What is the Association Between Postmenopausal Bleeding and Risk for Endometrial Cancer?
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
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
Pooled prevalence of PMB in women with endometrial cancer
Risk of endometrial cancer in women with PMB
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
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.
Please log in to access ObGFirst and the 2T US Atlas
Media - Internet
Computer System Requirements
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan