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Endometrial cancer is the most common gynecologic malignancy in U.S. and European women, but broad-based screening for this disease has not been recommended. In a nested case-control study of menopausal women who underwent transvaginal ultrasound (TVUS) as part of a large British trial of ovarian cancer screening (JW Womens Health Apr 16 2009), researchers evaluated TVUS-determined endometrial thickness and abnormalities in relation to subsequent diagnoses of endometrial cancer or atypical hyperplasia.
In analysis limited to 96 women with available TVUS measurements who had endometrial cancer or atypical hyperplasia without postmenopausal uterine bleeding, a 5-mm endometrial thickness cutoff had 77.1% sensitivity and 85.8% specificity. Greater weight, older age, and personal histories of breast cancer were associated with excess risk for endometrial cancer or atypical hyperplasia. When these factors were used to stratify women into quartiles, 39.5% of endometrial cancer or atypical hyperplasia cases were in the highest quartile. Among these highest-risk women, an endometrial thickness cutoff of 6.75 mm had 84.3% sensitivity and 89.9% specificity.
Jacobs I et al. Sensitivity of transvaginal ultrasound screening for endometrial cancer in postmenopausal women: A case-control study within the UKCTOCS cohort. Lancet Oncol 2010 Dec 13; [e-pub ahead of print]. (http://dx.doi.org/10.1016/S1470-2045(10)70268-0)
Vergote I et al. Should we screen for endometrial cancer? Lancet Oncol 2010 Dec 13; [e-pub ahead of print]. (http://dx.doi.org/10.1016/S1470-2045(10)70280-1)
Comment
Although this study — the largest yet to assess endometrial cancer screening performance — provides valuable information about the usefulness of transvaginal ultrasound in this context, the findings do not by themselves suggest that we should commence screening menopausal women for this gynecologic malignancy. Editorialists (all gynecologic oncologists) note the inexplicable finding that the optimal endometrial thickness cutoff in the highest-risk quartile was greater than that in lower-risk women; furthermore, the report provides no information about procedures (e.g., endometrial biopsies, hysteroscopies) performed in women with false-positive TVUS results. Finally, editorialists point out that not all endometrial cancers are life threatening. Accordingly, the long-term advantage of screening for endometrial cancer in asymptomatic women is uncertain.