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

METHODS:

• 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

RESULTS:

• 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

CONCLUSION:

• 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

Learn More – Primary Sources:

Long-term Follow-up After Endometrial Ablation in Finland: Cancer Risks and Later Hysterectomies.

Related ObG Topics:

Endometrial Ablation – When is This Procedure Appropriate?

Laparoscopic Excision vs. Ablation for Treating Endometriosis-Associated Pain

IUD, Hysterectomy or Ablation for Menorrhagia?