Objectives To avoid ‘missed’ cancers in women with endometrial hyperplasia, there is a need to quantify the potential for concurrent endometrial cancer and the future risk of progression to cancer. We systematically identify studies that evaluated concurrent and future risk of endometrial cancer in women diagnosed with endometrial hyperplasia.

Methods EMBASE, MEDLINE and Web of Science databases were searched for relevant articles. Random-effects meta-analyses were used to calculate pooled estimates and 95% confidence intervals (CIs) for the prevalence of concurrent cancer (within three months of endometrial hyperplasia diagnosis), or the incidence of cancer, identified at least three months after hyperplasia diagnosis.

Results A total of 36 articles were identified; 15 investigating concurrent and 21 progression to cancer. In pooled analysis of 11 studies of atypical hyperplasia, the pooled prevalence of concurrent endometrial cancer was 33.4% (95% CI: 26.1%, 42.8%) while no studies evaluated concurrent cancer prevalence in non-atypical hyperplasia. The risk of progression to cancer was high in atypical hyperplasia (n=5 studies, pooled annual incidence rate=8.2%, 95% CI 3.9%, 17.3%) and only one study reported on progression to cancer in non-atypical hyperplasia (annual incidence rate=2.6%, 95% CI: 0.6%, 10.6%), see figure 1.

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Abstract 348 Figure 1 Progression to Endometrial Cancer by Hyperplasia Type

^aPremenopausal women, ^bPostmenopausal women, ^cLNG-IUS(levonorgestrel intrauterine system) treated group, ^dOral progesterpme-treated group.

Conclusions Over a third of women with atypical hyperplasia had concurrent endometrial cancer, although the number of studies, especially population-based, is small. Progression to cancer in atypical hyperplasia was high, but few studies were identified. Population-based estimates are required, in both atypical and non-atypical hyperplasia patients, to better inform treatment strategies.