer risk (United States). Cancer Causes Control 2001; 12: 875-880.
61. 61. Liu T, Nie X, Wu Z, Zhang Y, Feng G, Cai S, et al. Can statistic adjustment of OR minimize the potential confounding bias for meta-analysis of case-control study? A secondary data analysis. BMC Med Res Method 2017; 17: 179.

Send email to the article author


Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Designed & Developed by : Yektaweb