A 25-year-old woman presents to the clinic for irregular menstrual cycles with reduced bleeding for the last two years. She also endorses excessive growth of facial hair for six months. She has a history of prediabetes and was advised lifestyle modification, including a controlled diet and regular exercise. She does not have any other medical conditions and does not take any medications. She does not smoke cigarettes and drinks alcohol socially.
She is 5’2” tall (158 cm), and weighs 176 lbs (80 kg), and her body mass index is 32.2 kg/m2. Vital signs are within normal limits. Physical examination reveals an obese female with evidence of coarse hair growth on her face. She is counseled about her condition and referred for imaging. Upon hearing her probable diagnosis, she is concerned it may increase her risk of cancer.
Which of the following is the most appropriate response by the physician?
The correct answer is:
A) An increase in the risk of endometrial cancer is associated with her probable diagnosis
This patient, presenting with irregular menstrual cycles and oligomenorrhea, along with virilization (facial hair growth) has polycystic ovary syndrome (PCOS). She also has prediabetes, hyperinsulinemia, and obesity, features commonly found in patients with PCOS.
Due to unopposed estrogen exposure, the risk of endometrial cancer is higher in women with PCOS than in women without PCOS.
Answer choice B: Her BMI, combined with prediabetes, increases her risk of pancreatic cancer, is incorrect. PCOS does not increase the risk of pancreatic cancer.
Answer choice C: No increased risk of cancer is associated with her probable diagnosis, is incorrect. PCOS is associated with an increased risk of endometrial cancer.
Answer choice D: There is an increased risk of all gynecological cancers, including vulvar, vaginal, cervical, uterine, and ovarian cancer, is incorrect. There is no association found between PCOS and these cancers
Answer choice E: There is an increased risk of breast cancer, but it can be mitigated by taking progesterone only pills, is incorrect. It is unclear what effect PCOS has on breast cancer, as it is associated with factors that both increase and decrease the risk. However, progesterone only pills slightly increase the risk of breast cancer even in healthy women.
Key Learning Point
Due to unopposed action of estrogens, patients with polycystic ovary syndrome (PCOS) have an increased risk of endometrial carcinoma.
