Grand Rounds

What are the Risk Factors Associated with Endometrial Ablation?

BACKGROUND AND PURPOSE:

No population-based studies on the effect of new endometrial ablation techniques on endometrial cancer exist
Also unknown is whether heavy menstrual bleeding is associated with increased risk for breast cancer
Soini et al. (Obstetrics & Gynecology, 2017) sought to determine endometrial and breast cancer rates post-ablation, as well as future hysterectomy rates

Observational, retrospective nationwide cohort (Finland; 1997-2014)
Women 30-49 years of age who underwent endometrial ablation
Primary outcome was cancer rates in the ablation cohort versus control cohort
Post-ablation hysterectomy rates were also compared between ablation and control cohorts as a secondary outcome

Final study cohort included 5484 women in the ablation group and 26,938 in the control group
154 total cancer incidence were recorded within ~39,000 women/years of patients with endometrial ablation
The standardized incidence for cancers was not statistically increased in the ablation group
- The standardized incidence ratio for endometrial cancer was 0.56 (95% CI 0.12–1.64; three observed compared with five expected cases)
- The standardized incidence ratio for breast cancer was 0.86 (95% CI 0.67–1.09; 67 observed compared with 78 expected cases)
Risk of hysterectomy was almost four-fold higher in the ablation cohort
Factors predisposing to postablation hysterectomy were
- Leiomyomas
- Age younger than 35 y/o
- At least two prior cesarean deliveries
- History of sterilization

Women with endometrial ablation were not at a higher risk for breast or endometrial cancer
There was a higher risk of hysterectomy due to higher rates of risk factors listed above
Authors state a limitation of study is that the type of ablation devices were not available, but there are no differences in effectiveness among various devices

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