STEP 1: Prevention and early detection

This step outlines recommendations for the prevention and early detection of endometrial cancer.

Evidence shows that not smoking, avoiding or limiting alcohol intake, eating a healthy diet, maintaining a healthy body weight, being physically active, being sun smart and avoiding exposure to oncoviruses or carcinogens may help reduce cancer risk (Cancer Council Australia 2018).

Recommendations for reducing the risk of developing endometrial cancer include:

  • maintaining a healthy weight
  • taking birth control pills, especially over an extended period
  • having progesterone therapy as part of hormone replacement therapy for women with an intact uterus.

The risk factors for developing endometrial cancer include:

  • age
  • obesity
  • diabetes
  • endometrial hyperplasia
  • Lynch syndrome (40–60 per cent lifetime risk of endometrial cancer)
  • a family history of endometrial cancer in a first-degree relative
  • PTEN gene mutations
  • unopposed postmenopausal oestrogen therapy
  • endometrial hyperplasia
  • nulliparity
  • anovulation
  • early menarche and late menopause
  • tamoxifen use in postmenopausal women
  • hormone secreting tumour of the ovary (granulosa cell tumour) (Cancer Australia 2019b; NCI 2019).

Everyone should be encouraged to reduce their modifiable risk factors, including taking the following steps.

Using oral contraceptives, which include both oestrogen and progesterone, for at least one year can reduce the risk of developing endometrial cancer. The reduction in risk is proportional to the time that the oral contraceptive was taken and can persist for up to 30 years after the last use of the pill (NCI 2019).

Risk-reducing surgery may be considered for women with:

  • non-genetic conditions where there is an increased risk of endometrial cancer such as atypical hyperplasia
  • genetic conditions (e.g. Lynch syndrome or PTEN mutation).

Women considering risk-reducing surgery should have a thorough family history taken, including male relatives, and consider referral to a familial cancer service to define the actual risk not only for the individual but also for other family members.

Family cancer history assessment is appropriate for women who have:

  • two or more first- or second-degree relatives diagnosed with endometrial or colorectal cancers, if one of the relatives received their diagnosis under the age of 50
  • three or more first- or second-degree relatives with Lynch syndrome–associated cancer, (e.g. adenocarcinoma of the colorectum, endometrium, small intestine, stomach, ovary or pancreas), urothelial carcinoma of the ureter or renal pelvis, cholangiocarcinoma, brain tumour or sebaceous gland tumour (eviQ 2019a).

Screening in asymptomatic women is not appropriate for the early detection of endometrial cancer (NCI 2019).