The John I. Brewer Memorial Lecture at 9:25 am today will consider whether hormone treatment or surgery should be considered for women with atypical endometrial hyperplasia.
David E. Cohn, MD, professor in the Department of Obstetrics and Gynecology and director of the Division of Gynecologic Oncology at The Ohio State University College of Medicine, will argue that surgery should be the standard of care for reasonable surgical candidates not interested in fertility.
He said that while hormones are successful in most — but not all — cases, therapy must be continued indefinitely to eliminate the development of future endometrial cancer.
“We know that women who have hyperplasia at the time of hysterectomy are found to have cancer in 40 percent of cases, and most people would argue that cancer should be treated with hysterectomy and not with hormones,” he said.
Amanda Nickles Fader, MD, associate professor and director of the Kelly Gynecologic Oncology Service and Johns Hopkins University in Baltimore, said that most women would not develop concurrent endometrial cancer, and 60 to 90 percent of hyperplasia and low-grade endometrial cancers respond to progestin therapy.
“Complex atypical hyperplasia is largely a public health problem related to excess weight and endogenous estrogen production,” Dr. Fader said. “Forty percent of women who develop this are younger than 45, and fertility is important to many of them. It’s time we explore more lifestyle modifications and medical options and move beyond hysterectomy as the only standard.”