Advancing in Endometrial Cancer Prevention: Exploring the Role of Circadian Disruption Factors and the Sensitivity of Cervicovaginal Cytology for its Detection

[eng] INTRODUCTION: Endometrial cancer (EC) is the most common gynecological tumor in developed countries, with an increasing incidence due to population aging and growing obesity. This cancer is estrogen-dependent, so factors that disrupt the circadian rhythm, such as night work or sleep duration, could influence your risk by altering the production and metabolism of these hormones. Identifying modifiable risk factors is crucial to developing preventive strategies. Despite limited and conflicting evidence, it is important to continue investigating the impact of circadian disruption on the development of EC. EC manifests primarily through abnormal uterine bleeding, especially in postmenopausal women. In fact, 90% of women with this type of cancer experience this symptom. Standard diagnostic evaluation includes pelvic ultrasonography and endometrial biopsy if an increase in endometrial thickness is detected. The lack of a screening program for EC has prompted the search for new screening tools for this cancer. Recent research has focused on the sensitivity of molecular analysis in cervical and vaginal cytology for the detection of EC. Although preliminary results suggest that this approach may be more sensitive than traditional morphological assessment, the exact sensitivity of morphological assessment in cervical and vaginal cytology for the diagnosis of EC is unknown. Consequently, its accuracy in detecting CE remains debatable. HYPOTHESIS: We propose that the EC in Catalonia could increase by 2030 due to factors such as population ageing and obesity. We also postulate whether circadian disruption and cervicovaginal cytology could play a role in the development and detection of this disease. OBJECTIVES: The thesis has three main objectives: 1) To project the incidence and mortality of CE in Catalonia until 2030; 2) To determine whether circadian rhythm disturbance, measured through night work and sleep duration, increases the risk of developing EC; and 3) To evaluate the sensitivity of the morphological evaluation of cervicovaginal cytology to detect EC.