LAUSR

Study Objective Atypical Hyperplasia carries a 30% risk of developing endometrial cancer over 20 years. Endometrial cancer has increased by 54% since the 1998. Overall hysterectomy rates are falling, and obesity increases. We reviewed 3 snapshot years over 10 years, in terms of hyperplasia numbers, management and surveillance. Design Retrospective case note audit with histological diagnosis of endometrial hyperplasia with or without atypia for 2008, 2013 and 2018. Setting Northern Health and Social Care Trust, Northern Ireland Patients or Participants 74 patients with a histological diagnosis of endometrial hyperplasia with or without atypia were identified. Interventions Medical treatment or hysterectomy. Measurements and Main Results • Endometrial Hyperplasia incidence 2008 - 19 cases (23% atypical / 77% without atypia); 2013 - 24 cases (42% atypical /58% without atypia) and 2018 - 31 cases (29% atypical /71% without atypia). • Mean BMI was 35, 39 and 36 in 2008, 2013 and 2018 respectively. • Age range 33 – 80 years. Mean age 2008 - 59; 2013 - 56; 2018 - 53. • 74% (n=17) with atypical hyperplasia underwent hysterectomy. 26% (n=6) had medical treatment with levonorgestrel IUS or oral progestogens, and surveillance due to surgical unsuitability or patient choice. • Hyperplasia without atypia was managed conservatively with progestogens and surveillance in 71% (n= 36) whilst 29% (n= 15) underwent hysterectomy; persistent bleeding in the absence of progressive histology being the main indication. • 84% (n= 26) of 2018 cohort were followed up according to 2016 Royal College of Obstetricians and Gynaecologists guidance. Conclusion Overall hyperplasia incidence is increasing. While BMI is elevated, there was no upward trend observed. Does the insidious decline in age demographic suggest that hyperplasia is occurring in younger women? Our review did not demonstrate a continuous increase in atypia, however there was a higher incidence in the 2013 group, who were also the most obese. Adherence to best practice surveillance in our hospitals was falling short.