News: Obese need better endometrial prevention strategies

In most obese women, neither oral contraceptives nor current screening methods are cost-effective endometrial cancer prevention strategies. But OCs 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 and Gynecology.

Janice S. Kwon, MD, 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, OC pills for 5 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 OCs 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 OCs may be a cost-effective prevention strategy.

Kwon JS, Lu KH. Cost-effectiveness analysis of endometrial cancer prevention strategies for obese women. Obstet Gynecol. 2008;112:56-63.