Endometrial cancer in women 40 years old or younger

Objective. The aim of this study was to characterize endometrial cancer in women 40 years of age and younger, with special attention toward body-mass index (BMI). Methods. A retrospective review of women age 40 and under with endometrial cancer was performed. Patients were identified via tumor registry data as w ell as a search of pathology department diagnoses over the dates 1980-1998. Data were abstracted regarding tumor grade and histology, stage, treatment , smoking, use of oral contraceptives, BMI, medical and family history, par ity, and survival. Data were also collected with regard to uterine conserva tion and pregnancies following endometrial cancer diagnoses. Results. Ninety-five patients were identified. The age range was 24-40 year s (median 37) with BMI ranging from 17.5 to 63.6 (median 28.4). Forty-eight patients (52%) were not obese, with BMI < 30. Seventy-six patients (80%) h ad stage I disease and 60 patients (63%) had grade 1 disease. All but 4 pat ients had endometrioid histology. Women with BMI < 25 were more likely to h ave advanced disease (P = 0.04) and more likely to have highrisk histology (P = 0.02). Of the 4 patients with high-risk histology (clear cell or serou s papillary), all had BMI < 25. Twelve patients were treated medically rath er than surgically, and 4 patients achieved pregnancy, with 5 live births. Conclusion. Women under 40 who are not obese are at higher risk of both adv anced disease and high-risk histology. Further study at the molecular and g enetic level is ongoing in our laboratory to determine whether the mechanis m of disease is different in slender woman. (C) 2001 Academic Press.