Population-based investigations into risk factors and surveillance strategies for endometrial hyperplasia and endometrial cancer

Abstract

Endometrial cancer is the fourth most common cancer in UK females and the leading gynaecological malignancy. A significant proportion of these cases arise from endometrial hyperplasia, a premalignant condition that offers opportunities for prevention and early detection. However, accurate diagnosis of endometrial hyperplasia remains challenging, and its natural progression and outcomes are not fully understood. Furthermore, more research is needed to clarify the aetiology of endometrial cancer in the general population.

Endometrial hyperplasia is classified into non-atypical hyperplasia, which carries a low risk of progression to cancer, and atypical hyperplasia, which has a higher risk. Management strategies vary: non-atypical hyperplasia is typically managed conservatively, while surgical intervention is recommended for atypical hyperplasia. Accurate histopathological diagnosis is critical, as misclassification can lead to unnecessary procedures or inappropriate treatments. This thesis includes a systematic review addressing interobserver variation among pathologists, exploring how differences in diagnostic practices may affect diagnostic consistency.

Additionally, two population-level studies were conducted that linked data from the Northern Ireland Endometrial Hyperplasia Register with the Northern Ireland Cancer Registry. These studies examined the relationship between endometrial hyperplasia and endometrial cancer, including whether prior hyperplasia diagnoses are associated with improved survival outcomes in endometrial cancer patients, as well as the prevalence of concurrent endometrial cancer diagnoses in individuals with both endometrial hyperplasia and cancer. Using UK Biobank data, this thesis also investigated the potential role of multimorbidity in influencing endometrial cancer risk, given that the presence of multiple chronic conditions may alter disease susceptibility and impact overall health outcomes, thereby potentially contributing to an increased risk of cancer development.

Overall, these studies aimed to contribute to improving the diagnosis, surveillance, and prevention strategies for endometrial hyperplasia and endometrial cancer.

Thesis is embargoed until 31 July 2028

Date of Award	Jul 2026
Original language	English
Awarding Institution	Queen's University Belfast
Sponsors	Northern Ireland Department for the Economy
Supervisor	Finian Bannon (Supervisor), Úna McMenamin (Supervisor) & Charlene McShane (Supervisor)