Endometrial Cancer Prevention Strategies Needed for Obese

Oral contraceptives, current screening methods not cost-effective for most obese women

FRIDAY, July 11 (HealthDay News) -- In most obese women, neither oral contraceptives nor current screening methods are cost-effective endometrial cancer prevention strategies. But oral contraceptives may be a cost-effective strategy for subgroups of women who are morbidly obese or have longstanding anovulation, researchers report in the July issue of Obstetrics & Gynecology.

Janice S. Kwon, M.D., of the University of Texas M.D. Anderson Cancer Center in Houston, and a colleague used a Markov decision-analytic model to evaluate four strategies in a hypothetical cohort of obese women: no prevention, oral contraceptive pills for five years, annual screening with endometrial biopsy from age 30, and biennial screening from age 30.

The researchers observed no significant group differences in average life expectancy, which ranged from 74.52 to 74.6 years. They also found that none of the strategies had an incremental cost-effectiveness ratio less than $50,000 per year of life saved compared to the next best strategy. They calculated that endometrial cancer risk in obese women had to be 13 times higher than the risk in the general population to make oral contraceptives a cost-effective strategy. The investigators also found that additional risk factors, such as morbid obesity and a longstanding history of anovulation, may define a subgroup of women at highest risk for endometrial cancer for whom oral contraceptives may be a cost-effective prevention strategy.

"Clearly, the prevalence of obesity in our society must decrease, but the obvious endpoint of sustained weight reduction seems so difficult to achieve," the authors state. "In the interim, it may be possible to identify obese women at highest risk of endometrial cancer who would benefit from current preventive strategies. However, the longer the obesity epidemic continues, the more important it will be to establish prevention strategies that provide additional health benefits at acceptable cost to all women at risk within this population."

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