Scoring women with postmenopausal bleeding can capture up to 90% of endometrial cancers, according to a meta-analysis recently published in JAMA Internal Medicine.
However, researchers led by Megan A. Clarke, PhD, MHS, of the National Cancer Institute warned that most women with postmenopausal bleeding will not be diagnosed with endometrial cancer.
“Current guidelines recommend a work-up to rule out endometrial cancer in all women with postmenopausal bleeding,” wrote Clarke and colleagues. “Our results support this recommendation by providing confidence that most endometrial cancer will be captured by targeting this risk group of women for early detection and prevention strategies.”
Endometrial cancer is the most common gynecologic cancer in developed countries and the incidence of the disease has increased in recent years. Postmenopausal bleeding is a common symptom of endometrial cancer. With this study, Clarke and colleagues wanted to assess the prevalence of postmenopausal bleeding in women with endometrial cancer and the risk for this cancer in women with postmenopausal bleeding.
The researchers reviewed the literature on endometrial cancer and postmenopausal bleeding from English-language studies published between 1977 and 2017. The analysis included data from 129 studies that included 34,432 women with postmenopausal bleeding and 6,358 women with endometrial cancer.
91% of women with endometrial cancer had postmenopausal bleeding. There was no significant difference in the prevalence of postmenopausal bleeding in the cancer stage. Looking at different geographic regions, the researchers found that the prevalence of postmenopausal bleeding was 94% in North America and 90% in West Asia and East Asia.
The overall overall risk of endometrial cancer in women with postmenopausal bleeding was 9%, according to the study. This risk increased to 12% when the data were limited to those studies that excluded women using hormone therapy.
“The use of hormone therapy affects this relationship on several levels,” said the researchers. “Certain combined formulations of estrogen plus progestin therapy have a protective effect on the endometrium. In addition, irregular uterine bleeding is a common side effect of hormone therapy, especially within the first 6 months after use. “
The risk of cancer in women with postmenopausal bleeding was lowest in North America (5%) and highest in Western Europe (13%).
“The widespread practice of referring all women with postmenopausal bleeding for transvaginal ultrasound and / or endometrial biopsy is associated with significant burdens and costs,” the researchers write. “Given the rise in the incidence and mortality of endometrial cancer, our findings raise the important question of how best to manage postmenopausal bleeding to maximize the usefulness of early detection approaches and avoid unnecessary harm.”
In an editorial published with the study, Dr. med. Kristen A. Matteson of the MPH of the Providence Women’s and Infant Hospital, Rhode Island, and colleagues named the study’s authors for conducting a study that “should inform both research and clinical care.”
Maurie Markman, MD, President of the Cancer Treatment Centers of America in Boca Raton, Florida, believes the results of this meta-analysis are important.
“This analysis is relevant because it provides a relatively straightforward summary for doctors who see women with postmenopausal bleeding with the potential for the underlying disease to be endometrial cancer. In the diagnostic decision-making process, it is important to know that approximately 90% of women with endometrial cancer will have postmenopausal bleeding, but conversely only about 10% of women with postmenopausal bleeding will ultimately have endometrial cancer, ”he told Cancer Network.
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