Endometrial cancer: trends in incidence and survival: a preventable disease?

Endometrial cancer is the commonest gynaecological cancer. Its relative increase in incidence over recent decades has been generally associated with a reduction in mortality. Evidence is presented to show a considerable variation in incidence worldwide; Australia, like England and Wales, has a comparatively low incidence. The incidence is highest in parts of the United States where it has shown an annual fall of nearly 3% between 1973 and 1987. The influence of hysterectomy, oral contraception and hormone replacement therapy at the menopause are discussed relative to incidence and prevention of the disease. Obesity and its prevention are also shown to have an influence on incidence and its ethnic variation worldwide. Despite a minor improvement in survival in FIGO published figures, the recent COSA-UK-NZ 'high risk' trial highlights the importance to the patient of closely monitored clinical trials.