Fatores de risco para câncer endometrial: análise da distribuição de variáveis em mulheres atendidas em um centro integrado ambulatorial em Brasília

Authors

  • Carolina Figueiredo Lopes
  • João Pedro Borges Andrade Grespan
  • João Vitor Borges Andrade Grespan
  • Edcley de Souza Teixeira
  • Nicanor Morales Neto
  • Demétrio Antônio Gonçalves Silva Gomes

DOI:

https://doi.org/10.54033/cadpedv21n3-054

Keywords:

Câncer Endometrial, Epidemiologia, Fatores de Risco, Oncologia Ginecológica

Abstract

Introdução: O câncer endometrial uterino é a malignidade ginecológica mais prevalente em mulheres brasileiras e uma das principais causas de morbidade e mortalidade. Mais de 60.000 novos casos são esperados durante o próximo ano, devido à crescente exposição da população aos fatores de risco sabidamente associados à neoplasia, como obesidade e sedentarismo. O diagnóstico e tratamento da neoplasia de endométrio são complexos e onerosos do ponto de vista de saúde pública, portanto, a prevenção primária é um pilar fundamental do manejo da condição. Objetivo: Este estudo tem como objetivo conhecer a prevalência de fatores associados ao câncer de endométrio em mulheres na pré e pós menopausa atendidas em um Centro Integrado Ambulatorial em Brasília. Metodologia: Foi realizado um estudo transversal e descritivo entre as mulheres atendidas no setor de Ginecologia de um Centro Ambulatorial de Atenção Primária. Foram coletados dados relativos às variáveis sociodemográficas, gineco-obstétricas e exposição a fatores associados ao câncer endometrial. As participantes assinaram o termo de consentimento livre e esclarecido e o estudo seguiu as normas da resolução 196/96.  RESULTADOS: A população foi composta por 106 mulheres. Dentre os fatores de risco conhecidos para o desenvolvimento do câncer de endométrio, encontrou-se a prevalência aumentada de mulheres com sobrepeso (41,5% das amostras) ou obesidade (29,2%), primigestas (41,1%) e nuligestas (30,1%). CONCLUSÃO: A prevalência elevada de alguns fatores aponta para a necessidade da implementação de medidas de prevenção e promoção à saúde com o objetivo de se reduzir a exposição das pacientes da área atendidas aos fatores associados ao câncer.

References

AMANT, Frederic et al. Endometrial cancer. The Lancet, v. 366, p. 491-505, 2005. DOI: https://doi.org/10.1016/S0140-6736(05)67063-8

AMERICAN CANCER SOCIETY. Cancer facts & figures 2014. American Cancer Society, 2014.

ANTUNES, Alessandra Rosa et al. Desempenho do IMC no diagnóstico de sobrepeso e obesidade: comparação de dois critérios internacionais. Salão de Iniciação Científica, v. 19, Porto Alegre, 2007.

BERAL, Valerie. Ovarian cancer and hormone replacement therapy in the Million Women Study. The Lancet, v. 369, n. 9574, p. 1703-1710, 2007. DOI: https://doi.org/10.1016/S0140-6736(07)60534-0

BEREK, Jonathan S. Berek & Novak's gynecology. Lippincott Williams & Wilkins, 2019.

BEREK, Jonathan S. et al. FIGO staging of endometrial cancer: 2023. International Journal of Gynecology & Obstetrics, 2023. DOI: https://doi.org/10.3802/jgo.2023.34.e85

BJØRGE, Tone et al. Body size in relation to cancer of the uterine corpus in 1 million Norwegian women. International journal of cancer, v. 120, n. 2, p. 378-383, 2007. DOI: https://doi.org/10.1002/ijc.22260

BOKHMAN, Jan V. Two pathogenetic types of endometrial carcinoma. Gynecologic oncology, v. 15, n. 1, p. 10-17, 1983. DOI: https://doi.org/10.1016/0090-8258(83)90111-7

BRASIL; MINISTÉRIO DA SAÚDE; CONSELHO NACIONAL DE SAÚDE. Resolução nº 466, de 12 de dezembro de 2012. Diário Oficial da União, v. 12, p. 59-59, 2013.

BRINTON, Louise A. et al. Reproductive, menstrual, and medical risk factors for endometrial cancer: results from a case-control study. American journal of obstetrics and gynecology, v. 167, n. 5, p. 1317-1325, 1992. DOI: https://doi.org/10.1016/S0002-9378(11)91709-8

BUCKSCH, Karolin et al. Cancer risks in Lynch syndrome, Lynch-like syndrome, and familial colorectal cancer type X: a prospective cohort study. BMC cancer, v. 20, p. 1-11, 2020. DOI: https://doi.org/10.1186/s12885-020-06926-x

CHELMOW, David et al. Executive summary of the uterine cancer evidence review conference. Obstetrics and gynecology, v. 139, n. 4, p. 626, 2022. DOI: https://doi.org/10.1097/AOG.0000000000004711

CHEN, Qi et al. Parity correlates with the timing of developing endometrial cancer, but not subtype of endometrial cancer. Journal of Cancer, v. 6, n. 11, p. 1087, 2015. DOI: https://doi.org/10.7150/jca.12736

CLARKE, Megan A. et al. Racial and ethnic differences in hysterectomy-corrected uterine corpus cancer mortality by stage and histologic subtype. JAMA oncology, v. 8, n. 6, p. 895-903, 2022. DOI: https://doi.org/10.1001/jamaoncol.2022.0009

COMMITTEE ON GYNECOLOGIC PRACTICE et al. Committee opinion no. 601: tamoxifen and uterine cancer. Obstet Gynecol, v. 123, n. 6, p. 1394-1397, 2014. DOI: https://doi.org/10.1097/01.AOG.0000450757.18294.cf

COTE, Michele L. et al. The growing burden of endometrial cancer: a major racial disparity affecting black women. Cancer Epidemiology, Biomarkers & Prevention, v. 24, n. 9, p. 1407-1415, 2015. DOI: https://doi.org/10.1158/1055-9965.EPI-15-0316

DATTA, Amrita et al. The clinico pathological features and survival in serous endometrial cancers. Gynecologic Oncology Reports, v. 47, p. 101194, 2023. DOI: https://doi.org/10.1016/j.gore.2023.101194

DI DONATO, V. et al. Impact of Hormone Receptor Status and Ki-67 Expression on Disease-Free Survival in Patients Affected by High-risk Endometrial Cancer. International journal of gynecological cancer: official journal of the International Gynecological Cancer Society, v. 28, n. 3, p. 505–513, 2018. DOI: https://doi.org/10.26226/morressier.599bdc7bd462b80296ca12cc

FÁVERO, L. P. et al. Análise de dados – modelagem multivariada para tomada de decisões. Rio de Janeiro: Elsevier, 2009.

FEBRASGO. Federação Brasileira das Associações de Ginecologia e Obstetrícia. Hiperplasia endometrial e câncer do endométrio. Protocolos Febrasgo, São Paulo, n. 9, 2021. Disponível em: https://sogirgs.org.br/area-do-associado/Hiperplasia-endometrial-e-cancer-do-endometrio-2021.pdf. Acesso em: 5 jul. 2023.

FELIX, Ashley S. et al. Factors associated with Type I and Type II endometrial cancer. Cancer Causes & Control, v. 21, p. 1851-1856, 2010. DOI: https://doi.org/10.1007/s10552-010-9612-8

FERLAY, J. et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 11. Lyon, France: 2012. Disponível em: <http://globocan.iarc.fr>. Acesso em: 04 jul 2023.

FREUND, J. E.; SIMON, G. A. Estatística aplicada: Economia. Administração e Contabilidade, 11a ed., Editora Artmed Bookman, São Paulo, 2006.

FURNESS, Sue et al. Hormone therapy in postmenopausal women and risk of endometrial hyperplasia. Cochrane Database of Systematic Reviews, n. 3, 2004. DOI: https://doi.org/10.1002/14651858.CD000402.pub2

GEHRIG, Paola A. et al. Association between uterine serous carcinoma and breast cancer. Gynecologic oncology, v. 94, n. 1, p. 208-211, 2004. DOI: https://doi.org/10.1016/j.ygyno.2004.04.009

GOLDSTEIN, Steven R. The effect of SERMs on the endometrium. Annals of the New York Academy of Sciences, v. 949, n. 1, p. 237-242, 2001. DOI: https://doi.org/10.1111/j.1749-6632.2001.tb04027.x

HENDERSON, Brian E. The cancer question: an overview of recent epidemiologic and retrospective data. American journal of obstetrics and gynecology, v. 161, n. 6, p. 1859-1864, 1989. DOI: https://doi.org/10.1016/S0002-9378(89)80007-9

HOWLADER, N. et al. SEER Cancer Statistics Review, 1975-2014, National Cancer Institute. Bethesda, MD, November 2016. Disponível em: <https://seer.cancer.gov/csr/1975_2014/>. Acesso em: 04 jul 2023.

KARAGEORGI, Stalo et al. Reproductive factors and postmenopausal hormone use in relation to endometrial cancer risk in the Nurses' Health Study cohort 1976–2004. International journal of cancer, v. 126, n. 1, p. 208-216, 2010. DOI: https://doi.org/10.1002/ijc.24672

KATAGIRI, Ryoko et al. Reproductive factors and endometrial cancer risk among women. JAMA network open, v. 6, n. 9, p. e2332296-e2332296, 2023. DOI: https://doi.org/10.1001/jamanetworkopen.2023.32296

KAUARK, F. S. et al. Metodologia da pesquisa: um guia prático. Bahia, Editora Via Litterarum, 1a ed, 2010.

LA VECCHIA, Carlo et al. Risk factors for endometrial cancer at different ages. Journal of the National Cancer Institute, v. 73, n. 3, p. 667-671, 1984.

LACHANCE, J. A. et al. The effect of age on clinical/pathologic features, surgical morbidity, and outcome in patients with endometrial cancer. Gynecologic oncology, v. 101, n. 3, p. 470-475, 2006.

LACHANCE, J. A. et al. The effect of age on clinical/pathologic features, surgical morbidity, and outcome in patients with endometrial cancer. Gynecologic oncology, v. 101, n. 3, p. 470-475, 2006. DOI: https://doi.org/10.1016/j.ygyno.2005.11.009

LIANG, Sharon X. et al. Personal history of breast cancer as a significant risk factor for endometrial serous carcinoma in women aged 55 years old or younger. International journal of cancer, v. 128, n. 4, p. 763-770, 2011. DOI: https://doi.org/10.1002/ijc.25395

LORTET-TIEULENT, J. et al. International Patterns and Trends in Endometrial Cancer Incidence, 1978–2013. JNCI: Journal of the National Cancer Institute, v. 110, n. 4, p. 354–361, 1 abr. 2018. DOI: https://doi.org/10.1093/jnci/djx214

LUKANOVA, Annekatrin et al. Circulating levels of sex steroid hormones and risk of endometrial cancer in postmenopausal women. International journal of cancer, v. 108, n. 3, p. 425-432, 2004. DOI: https://doi.org/10.1002/ijc.11529

MAXWELL, G. Larry et al. Racial disparity in survival among patients with advanced/recurrent endometrial adenocarcinoma: a Gynecologic Oncology Group study. Cancer: Interdisciplinary International Journal of the American Cancer Society, v. 107, n. 9, p. 2197-2205, 2006. DOI: https://doi.org/10.1002/cncr.22232

MCCULLOUGH, Marjorie L. et al. Body mass and endometrial cancer risk by hormone replacement therapy and cancer subtype. Cancer Epidemiology Biomarkers & Prevention, v. 17, n. 1, p. 73-79, 2008. DOI: https://doi.org/10.1158/1055-9965.EPI-07-2567

MCPHERSON, Carol P. et al. Reproductive factors and risk of endometrial cancer The Iowa Women's Health Study. American journal of epidemiology, v. 143, n. 12, p. 1195-1202, 1996. DOI: https://doi.org/10.1093/oxfordjournals.aje.a008707

MOORE, Kathleen N.; FADER, Amanda Nickles. Uterine papillary serous carcinoma. Clinical obstetrics and gynecology, v. 54, n. 2, p. 278-291, 2011. DOI: https://doi.org/10.1097/GRF.0b013e318218c755

MOURITS, Marian JE et al. Tamoxifen treatment and gynecologic side effects: a review. Obstetrics & Gynecology, v. 97, n. 5, p. 855-866, 2001. DOI: https://doi.org/10.1016/S0029-7844(00)01196-0

NYHOLM, Henrik CJ et al. Plasma oestrogens in postmenopausal women with endometrial cancer. BJOG: An International Journal of Obstetrics & Gynaecology, v. 100, n. 12, p. 1115-1119, 1993. DOI: https://doi.org/10.1111/j.1471-0528.1993.tb15176.x

PERSSON, Ingemar et al. Risk of endometrial cancer after treatment with oestrogens alone or in conjunction with progestogens: results of a prospective study. BMJ: British Medical Journal, v. 298, n. 6667, p. 147, 1989. DOI: https://doi.org/10.1136/bmj.298.6667.147

POTISCHMAN, Nancy et al. Case—control study of endogenous steroid hormones and endometrial cancer. JNCI: Journal of the National Cancer Institute, v. 88, n. 16, p. 1127-1135, 1996. DOI: https://doi.org/10.1093/jnci/88.16.1127

POTISCHMAN, Nancy et al. Reversal of relation between body mass and endogenous estrogen concentrations with menopausal status. JNCI: Journal of the National Cancer Institute, v. 88, n. 11, p. 756-758, 1996. DOI: https://doi.org/10.1093/jnci/88.11.756

RIGGS, B. Lawrence; HARTMANN, Lynn C. Selective estrogen-receptor modulators—mechanisms of action and application to clinical practice. New England Journal of Medicine, v. 348, n. 7, p. 618-629, 2003. DOI: https://doi.org/10.1056/NEJMra022219

SANCHEZ-COVARRUBIAS, Alex P. et al. African ancestry is associated with aggressive endometrial cancer. American Journal of Obstetrics & Gynecology, v. 228, n. 1, p. 92-95. e10, 2023. DOI: https://doi.org/10.1016/j.ajog.2022.07.040

SARINK, Danja et al. Racial/ethnic differences in anthropometric and hormone-related factors and endometrial cancer risk: the Multiethnic Cohort Study. British Journal of Cancer, v. 124, n. 10, p. 1724-1733, 2021. DOI: https://doi.org/10.1038/s41416-021-01292-2

SCHUMER, Susan Tinsley; CANNISTRA, Stephen A. Granulosa cell tumor of the ovary. Journal of clinical oncology, v. 21, n. 6, p. 1180-1189, 2003. DOI: https://doi.org/10.1200/JCO.2003.10.019

SETIAWAN, Veronica Wendy et al. Type I and II endometrial cancers: have they different risk factors?. Journal of Clinical Oncology, v. 31, n. 20, p. 2607, 2013.

SHERMAN, Mark E.; DEVESA, Susan S. Analysis of racial differences in incidence, survival, and mortality for malignant tumors of the uterine corpus. Cancer, v. 98, n. 1, p. 176-186, 2003. DOI: https://doi.org/10.1002/cncr.11484

SIITERI, Pentti K. Adipose tissue as a source of hormones. The American journal of clinical nutrition, v. 45, n. 1, p. 283-289, 1987. DOI: https://doi.org/10.1093/ajcn/45.1.283

SILVEIRA, Tauana Pavanelli do Amaral de et al. Conhecimento e práticas de médicos da atenção primária à saúde relacionadas à prevenção do câncer. 2016. Tese de Doutorado. Universidade de São Paulo.

SMRZ, Stacy A. et al. An ecological evaluation of the increasing incidence of endometrial cancer and the obesity epidemic. American Journal of Obstetrics and Gynecology, v. 224, n. 5, p. 506. e1-506. e8, 2021. DOI: https://doi.org/10.1016/j.ajog.2020.10.042

STROM, Brian L. et al. Case-control study of postmenopausal hormone replacement therapy and endometrial cancer. American journal of epidemiology, v. 164, n. 8, p. 775-786, 2006. DOI: https://doi.org/10.1093/aje/kwj316

SUNG, Hyuna et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, v. 71, n. 3, p. 209-249, 2021. DOI: https://doi.org/10.3322/caac.21660

TOMICA, D. et al. Impact of estrogen and progesterone receptor expression in the cancer cells and myometrium on survival of patients with endometrial cancer. Journal of obstetrics and gynecology: the journal of the Institute of Obstetrics and Gynaecology, v. 38, n. 1, p. 96–102, jan. 2018. DOI: https://doi.org/10.1080/01443615.2017.1328591

WEIDERPASS, Elisabete et al. Risk of endometrial cancer following estrogen replacement with and without progestins. Journal of the National Cancer Institute, v. 91, n. 13, p. 1131-1137, 1999. DOI: https://doi.org/10.1093/jnci/91.13.1131

WRIGHT, Jason D. et al. Racial disparities for uterine corpus tumors: changes in clinical characteristics and treatment over time. Cancer, v. 115, n. 6, p. 1276, 2009. DOI: https://doi.org/10.1002/cncr.24160

WU, Q.-J. et al. Parity and endometrial cancer risk: a meta-analysis of epidemiological studies. Scientific Reports, v. 5, n. 1, p. 14243, 16 nov. 2015. DOI: https://doi.org/10.1038/srep14243

XU, Wang‐Hong et al. Menstrual and reproductive factors and endometrial cancer risk: Results from a population‐based case‐control study in urban Shanghai. International journal of cancer, v. 108, n. 4, p. 613-619, 2004. DOI: https://doi.org/10.1002/ijc.11598

ZELENIUCH-JACQUOTTE, A. et al. Postmenopausal endogenous oestrogens and risk of endometrial cancer: results of a prospective study. British journal of cancer, v. 84, n. 7, p. 975-981, 2001. DOI: https://doi.org/10.1054/bjoc.2001.1704

Published

2024-03-14

How to Cite

Lopes, C. F., Grespan, J. P. B. A., Grespan, J. V. B. A., Teixeira, E. de S., Morales Neto, N., & Gomes, D. A. G. S. (2024). Fatores de risco para câncer endometrial: análise da distribuição de variáveis em mulheres atendidas em um centro integrado ambulatorial em Brasília. Caderno Pedagógico, 21(3), e3122. https://doi.org/10.54033/cadpedv21n3-054

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