by Philippe Koninckx | Feb 22, 2010 | 1 Endometriose
Endometriose en kanker Zoals net gepubliceerd in 2010 World Endometriosis Society World Endometriosis Society e-Journal Volume 12 No 1, 2010 8 Dear Editor, The association between ovarian cancer and endometriosis has become highlighted over the last years and the last eJournal adequately details the available data. The interpretation of the data with RR ratios and confidence intervals, however, unfortunately leaves a feeling of ‘How to lie with statistics’. We know the limitations of cohort studies and of associations. Since our interpretation of data as emerging from the published articles seems at least insufficiently prudent, biased and incomplete – if not incorrect – and potentially harmful, inducing fear in women with endometriosis, some discussion seems appropriate. Biochemical similarities Often biochemical similarities between endometriosis and cancer are described (Prowse et al, 2006; Mandai et al, 2009). The pathophysiology of endometriosis clearly is not well understood. Considering typical, cystic, and deep endometriosis as a benign tumour caused by a genomic incident (Koninckx et al, 1997) (and subtle lesions as a physiologic condition occurring intermittently in all women) remains the easiest way to explain hereditary influences and effects of dioxins and total body radiation. It, moreover, could explain the many described differences in the endometrium of women with and without endometriosis: the slight differences could point to some genetic disturbances making them more susceptible to develop endometriosis. The Sampson hypothesis seems attractive since viable endometrial cells, with implantation capacity are found in the peritoneal fluid of most women. To the best of our knowledge, however, a progression from subtle to typical to cystic or deep lesions has never been observed nor demonstrated. The...
by Philippe Koninckx | Nov 23, 2009 | 1 Endometriose
A lady asked : I have a cystic ovarian endometriosis ; do I have an increased riks of ivarian cancer ? The association between cystic ovarian endometriosis and ovarian cancer remains problematic and disturbing. Too often this soo called association is highlighted ; it creates fear in many patients and is often an alibi not to perform laparoscopic surgery but a laparotomy instead. Fact 1 In large series there is some statistical association demonstrating that ovarian cancer is slightly more frequent in women with cystic ovarian endometriosis dan in women without. The association however is so weak that it can be considered as clinically irrelevant. Then there is a lot of speculation to explain this. Fact 2 In large series of ultrasound diagnosis of cystic ovarian endometriosis ovarian cancer is found in some 3% of women, almost all of them in women after menopause though. Comments Statistical associations cannot demonstrate a cause and effect relationship and should be interpreted carefully. Most important is the strength of the association. The association of cystic ovarian endometriosis and ovarian cancer is much weaker than the association between the use of oral contraception and tubal sterilisation and a decrease in ovarian cancer. The latter has been used to suggest that some ascending viral infections might be related to the onset of ovarian cancer, but has never been used as an argument to perform mass sterilisations or for the use of oral contraception. Associations should be interpreted clinically. With the data we have today, it is important for the patients to know that If you have a cystic ovarian endometriosis and are less than...
