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 HT 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 women have potential to capture 90% of endometrial cancers
However, most women with PMB will not be diagnosed with endometrial cancer
New strategies should be developed to inform the use of early detection markers and clinical management strategies
In women with PMB and at a minimum an endometrial thickness of 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.
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