Early Surgery for Endometrial Cancer Increases Risk of Death

Women with uterine cancer who underwent surgery within the first two weeks after diagnosis suffered a significantly increased risk of death within five years, according to a new study.

Researchers at the University of Pennsylvania (Penn; Philadelphia, USA) queried the U.S. National Cancer Database between 2003 and 2012 for incident endometrial cancers to determine the impact of time from diagnosis to surgical treatment on mortality, and to characterize women who may be at highest risk; cancers were classified as low or high risk, and were analyzed separately. Demographic, clinic-pathologic, and health system factors were also collected, and hazard ratios for mortality were calculated by interval between diagnosis and surgery.

The results showed that nearly two-thirds of the cases (140,078) were considered low-risk cancers. Of these, patients who had surgery in the first or second week after diagnosis had a 14% increased risk of death within five years, compared to patients who had surgery in weeks three or four. For women with high-risk cancers (68,360), that risk rose to 20%. The authors suggest that the likely cause for the increased risk is rooted in the delivery of care, rather than the cancer itself. In both risk groups, patients undergoing early surgery were more likely to die within 30 days of their operation.

The patients likelier to undergo earlier surgery were more likely to be black, have advanced stage disease, have no insurance or be on Medicaid, and receive care at low-volume hospitals. The researchers therefore suggest that the target interval between diagnosis and treatment of endometrial cancers be less than eight weeks, but that adequate preoperative optimization should be prioritized over expedited surgery. The study was published on December 8, 2016, in the American Journal of Obstetrics and Gynecology.

“We suspect that physicians diagnosing endometrial cancer may believe, not unreasonably, that the best thing they can do for those patients is to operate as soon as possible, because if they wait too long the cancer could progress, resulting in a worse outcome,” said senior author David Shalowitz, MD, of the Penn division of gynecologic oncology. “But the results of our study suggest that pre-surgical care and referring patients to a gynecologic oncologist may be more important.”

“Knowledge is power,” concluded Dr. Shalowitz. “The primary goal is to make sure that there is a mechanism in place so that women who have a cancer diagnosis can see a specialist in the appropriate time period, that they are able to physically get to a high-volume treatment center, and that the process of referral and medical optimization for surgery can be done expediently.”

Endometrial cancer begins in endometrium, a layer of cells that form the lining of the uterus. It is often detected at an early stage since it frequently produces abnormal vaginal bleeding which prompts women to see their doctors. Risk factors include hormonal imbalance; irregular ovulation patterns; early menstruation; never having been pregnant; old age; obesity; tamoxifen hormone therapy for breast cancer; and hereditary nonpolyposis colorectal cancer (HNPCC), a syndrome that increases the risk of colon cancer and other cancers, including endometrial cancer.

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