Endometrial Cancer Prevention
Can endometrial cancer be prevented?
Surgical removal of the uterus is the most effective way to prevent endometrial cancer. This surgery is known as a risk-reducing hysterectomy (sometimes called prophylactic surgery). Certain medications may also lower the risk of endometrial cancer, but they are not as effective as surgery. The decision to have a hysterectomy or take medication to lower your risk is deeply personal. Speak with a genetic counselor and a gynecologic surgeon to understand your risks for cancer and preventive options.
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SIGN UP FOR CONTENT UPDATESCan medications lower the risk for endometrial cancer?
Healthy, high-risk individuals may benefit from medications to lower their risk for endometrial cancer. This approach to lowering risk is sometimes called "." High-risk people who are considering medications to lower their risk for endometrial cancer should speak with their doctor to decide whether is their best option for managing their risk. Although medications can lower the risk of endometrial cancer, some risk still remains. For this reason, high-risk people choosing should be aware of the signs of endometrial cancer and discuss screening options with their doctor.
Which medications can lower the risk for endometrial cancer?
Two medications that may lower endometrial cancer risk are progesterone and aspirin. More research is needed for experts to understand how well these medications work, and who may benefit most from their use.
Progesterone
Often used as birth control, progesterone has been shown to lower the risk for ovarian cancer in both high-risk women and average-risk women. Some small studies also suggest that progesterone can lower the risk for endometrial cancer in high-risk women.
Progesterone may be given as a pill, injection or through an Intrauterine Device (IUD). Progesterone can have side effects which vary widely based on how the medication is taken. These side effects may include an increased risk for breast cancer and blood clots and weight gain.
Aspirin
In people with , daily aspirin may decrease the risk for colon cancer. Researchers are studying whether aspirin lowers the risk for other cancers, including endometrial cancer. Aspirin can increase the risk for bleeding.
What is a risk-reducing hysterectomy?
Hysterectomy is surgery to remove the uterus to treat or prevent disease. "Risk-reducing hysterectomy" refers to the removal of the healthy uterus to reduce a person's risk of developing cancer. The should also be removed at the time of risk-reducing hysterectomy. Often the cervix is also removed during this surgery.
Research on hysterectomy in high-risk women has shown that:
- hysterectomy is an effective way to lower the risk for endometrial cancer.
- hysterectomy may not affect how long high-risk women survive.
Surgery can have risks and side effects. It's important for people to speak with experts in order to learn as much as possible about their endometrial cancer risk and to make an informed decision about the best option for lowering their risk.
Gynecologic Cancer Detection and Prevention
Who should have a risk-reducing hysterectomy?
The National Comprehensive Cancer Network (NCCN), is an organization of cancer experts that creates guidelines on cancer care and updates them yearly. NCCN's guidelines discuss the benefits and limitations for risk-reducing hysterectomy in women with an linked to endometrial cancer and which women are most likely to benefit from the surgery.
The NCCN guidelines suggest that women who have completed their childbearing should talk with their doctor about risk-reducing hysterectomy if they have an inherited mutations in any of the following genes:
For people at high risk for endometrial cancer who also need to have colorectal surgery, NCCN guidelines recommend considering scheduling their risk-reducing hysterectomy and colorectal cancer surgery at the same time.
Should the ovaries be removed during risk-reducing hysterectomy?
People who are at high risk for both endometrial and ovarian cancer may consider removal of the ovaries at the time of risk-reducing hysterectomy. Mutations in the following genes increase the risk for endometrial, and ovarian cancer:
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*More research is needed to confirm a link between ovarian cancer and mutations.
People with mutations in these genes should have a conversation with their surgeon about the benefits and risks of risk-reducing removal of their ovaries (also known as ) at the time of risk-reducing hysterectomy. The are typically removed during risk-reducing hysterectomy even if the ovaries are spared.
Should the uterus be removed during risk-reducing surgery to remove the ovaries?
Some people who have increased risk for ovarian and cancer may choose to remove their uterus at the same time that they undergo risk-reducing removal of their ovaries and . This includes people with mutations in the following genes:
*Note that mutations have been linked to a rare but aggressive form of endometrial cancer.
You can read more about the benefits and risks of this decision in our section on surgery to lower and ovarian cancer risk.
Should the uterus be removed vaginally or as an open surgery?
Hysterectomy may be performed using an incision through the vagina (known as vaginal hysterectomy) or through an incision in the lower abdomen (known as laparotomy).
- Open surgery (also known as a laparotomy) involves one incision in the lower abdomen to remove the uterus.
- Vaginal surgery involves an incision from the vagina into the pelvic area to remove the uterus. This surgery requires a shorter recovery time than open surgery. Most risk-reducing surgeries can be performed vaginally.
What are the risks of hysterectomy?
Every surgery has potential risks; some are more serious than others. Some hysterectomy risks can affect recovery. Some possible risks include:
- infection
- delayed healing
- injury to the bladder
- blood loss
- blood clots
It is important for people to discuss possible surgical risks with a surgeon to understand the seriousness and likelihood of these risks before making the decision to have risk-reducing surgery.
Does insurance cover the cost for risk-reducing hysterectomy?
Most insurance plans will cover the cost of risk-reducing hysterectomy for certain high-risk people, however out-of-pocket costs may apply. Visit our page on paying for preventive care for more information.