1. Risk factors and Epidemiology of Endometrial and Ovarian Cancer By: Tammy, Merissa, and Heather For: Nursing 519 Unit 6

2. Endometrial cancer and ovarian cancer share many risk factors, however there are a few differences.

3. Endometrial Cancer - Epidemiology Endometrial cancer is the most common cancer of the pelvic region and accounts of 6% of all cancers in women (McCance & Huether, 2006). There is a higher incidence in white women, but higher mortality rates (nearly double) in black women (McCance & Huether, 2006).

4. Risk Factors for Endometrial Cancer Chronic exposure to estrogen, which can be caused by… Early menarche (beginning menstruation before age 12) Hormone replacement therapy (HRT) with exogenous estrogen (i.e., without progesterone) Late menopause (after age 52)

5. Risk factors for Endometrial Cancer Presence of an estrogen-secreting (tumour (e.g., some types of breast cancer) Nulliparity (having never given birth) or low parity (Swierzewski, 1999) Women with hereditary nonpolyposis colorectal cancer, caused by a genetic abnormality, have an increased risk of developing a variety of cancers, including endometrial cancer (Mayoclinic, 2008).

6. Risk factors for Endometrial Cancer Age (more common after age 50) Family history of uterine cancer Personal history of breast, colorectal, or ovarian cancer Prior pelvic radiation therapy Race (endometrial cancer is more common in Caucasian women and uterine sarcoma is more common in African American women) Obesity (Swierzewski, 1999).

7. Protection against Endometrial Cancer The birth control pill, controlling obesity, managing hypertension, and controlling diabetes have proven to have protective benefits against endometrial cancer (Copstead & Banasik, 2000; Mayoclinic.com, 2008; McCance & Huether, 2006).

8. Challenges in detecting Endometrial Cancer Endometrial cancer can be difficult to detect as it is largely asymptomatic, however vaginal bleeding is a common sign. This can be misleading as the majority of the population of women with endometrial cancer are in the menopausal age group and may consider this a normal sign to completing menarche.

9. Ovarian Cancer - Epidemiology Ovarian cancer accounts for 3% of all cancers in women and has the greatest mortality rate (66%) of all female reproductive cancers, likely due to being difficult to detect in the early stages of the disease (Copstead & Banasik, 2000; McCance & Huether, 2006). Ovarian cancer has a 5-10% familial inheritance, often associated with the breast cancer gene 1 or 2 (McCance & Huether, 2006).

10. Risk factors for Ovarian Cancer Family History (mother or sister with the disease, usually developed early) Age (over 55) Obesity Never pregnant Hormonal therapy (MedicineNet.com, 2009).

11. Risk Factors for Ovarian Cancer Early menarche Late menopause Use of fertility drugs (McCance & Huether, 2006)

12. Protection against Ovarian Cancer Factors providing protective benefits against ovarian cancer include multiple pregnancies, prolonged lactation, and use of birth control pills (Mayoclinic.com, 2008; McCance & Huether, 2006).

13. To Recap… Common risk factors for Endometrial and Ovarian Cancers… Early menarche Late menopause Familial (genetic) predisposition to cancer Obesity (McCance & Huether, 2006; Mayoclinic, 2008; MedicineNet.com, 2009; Swierzewski, 1999).

14. To Recap… Common protective factors against Endometrial and Ovarian Cancers… Oral contraceptive (birth control pill) use Controlling obesity Having babies! (McCance & Huether, 2006)

15. A question to ponder... As a NP, what test(s) would you order if you suspected a patient had endometrial cancer? Ovarian cancer? Thank you for your participation!

16. References: Copstead, L. C., & Banasik, J. (2000). Pathophysiology: Biological and behavioral perspectives. (2nd ed.). Philadelphia, PA: W.B. Saunders Company. Mayoclinic.com (2008). Endometrial cancer. Retrieved February 9, 2009 from http://www.mayoclinic.com/health/endometrial- cancer/DS00306/DSECTION=risk%2Dfactors http://www.mayoclinic.com/health/endometrial- cancer/DS00306/DSECTION=risk%2Dfactors Mayoclinic.com (2008). Ovarian cancer. Retrieved February 9, 2009 from http://www.mayoclinic.com/health/ovarian- cancer/DS00293/DSECTION=risk%2Dfactorshttp://www.mayoclinic.com/health/ovarian- cancer/DS00293/DSECTION=risk%2Dfactors

17. References: McCance, K., & Huether, S. (2006). Pathophysiology: The biologic basis for disease in adults and children. (5th ed.). St. Louis, MI: Elsevier Mosby. MedicineNet.com. (2009). Ovarian Cancer. Retrieved February 9, 2009 from: http://www.medicinenet.com/ovarian_cancer/pag e2.htm http://www.medicinenet.com/ovarian_cancer/pag e2.htm Swierzewski, S. (1999). Endometrial Cancer: Causes and risk factors, signs and symptoms. Retrieved February 9, 2009 from: http://www.oncologychannel.com/endometrialca ncer/riskfactors.shtml http://www.oncologychannel.com/endometrialca ncer/riskfactors.shtml