The incidence of cancers related to female reproductive systems (gynaecological cancers) in the UK is changing. The number of endometrial (womb) cancer cases has risen dramatically and this increase does not appear to be slowing. Much is not known about the size of the effect of different risk factors for gynaecological cancers in different ethnic or age groups, or the long-term effects on patients’ overall health. This study will use routinely collected data to assess two main aims. Firstly, we will select a sample of women within the clinical research practice database, and use this to assess the incidence of endometrial, cervical cancer, or other gynaecological cancer in different age groups and ethnicities. We will also seek to identify different risk factors for these diseases, such as obesity, other medical conditions (e.g. polycystic ovary syndrome), prescriptions (metformin use). We will also investigate the interaction between gynaecological cancers and previous gynaecological history, other cancer diagnoses, recurrence, long-term illness and reduced immune system effectiveness. Furthermore, as many women who develop a gynaecological cancer have medical conditions that can make surgery challenging and high-risk, we also aim to assess different surgical options for endometrial cancer. Using data from women who have already undergone surgery (open, standard keyhole or robotic) and matching them for risk factors and characteristics, enables a real world ‘matched’ study to compare the outcomes from the three surgical approaches, including any impact on long-term cancer survival, complications and deaths, to determine the best treatment options for women.
The incidence of gynaecological malignancies is changing. Endometrial cancer (EC) incidence and mortality rates are rising and to date, modelling of the predicted incidence has failed to guide clinicians and healthcare providers as to the magnitude and complexity of the future EC population so that services can be commissioned appropriately. In particular, the questions as to whether there should be a screening programme, supra-regional centres for complex surgical cases and biomarker monitoring for disease recurrence have been raised. The objective of this research is to determine associations between the incidence/recurrence of EC and demographic and treatment factors, to enable identification of populations at increased risk and the most efficacious treatments, as well as enabling more accurate modelling of future incidences. This information is essential for commissioning services, the development of primary prevention strategies, optimising surgical and recurrence management and reducing health inequalities.
Aims:
i) to assess EC incidence in different populations
ii) to assess previous gynaecological history in women subsequently diagnosed with EC
iii) to assess rates of subsequent cancer diagnosis (including EC recurrence) in women who have had EC
iv) to assess optimal surgical management for EC
v) to describe and better understand the pre-menopausal EC population
vi) to model future incidence of EC given increasing obesity levels in the UK population
Data sources utilised will be CPRD, HES, Patient Level Index of Multiple Deprivation and NCRAS data (registration data, SACT and RTDS). Two cohorts will be extracted from CPRD
For the analyses Poisson regression models will be utilised to assess risk factors for incidence of EC. Cox proportional hazard models will be used to assess surgical interventions in the propensity matched study, and Markov models will be used to assess how future incidence of EC may change as the population in the UK changes.
i) The annual incidence rate of EC in different demographic groups (e.g. age group, ethnicity, obesity/overweight, parity, co-morbidities),
ii) Within EC population :
• Rates of stage of disease/histology/survival;
• Rates of primary treatment – surgery (route)/radiotherapy/chemotherapy/hormones;
• The incidence rates of secondary cancers and EC reoccurrence;
• Hazard ratios of hospitalisation, mortality and subsequent treatments comparing type of surgical management for EC.
• Estimation of future incidence rates in a UK population.
Esther Moss - Chief Investigator - University of Leicester
Clare Gillies - Corresponding Applicant - University of Leicester
Elpida Vounzoulaki - Collaborator - University of Leicester
Francesco Zaccardi - Collaborator - University of Leicester
Kamlesh Khunti - Collaborator - University of Leicester
Sharmin Shabnam - Collaborator - University of Leicester
Clare Gillies - Collaborator - University of Leicester
HES Admitted Patient Care;NCRAS Cancer Registration Data;NCRAS National Radiotherapy Dataset (RTDS) data;NCRAS Systemic Anti-Cancer Treatment (SACT) data;ONS Death Registration Data;Patient Level Index of Multiple Deprivation