51 Association of endometrial thickness with premenopausal endometroid endometrial cancer and atypical hyperplasia and correlation to patient and disease characteristics

Missed opportunities for young women with endometrial cancer: A call to action

“…Further, young non-Hispanic Black and Hispanic women are disproportionately affected by the increase in endometrial cancer ( Somasegar et al, 2023 ). Though the association between obesity, anovulatory bleeding, excess estrogen, and the development of endometrial cancer is well established, Grubman and colleagues additionally identified incomplete workup of abnormal uterine bleeding (AUB) as a risk factor for delayed diagnosis and worse oncologic outcomes for premenopausal women with endometrial cancer ( Grubman et al, 2023 , Dolly et al, 2016 ).…”

“…The American College of Obstetricians and Gynecologists (ACOG) recommends tissue sampling as a first line test for women over age 45 with AUB due to the increased probability of endometrial cancer ( American College of Obstetricians and Gynecologists Committee on Practice Bulletins – Gynecology, 2012 ). In fact, women with AUB over age 45 in Grubman’s study experienced a reduced time to endometrial sampling ( Grubman et al, 2023 ). Because ACOG recommends several other diagnostic steps or the presence of additional risk factors, including obesity, history of polycystic ovarian syndrome (PCOS), persistent AUB, or failure of medical management, prior to tissue sampling for women under age 45, these younger women are especially at risk for delayed diagnosis of endometrial cancer.…”

“…Furthermore, research by Doll and colleagues has demonstrated the reliance on the 4 mm endometrial thickness threshold may contribute to healthcare disparities by delaying endometrial cancer diagnosis for Black women and having a five-fold increased chance of missing a cancer diagnosis based on this threshold ( Doll et al, 2021 ). In Grubman’s study, most patients experienced an incomplete workup for AUB, and ultrasound was frequently the only intervention received ( Grubman et al, 2023 ). Clearly, there is a need for earlier and more frequent tissue sampling.…”

“…In addition to the need for better public education regarding AUB, healthcare providers can improve adherence to guidelines for patients at risk for endometrial cancer. Though ACOG recommends first-line endometrial biopsy for patients at increased risk of hyperplasia or cancer, fewer than half (43.6 %) of patients meeting these criteria underwent prompt endometrial sampling in Grubman’s study ( Grubman et al, 2023 ). Obese patients at the highest risk (class III obesity, BMI ≥ 40 kg/m 2 ) of endometrial cancer were among the least likely (only 10.9 %) to receive a complete work-up and experienced a prolonged time to sampling.…”