Is there a survival advantage in diagnosing endometrial cancer in asymptomatic postmenopausal patients? An Israeli Gynecology Oncology Group study

Ofer Gemer, Yakir Segev, Limor Helpman, Nasreen Hag-Yahia, Ram Eitan, Oded Raban, Zvi Vaknin, Sophia Leytes, Alon Ben Arie, Amnon Amit, Tally Levy, Ahmed Namazov, Michael Volodarsky, Inbar Ben Shachar, Ilan Atlas, Ilan Bruchim, Ofer Lavie

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Background: Incidental ultrasonographic findings in asymptomatic postmenopausal women, such as thickened endometrium or polyps, often lead to invasive procedures and to the occasional diagnosis of endometrial cancer. Data supporting a survival advantage of endometrial cancer diagnosed prior to the onset of postmenopausal bleeding are lacking. Objective: To compare the survival of asymptomatic and bleeding postmenopausal patients diagnosed with endometrial cancer. Study Design: This was an Israeli Gynecology Oncology Group retrospective multicenter study of 1607 postmenopausal patients with endometrial cancer: 233 asymptomatic patients and 1374 presenting with postmenopausal bleeding. Clinical, pathological, and survival measures were compared. Results: There was no significant difference between the asymptomatic and the postmenopausal bleeding groups in the proportion of patients in stage II–IV (23.5% vs 23.8%; P =.9) or in high-grade histology (41.0% vs 38.4%; P =.12). Among patients with stage-I tumors, asymptomatic patients had a greater proportion than postmenopausal bleeding patients of stage IA (82.1% vs 66.2%; P <.01) and a smaller proportion received adjuvant postoperative radiotherapy (30.5% vs 40.6%; P =.02). There was no difference between asymptomatic and postmenopausal bleeding patients in the 5-year recurrence-free survival (79.1% vs 79.4%; P =.85), disease-specific survival (83.2% vs 82.2%; P =.57), or overall survival (79.7% vs 76.8%; P =.37). Conclusion: Endometrial cancer diagnosed in asymptomatic postmenopausal women is not associated with higher survival rates. Operative hysteroscopy/curettage procedures in asymptomatic patients with ultrasonographically diagnosed endometrial polyps or thick endometrium are rarely indicated. It is reasonable to reserve these procedures for patients whose ultrasonographic findings demonstrate significant change over time.

Original languageEnglish
Pages (from-to)181.e1-181.e6
JournalAmerican Journal of Obstetrics and Gynecology
Volume219
Issue number2
DOIs
StatePublished - 1 Aug 2018

Keywords

  • asymptomatic
  • endometrial cancer
  • polyp
  • postmenopausal bleeding
  • ultrasound

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