BACKGROUND AND PURPOSE:

• Estimated risk of occult uterine cancer unclear and often not based on subtypes
• Desai et al. (AJOG, 2019) sought to examine the prevalence of occult uterine cancer at hysterectomy for benign indications as well as related risk factors

METHODS:

• Retrospective Cohort Study
  • New York Statewide Planning and Research Cooperative System (SPARCS) database (2003-2013)
  • New York State Cancer Registry
• Participants
  • Inpatient or outpatient hysterectomy for benign indications
• Data analysis
  • Occult cancer definition: Newly diagnosed corpus uteri cancer within 28 days after the index hysterectomy
  • Prevalence of occult uterine cancer was estimated overall and by subtype
  • Developed and validated risk prediction models

RESULTS:

• 229,536 women were included
• Prevalence of occult cancer
  • Overall: 0.96% (95% CI, 0.92 to 1.00%)
  • Endometrial carcinoma: 0.75% (95% CI, 0.71 to 0.78%)
  • Uterine sarcoma: 0.22% (95% CI, 0.20 to 0.23%)
  • Leiomyosarcoma: 0.15% (95% CI, 0.13 to 0.17%)
• Stage
  • 71% of the endometrial carcinomas and 58.0% of the uterine sarcomas were at localized stage
• Risk for all occult uterine cancer
  • Varied across the age spectrum
    • 18-29 years: 0.10% | ≥75 years: 4.40% 
    • 1.03% prevalence reached in the 50 to 54 year cohort
  • Varied by indication
    • Endometriosis: 0.14% | Uterine fibroids: 0.62% | Postmenopausal bleeding: 8.43%
• Risk factors for occult uterine cancer included
  • Race/ethnicity
  • Obesity
  • Comorbidity
  • Personal history of malignancy
• Prediction models incorporating these risk factors had
  • High negative predictive values: 99.8% for endometrial carcinoma | 99.9% for uterine sarcoma
  • Relatively low positive predictive value

CONCLUSION:

• Overall, approximately 1% of women undergoing hysterectomy for benign indications had occult uterine cancer
• Prevalence higher than in some previous studies, however those tend to focus on myomectomy not hysterectomy and therefore may be skewed toward a younger, healthier patient population
• Patient characteristics may be useful and applied to algorithms
  • Risk algorithms in this study performed better for ruling out cancer rather than predicting the presence of an occult malignancy

Learn More – Primary Sources:

Prevalence, characteristics, and risk factors of occult uterine cancer in presumed benign hysterectomy

Related ObG Topics:

What is the Proportion of Cancer Attributable to Obesity in the U.S.?

What is the Prevalence of Occult Malignancy During Hysterectomy or Myomectomy for Benign Indications?

What is the Incidence of Occult Uterine Malignancy Following Vaginal Hysterectomy with Morcellation?