Perimenopausal management of ovarian endometriosis and associated cancer risk: When is medical or surgical treatment indicated?

P Vercellini, P Viganò, L Buggio, S Makieva, G Scarfone, FM Cribiù, F Parazzini, E Somigliana

Research output: Contribution to journalArticle

Abstract

In women with endometriosis, the lifetime risk of ovarian cancer is increased from 1.4% to about 1.9%. The risk of clear cell and endometrioid ovarian cancer is, respectively, tripled and doubled. Atypical endometriosis, observed in 1–3% of endometriomas excised in premenopausal women, is the intermediate precursor lesion linking typical endometriosis and clear cell/endometrioid tumors. Prolonged oral contraceptive use is associated with a major reduction in ovarian cancer risk among women with endometriosis. Surveillance ± progestogen treatment or surgery should be discussed in perimenopausal women with small, typical endometriomas. In most perimenopausal women with a history of endometriosis but without endometriomas, surveillance instead of risk-reducing bilateral salpingo-oophorectomy seems advisable. Risk-reducing salpingo-oophorectomy might benefit patients at particularly increased risk, but the evidence is inconclusive. Risk profiling models and decision aids may assist patients in their choice. Screening of the general perimenopausal population to detect asymptomatic endometriomas is unlikely to reduce disease-specific mortality. © 2018
Original languageEnglish
Pages (from-to)151-168
Number of pages18
JournalBest Practice and Research: Clinical Obstetrics and Gynaecology
Volume51
Issue number1
DOIs
Publication statusPublished - 2018

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Endometriosis
Neoplasms
Ovarian Neoplasms
Therapeutics
Ovariectomy
Decision Support Techniques
Progestins
Oral Contraceptives
Mortality

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Perimenopausal management of ovarian endometriosis and associated cancer risk: When is medical or surgical treatment indicated? / Vercellini, P; Viganò, P; Buggio, L; Makieva, S; Scarfone, G; Cribiù, FM; Parazzini, F; Somigliana, E.

In: Best Practice and Research: Clinical Obstetrics and Gynaecology, Vol. 51, No. 1, 2018, p. 151-168.

Research output: Contribution to journalArticle

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