Endometrial carcinoma in young women taking oral contraceptive agents.

Because of the reported rarity of endometrial carcinoma in young women who were taking oral contraceptives a Registry was established in November 1973 to record and review cases; this report is a summary of the first 21 cases entered in the Registry. All of these patients were less than 40-years-old. Oral contraceptive use was documented and ranged from 6 months to 10 years. 7 had taken 1 agent only while 14 had taken 2 or more preparations. In 7 patients oral contraceptives had been discontinued from 8 months to 6 years before the diagnosis of carcinoma was made. The diagnoses were confirmed by review of the slides. All were invasive carcinomas although 5 were classified as focal. Metastases were found in 1 case. Benign ovarian tumors were also found to be present in 3 patients. In 4 cases the ovaries were found to have subcapsular fibrosis and multiple lutenized follicular cysts (Stein-Leventahl syndrom). Of the 19 who underwent hysterectomy 7 had had preoperative radiation therapy. Of these 4 were found to have no residual tumor. Of 12 patients without prior radiation 9 were found to have a tumor limited to the endometrium. In 2 cases a residual tumor was not found after curettage only. These tumors were considered to have been focal. Histologic classification of the 21 tumors was adenocarcinoma in 10 adenoacanthoma in 5 mixed adenosquamous carcinoma in 2 clear cell carcinoma in 1 and secretory carcinoma in 3. Oracon (dimethisterone 25 mg and ethinyl estradiol .1 mg) had been used by 10 of 11 patients who had received only or mostly sequential agents. This preponderence of sequential agents was considered significant because it has been estimated that only 8% of contraceptives users take sequentials.