Endometrial cancer (cancer of the uterine lining) has traditionally been viewed as a disease affecting middle-aged to older women. But in Malaysia, doctors are observing a shift: more cases among younger women, sometimes in their 20s or 30s. The implications are serious, as early detection is critical and management becomes more complex when fertility preservation is a concern.
While national-level, age-specific data on very young women (20s-30s) are limited, several studies point to an upward trend in uterine/endometrial cancers in Malaysia, and a nontrivial proportion of cases in reproductive age group women.
- A retrospective study in Hospital Melaka found that out of 281 endometrial cancer cases (2002-2020), 44.8% occurred in reproductive age group women.
- In Hospital Universiti Sains Malaysia (HPUSM) between 2016 and 2022, of 82 endometrial cancer patience, 32 (47.1%) were reproductive age group women
- The Malaysia National Cancer Registry (2012-2016) reports that uterine (womb) cancer rank among the top cancers in women in the country.
Though many of these cases still cluster in older age groups (often 50s-60s), the rising share in younger (premenopausal) women is a warning sign.
Why might this be Happening?
Dr. Anuradha, Consultant Gynaecologist and Gynaecology-Oncology Surgeon, states that the change is gradual but increasingly evident.
“It has been slowly increasing over the last few years. Due to an unhealthy lifestyle (poor diet & lack of physical activity) and exposure to harmful substances, leading to inflammation, hormonal imbalance and DNA damage” said Dr. Anuradha.
These are some factors align with known risk contributors for endometrial cancer in medical literature:
- Obesity and metabolic syndrome: A adipose (fat) tissue produces extra estrogen, which stimulates the endometrium and may predispose to malignant changes.
- Sedentary Lifestyle/low physical activity: Linked to higher cancer risk generally and possibly to hormone-sensitive cancers.
- Reproductive Factors: Polycystic Ovarian Syndrome (PCOS), nulliparity (never having given birth), earlier age at menarche and fewer pregnancies are recognised risk factors. Dr. Anuradha, echoes this,” Sedentary lifestyle, unhealthy diet, obesity. As well Polycystic Ovarian Syndrome, nulliparity and genetics are known risk factors”.
However, Dr. Anuradha cautions that lifestyle factors alone do not fully explain the rise. Genetic predispositions, family histories, and possibly earlier detection are also part of the picture.
The Challenge of Early Recognition
One of the core issues is that many early signs are subtle or dismissed. According to Dr. Anuradha, the most common early signs are abnormal vaginal bleeding (heavy or prolonged menses), abnormal vaginal discharge, postmenopausal bleeding, pelvic pain. Young women tend to miss or ignore changes in vaginal bleeding. In practice, a women experiencing irregular periods or unusual bleeding lasting more than a month should seek a doctor’s assessment, she advises.
In Malaysia, many patients still present at later stages, which limits treatment options and prognoses. In one local hospital (HPUSM) nearly half the patience presented with abnormal uterine bleeding, and a smaller fraction with postmenopausal bleeding or pelvic pain.
Treatment Dilemmas and Fertility Preservation
Standard care for endometrial cancer often involves surgical removal of the uterus (hysterectomy) possibly with removal of ovaries, and sometimes lymph node assessment. But for younger patients who want children, Dr. Anuradha explains a more conservative route:
“In a very early stage, hormonal treatment can be given in a patient who is keen to preserve the uterus if deemed suitable by the doctor. However, it is not the standard care of management for endometrial cancer. Response rate 50-60% with recurrence rate 40%”, said Dr. Anuradha.
In other words, about half of suitable patients may respond initially, but nearly two in five may experience relapse. This option is reserve for very early disease, carefully selected patients, and requires close monitoring.
What can be done: Awareness, Screening, Healthy Living
- For endometrial cancer, there is no guaranteed way to prevent it. But Dr. Anuradha stresses actionable steps
- Maintain a healthy weight, balanced diet, and regular physical activity
- Be aware of family history or genetic predispositions
- Seek evaluation promptly for persistent or abnormal bleeding
- Support better screening and early diagnostic pathways in healthcare systems
Because early detection greatly improves outcomes, increasing awareness among younger women is critical. What might be dismissed as ‘just irregular periods’ could warrant medical review.
The rise of endometrial cancer among younger Malaysian women signals an urgent need for greater awareness, earlier detection, and healthier lifestyle practices. While genetic and reproductive factors play their part, much of the risk is shaped by the way we live today as well. For young women, a key message is simple, never ignore abnormal bleeding or unusual changes in your menstrual cycle.
As endometrial cancer continues to affect women at younger ages, the voices of specialist like Dr. Anuradha remind us that vigilance, education, and timely healthcare are our strongest tools in reducing it’s impact.
With expert insights from Dr. Anuradha, Consultant Gynaecologist and Gynaecology Oncology Surgeon.
This is a Varnam Exclusive Feature! Any Reproduction Requires A Credit To Varnam Malaysia.
Sources: MDPI, MJPath, MOH, Cancer Matters,
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