Evaluations that focus on postmenopausal bleeding have the potential to capture as many as 90% of endometrial cancer, thus aiding in early detection and implementation of prevention strategies among women at increased risk for the disease, researchers have found (JAMA Intern Med. 2018;178[9]:1210-1222).

“As the worldwide burden of endometrial cancer continues to rise, interest is growing in the evaluation of early detection and prevention strategies among women at increased risk,” explained lead investigator Megan Clarke, PhD, MHS, Postdoctoral Fellow, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, and colleagues.

“Focusing efforts on women with postmenopausal bleeding…a common symptom of endometrial cancer, may be a useful strategy; however, PMB [postmenopausal bleeding] is not specific for endometrial cancer and is often caused by benign conditions,” they added. 

Prevalence of and Risks from Postmenopausal Bleeding

To establish a reference for the rate of postmenopausal bleeding in women with endometrial cancer, as well as the risk of endometrial cancer in women with postmenopausal bleeding,

Dr Clarke and colleagues performed a review and analysis of existing data.

“To our knowledge, this systematic review and meta-analysis is the first to evaluate the prevalence of PMB in endometrial cancer and the risk of endometrial cancer in women with PMB, 2 important variables for evaluating the role of PMB in early detection of endometrial cancer,” they said.

Dr Clarke and colleagues searched PubMed and Embase databases for studies reporting the frequency of postmenopausal bleeding in women with endometrial cancer and the risk for endometrial cancer in women with postmenopausal bleeding that were published between January 1, 1977, and January 31, 2017. Study quality and risk for bias were assessed using the Newcastle-Ottawa Quality Assessment Scale and the Quality Assessment of Diagnostic Accuracy Studies tool.

A total of 40,790 patients from 129 unique studies—including 34,432 patients with postmenopausal bleeding and 6358 patients with endometrial cancer—were analyzed.

A Foundation for Improving Risk-Informed Decision-Making

The pooled data from all 129 studies revealed a 91% prevalence of postmenopausal bleeding among women with endometrial cancer, regardless of tumor stage (95% confidence interval [CI], 87%-93%). The pooled risk for endometrial cancer among women with postmenopausal bleeding was 9% (95% CI, 8%-11%); this value varied depending on the use of hormone therapy (range, 7% [95% CI, 6%-9%] to 12% [95% CI, 9%-15%]; P <.001 for heterogeneity) and by geographic region (range, 5% [95% CI, 3%-11%] in North America to 13% [95% CI, 9%-19%] in Western Europe; P = .09 for heterogeneity).

“Our study represents an important and timely evaluation of the risk of endometrial cancer in women with PMB and can serve as a reliable reference for the prevalence of PMB in women with endometrial cancer and the risk of endometrial cancer in women with PMB, 2 requisite prior probabilities for prediction of endometrial cancer risk and secondary and tertiary prevention,” Dr Clarke and colleagues concluded.

“As new markers are discovered or new clinical management strategies are evaluated, our results can aid in the assessment of their potential clinical value and will help to inform clinical and epidemiologic risk prediction models to support clinical decision making,” they added.—Janelle Bradley