What are the guidelines for screening for endometrial (uterine lining) cancer?

From the Guidelines

Routine screening for endometrial cancer is not recommended for the general population, but women at high risk, such as those with Lynch syndrome, should consider annual screening starting at age 35 or 5-10 years before the earliest family diagnosis, as recommended by the most recent guidelines 1. The approach to screening for endometrial cancer varies based on the level of risk. For women at average risk, the most important approach is prompt evaluation of abnormal uterine bleeding, especially postmenopausal bleeding, as this is the earliest and most common symptom of endometrial cancer 1. Any woman with postmenopausal bleeding should undergo endometrial sampling, typically via endometrial biopsy in an office setting.

Key Considerations for High-Risk Women

• Women with Lynch syndrome or a strong family history of endometrial cancer are at high risk and should consider annual screening starting at age 35 or 5-10 years before the earliest family diagnosis 1.
• Screening typically involves endometrial biopsy, which is highly sensitive and specific as a diagnostic procedure 1.
• Transvaginal ultrasound may be considered at the clinician’s discretion but is not recommended as a screening tool in premenopausal patients due to the wide range of endometrial stripe thickness throughout the normal menstrual cycle 1.
• Total hysterectomy has not been shown to reduce endometrial cancer mortality but can reduce the incidence of endometrial cancer and is a risk-reducing option that can be considered, especially in women with Lynch syndrome 1. Some key points to consider in the management of women at high risk for endometrial cancer include:
• The importance of prompt reporting and evaluation of any abnormal uterine bleeding or postmenopausal bleeding 1.
• The role of endometrial biopsy as a diagnostic tool in women with symptoms or at high risk 1.
• The consideration of risk-reducing strategies such as total hysterectomy and bilateral salpingo-oophorectomy, particularly in women with Lynch syndrome 1. Overall, the approach to screening for endometrial cancer should be individualized based on a woman’s risk factors and medical history, with a focus on prompt evaluation of symptoms and consideration of risk-reducing strategies for those at high risk 1.

From the Research

Screening Methods for Endometrial Cancer

• Transvaginal ultrasound and endometrial biopsy are commonly used screening methods for endometrial cancer, particularly in women with Lynch syndrome 2, 3.
• The sensitivity of endometrial screening using transvaginal ultrasound and/or hysteroscopy/endometrial biopsy is 66.7%, with a number needed to screen ranging from 4 to 38 (median 7) 2.
• The sensitivity of endometrial biopsy alone is 57.1%, with a number needed to screen ranging from 23 to 380 (median 78) 2.
• Transvaginal ultrasound has a sensitivity of 34.4% and a number needed to screen ranging from 35 to 973 (median 170) 2.

Risk Factors and High-Risk Groups

• Women with Lynch syndrome have a 12-47% lifetime risk of developing endometrial cancer and are recommended to undergo annual surveillance using transvaginal ultrasound and endometrial biopsy from the age of 30-35 years 3.
• Women taking tamoxifen have a higher risk of endometrial cancer and should report any bleeding or spotting, although ultrasound screening is not recommended for asymptomatic women taking tamoxifen 4.
• Families with hereditary non-polyposis colon cancer have a higher risk of endometrial cancer and require counseling about this risk 4.

Prevention and Chemoprevention

• Progestin-containing oral contraceptives (OCP) have been shown to reduce the risk of endometrial cancer by 50% in women at general population risk, and may be effective in women with Lynch syndrome 5.
• Depo-Provera (depo-MPA) and OCP have been shown to induce a dramatic decrease in endometrial epithelial proliferation and microscopic changes in the endometrium characteristic of progestin action in women with Lynch syndrome 5.

Diagnostic Accuracy of Screening Methods

• Transvaginal ultrasonography has high sensitivity in diagnosing endometrial abnormalities, particularly when combined with aspiration biopsy 6.
• Hysteroscopy is necessary in postmenopausal women with an endometrium of 4 mm or more, as well as in premenopausal patients with endometrial thickness more than 5 mm (preovulatory phase of the cycle) and in those with suspected polyps or myomas 6.