BACKGROUND AND PURPOSE:

• Postmenopausal bleeding (PMB) is a common symptom of endometrial cancer but also associated with benign conditions
  • Endometrial cancer varies from 3% to 25%
  • Data on PPV and sensitivity of PMB for endometrial cancer are limited
  • PPV depends on underlying prevalence
    • PPV will improve in high prevalence populations
  • Clarke et al. (JAMA Internal Medicine, 2018) assessed the risk of endometrial cancer in the setting of PMB

METHODS:

• Systematic review and meta-analysis
• Studies reporting on endometrial cancer and PMB correlation and risk assessment
• Two independent authors selected and assessed studies for bias using accepted tools
• Primary outcomes
  • Pooled prevalence of PMB in women with endometrial cancer
  • Risk of endometrial cancer in women with PMB

RESULTS:

• 129 studies
  • 34,432 patients with PMB | 6,358 with endometrial cancer
• Pooled prevalence of PMB among women with endometrial cancer was 91% (95% CI, 87%-93%), with no significant difference by stage
  • Stage 1: 94%
  • Stage II to IV: 84%
• Risk of endometrial cancer among women with PMB was 9% (95% CI, 8%-11%), varying by
  • Hormone therapy (HT) excluded (12%) vs studies where HT was included (7%)
  • Geographic region: 5% (North America) to 13% (Western Europe)
  • Risk higher when enrollment was prior to 1990 (13%) vs 2010-2017 (8%)
• Patients with a minimum endometrial thickness of 4-5 mm: 19%
• Patients with polyps: 3%
• Endometrial cancer was not associated with
  • Mean age | Years since menopause | Percentage of women using HT

CONCLUSION:

• Detection strategies focused on PMB have potential to capture 90% of endometrial cancers
  • However, most women with PMB will not be diagnosed with endometrial cancer
• Women with PMB and a minimum endometrial thickness (4-5mm), the pooled risk of endometrial cancer was 19%, approximately 2x the risk of the general pool
  • Polyp risk was lower than general pool
• The authors state

As new markers are discovered or new clinical management strategies are evaluated, our results can aid in the assessment of their potential clinical value and will help to inform clinical and epidemiologic risk prediction models to support clinical decision making.

Learn More – Primary Sources:

Association of Endometrial Cancer Risk With Postmenopausal Bleeding in Women: A Systematic Review and Meta-analysis

Related ObG Topics:

Transvaginal Ultrasound in the Evaluation of Postmenopausal Bleeding

Endometrial Cancer: Beyond The Basics

Ovarian or Endometrial Cancer? Consider Lynch Syndrome