BACKGROUND AND PURPOSE:

• Screening for endometrial cancer is not currently recommended, although ultrasound has the potential to identify disease at an early stage
• Transvaginal ultrasound can detect endometrial cancer in asymptomatic patients
  • Endometrial thickness >11mm: 6.7% of cases will have an endometrial cancer diagnosis
  • Postmenopausal polyps: 0.87-2.31% will have an endometrial cancer diagnosis
• Gerner et al. (AJOG 2018) compared the survival of postmenopausal patients who had endometrial cancer diagnosed prior to symptoms vs those who presented with bleeding

METHODS:

• Retrospective multicenter study
• Data of consecutive patients who were followed up from date of surgery until an event
  • Recurrence
  • Death from endometrial cancer
  • Death
  • Follow up to 10 years
• Two patient cohorts (postmenopausal) were compared
  • Asymptomatic
  • bleeding
• Primary outcomes include the following measures
  • Clinical | Pathological | Survival

RESULTS:

• 1,607 patients were included
  • 233 asymptomatic (usually endometrial thickening following routine transvaginal ultrasound examination)
  • 1374 presented with postmenopausal bleeding
• Asymptomatic patients did not have a lower rate of advanced disease (II–IV) or high-grade histology
• Among patients with stage-I tumors, asymptomatic patients had
  • A greater proportion than postmenopausal bleeding patients of stage IA (82.1% vs 66.2%; P < .01)
  • A smaller proportion received adjuvant postoperative radiotherapy (30.5% vs 40.6%; P = .02)
• There was no difference between asymptomatic and postmenopausal bleeding patients in the following
  • The 5-year recurrence-free survival (79.1% vs 79.4%; P = .85)
  • Disease-specific survival (83.2% vs 82.2%; P = .57)
  • Overall survival (79.7% vs 76.8%; P = .37)

CONCLUSION:

• The difference in timing between asymptomatic and symptomatic detection allows early cancers to further penetrate the endometrium, but not result in metastases or worsening histology
• Treatment in asymptomatic postmenopausal women was not associated with higher survival rate
• This study agrees with previous literature that there does not appear to be an advantage to using ultrasound to screen for endometrial cancer
• The authors recognize limitations to this study, including retrospective design, and note that RCTs would be worthwhile
• In addition, they recommend that based on the results of this study, asymptomatic women with endometrial polyps or thickening could be carefully followed up with repeat 3-month ultrasounds
  • Bleeding or other symptoms should generate invasive confirmatory testing

Learn More – Primary Sources:

Is there a survival advantage in diagnosing endometrial cancer in asymptomatic postmenopausal patients? An Israeli Gynecology Oncology Group study

Related ObG Topics:

Transvaginal Ultrasound in the Evaluation of Postmenopausal Bleeding

Ovarian or Endometrial Cancer? Consider Lynch Syndrome

Endometrial Cancer: Beyond The Basics