Polycystic ovary syndrome (PCOS) is a gynecological problem, which influences 1 in 10 females of childbearing age. It is the most common endocrinopathy in reproductive females with an estimated incidence of around 10 percent. Females with PCOS maybe characterized bymenstrualirregularity, a polycystic morphology of the ovary, and hyperandrogenism.
“As per to PCOS Foundation, solely 50% of females suffering from PCOS have been diagnosed”
PCOS is known to be a major reason behind 70% of infertility issues. Further, if the problem isleft untreated, it can leads to several comorbidities, for instance, insulin resistance (50 to 70 percent in the cases with PCOS), hypertension, metabolic syndrome, type-2 diabetes, cardiovascular disease, obstructive sleep apnea, dyslipidemia, and endometrial cancer.
“Females suffered from PCOS found to have 2.7 fold enhanced risk for endometrial cancer development”
Some of the evidence also found an association between PCOS and increased risk of ovarian cancer and breast cancer.
Let's scrutinize the mechanism of action behind PCOS in causing these cancers in deep:
Primary ovarian insufficiency
The major cause behind PCOS and increasing cancer risk is the insufficiency of ovaries to work normally. The elevated androgen levels and prolonged anovulation are two of them.
Elevated Androgen Levels
Hyperandrogenism (increased androgen levels) is known as one of the major integrant of all three clinical diagnostic criteria (along with polycystic ovaries and ovulatory dysfunction) for PCOS.
Risch, in 1998 intended that one of the major causes behind ovarian cancer is the androgen stimulation of the ovarian cell.
Further, talking about breast cancer and PCOS relationship, circulating androgens can play a substantial role in breast carcinogenesis.
In the results of one of the pooled analyses, it is found that breast cancer risk enhances with an increase in testosterone levels in postmenopausal females. An equivalent enhanced risk has been stated by cohort studies in premenopausal females.
Prolonged anovulation
Anovulation is a term, which is used when the ovary failed to produce, mature, or release eggs.
Due to ensuing exposure to estrogen unopposed by progesterone, PCOS is marked by prolonged anovulation. This explains, why females having PCOS have an increased risk of endometrial cancer, an estrogen-sensitive disease.
However, the relationship between estrogen and breast/ovarian cancer is more complicated and pertains to the menopausal status and sub-types of disease. This explains the dearth of overall enhanced risk for these cancers.
PCOS medications that may influence cancer risk
Oral contraceptives
For females who are not seeking to getting pregnant, the combined oral contraceptives are one of the front-line therapies for menstrual irregularities in the females with PCOS.
Combined oral contraceptives are related to the reduced ovarian, colorectal and endometrial cancers risk.
However, talking about breast and cervical cancer, the association of these cancers with oral contraceptives is detrimental.
According to the reports of analysis, the females who had ever taken oral contraceptives had a minor (about 7%) rise in the risk of breast cancer in comparison to females who had never taken oral contraceptives.
In another study, it is found that 10%, 60%, and doubling the risk in cervical cancer with less than 5, 5-9 and 10 or more years of use. Although, the risk of this cancer get declined over time after females stop taking oral contraceptives.
Metformin
Metformin is given to females with PCOS to reduce the risk or treat type 2 diabetes, improving resistance, and regulatingthe menstrual cycle.
Many pieces of evidence have proposed that metformin use may be defensive against certain types of cancers. A more recent study among females in general practice databases from the United Kingdom Germany stated no relationship between metformin users and breast cancer prevalence when compared with the sulfonylurea and insulin users.
The relationship between ovarian cancer and metformin use has been less evaluated as compared to the endometrial and breast cancer. Although, metformin use has been showed to impact ovarian cancer cell progression.
Only one observational analysis has stated the connection between the risk of ovarian cancer and metformin remarking a reduction in the risk of ovarian cancer with enhancing metformin use.
Ovulation-induction therapies
Clomiphene, a known therapy for PCOS-related infertility, is a selective estrogen receptor modulator that provokes the ovaries to ovulate. However, the decrease or increase in estrogen receptor activation in other tissues can be varied.
Clomiphene isfound to exhibits a pro-apoptotic effect against breast cancer cell lines. This may elucidate why females who obtained clomiphene for PCOS-associated infertility have a decreased breast cancer risk in some of the scientific evidence.
Further, endometrial cancer is rarely studied. In one of the largest analyses to date, Brinton et al. stated a slight non-significant rise in endometrial cancer risk in the clomiphene users.
The relationships between PCOS and endometrial, breast and ovarian cancer are complicated, needed examination of PCOS diagnostic criteria, confounding and mediating factors, co-morbid conditions, menopausal status, etiologic heterogeneity of cancer subtypes as well as management alternatives that may also impact cancer risk. Moreover, the oddity of endometrial and ovarian cancers make these cancers even more complex to analyze. Larger properly designed analyses, or pooled analyses, may aid to clarify these complex relationships.
However, PCOS can be controlled and also the risk of cancer. For this, the adoption of a healthy lifestyle is a must.
PCOS Controlled Tips:
Caloric Intake:
Obese people suffering from PCOS should limit their Caloric consumption in an attempt to lose weight. The suggested amount of weight to shred is 1 pound every week. This implies that a weekly caloric loss of 3,500 Calories or a daily loss of 500 Calories required to be done.
Raw red onion:
Raw red onion found to lower cholesterol levels in females with PCOS. Being that 70% of PCOS females have abnormal lipid profiles, with high levels of cholesterol being predominant, it is depicted that PCOS females take a serving of raw red onion every day.
Low Glycemic Index:
The Glycemic Index shows that impact of carbohydrate on levels of blood glucose over a span of 2 hours. PCOS females should avoid foods that have a high glycemic index. As such type of can increase insulin resistance, which will further decrease the androgens levels.
Omega-3:
Females with PCOS must also consume omega-3 fatty acids (1.1grams per day) as these fatty acids are known to regulate hormone balance.
Exercise training:
Both lean and obese PCOS females must do exercise daily to regulate weight and modifying body composition by lowering fat mass and improving free fat mass. This will aid in improving the resting metabolic rate. This further, helps in long-lasting weight management. The workout must include both resistance and endurance training.
Follow these and prevent yourself from the risk of PCOS and associated cancer risk.