SGO Endorses ACOG Publication “Management of Endometrial Intraepithelial Neoplasia or Atypical Endometrial Hyperplasia”
Lee-may Chen, MD
The Society of Gynecologic Oncology (SGO) recently endorsed, “Management of Endometrial Intraepithelial Neoplasia or Atypical Endometrial Hyperplasia,” an American College of Obstetricians and Gynecologists (ACOG) Clinical Consensus. This article appears in the September 2023 issue of Obstetrics & Gynecology (the “Green Journal”). It discusses occurrences of endometrial intraepithelial neoplasia (EIN) or atypical endometrial hyperplasia (AEH) developing into endometrial adenocarcinoma, ruling out endometrial cancer to avoid under-treatment when considering non-surgical approaches, and the need for appropriate therapies and vigilant monitoring when opting for non-surgical treatment methods.
ACOG has moved towards Clinical Consensus documents, replacing the previous Committee Opinions. Lee-may Chen, MD, of University of California San Francisco, serves as the SGO liaison to the ACOG committee that developed this document. Dr. Chen explains, “This document is particularly important to SGO as it sets forth recommendations for earlier detection of endometrial cancer, as well as management strategies, including both surgical and non-surgical.”
A primary goal of this document is to ensure appropriate and more targeted treatment plans are developed and performed; additionally, it is intended to outline ways in which clinicians can proactively follow up with patients to assess treatment response and counsel patients on lifestyle modifications that can improve overall health and may decrease the risk of EIN–AEH and endometrial cancer.
Hysterectomy is the definitive treatment for EIN–AEH, the surgical route often taken by individuals who do not desire to preserve fertility. Should clinicians opt to treat patients with non-surgical strategies, this document urges clinicians to consider long-term maintenance therapy with progestational agents for patients with continuing risk factors for endometrial cancer such as increasing age, late menopause, having never birthed a child, or chronic irregular menstrual cycles. Whether a clinician employs surgical or non-surgical strategies, this publication recommends management strategies that rule out endometrial cancer, prevent or delay progression to endometrial cancer, and reduce the risk of cancer regression.
Speaking to disparities, Dr. Chen expresses, “In considering the diverse presentation of endometrial cancer, the authors acknowledge that Black individuals are less likely to receive guideline-compliant care and more likely to present with non-endometrioid histology.” The evidence-based strategies presented in this publication such as frequent repetition of endometrial sampling and endpoints of treatment are methods suggested to help minimize progression to more advanced endometrial malignancy and improve cancer care for all populations.