Endometrial carcinoma in high‐risk populations: is it time to consider a screening policy?

Abstract

Endometrial carcinoma (EC) is the leading female genital tract malignancy in industrialized countries. It will become an important public health problem in the coming years in the USA and Europe, where its incidence is increasing, and next-generation interventions should include periodical screening in high-risk women. In this review, we discuss the importance to gynaecologists of detecting women at high risk and offering an adequate screening programme. Screening for EC is particularly challenging and there is currently no proven programme for the surveillance of women estimated to be at an increased risk of developing this form of cancer. The data in the literature, including this and previous issues of Cytopathology, and personal experience suggest that endometrial liquid-based cytology (LBC) might play an essential role in a screening policy for EC. LBC may enable practitioners to reduce age-adjusted mortality for women at high risk for EC

Clinical translation for endometrial cancer stem cells hypothesis

“…In the UK, there was an increase from 13.5 to 20.3 per 100,000 considering 1993 and 2010 [3]. In Europe, the latest report from 2012 considering corpus uteri cancer show an incidence from 14 to 29 per 100,000 and a mortality rate rounding 4 for 100,000 (http://globocan.iarc.fr).…”

New perspectives on screening and early detection of endometrial cancer

“…First reports evaluating asymptomatic women showed that fragments of tissue obtained by devices comparable to pipelle were very valuable in the diagnosis of endometrial cancer, contrary to endometrial smears . Interpretation of endometrial smears has been hampered in the past years by excess of mucus and blood, and overlapping cells . However, the introduction of liquid‐based technologies in the past years has reduced these flaws and helped improving the accuracy of endometrial cytology .…”

“…104,105 Interpretation of endometrial smears has been hampered in the past years by excess of mucus and blood, and overlapping cells. 106 However, the introduction of liquid-based technologies in the past years has reduced these flaws and helped improving the accuracy of endometrial cytology. 106 Endometrial smears have been used in Japan in mass early detection programs (among symptomatic ≥50 aged women attending a cervical cancer screening program), which showed the identification of less aggressive cancers compared to the regular diagnoses in the outpatient clinics.…”

“…106 However, the introduction of liquid-based technologies in the past years has reduced these flaws and helped improving the accuracy of endometrial cytology. 106 Endometrial smears have been used in Japan in mass early detection programs (among symptomatic ≥50 aged women attending a cervical cancer screening program), which showed the identification of less aggressive cancers compared to the regular diagnoses in the outpatient clinics. 107 Other promising sampling methods include vaginal tampons: epigenomic analyses of DNA obtained with tampons or vaginal swabs have shown feasibility to detect endometrial cancer in few proof-of-concepts.…”

Bioinformatic screening for candidate biomarkers and their prognostic values in endometrial cancer

“…Currently, there are no known reliable diagnostic and prognostic biomarkers for EC. Cancer antigen 125 (CA125), being most frequently used as a biomarker for ovarian cancer, has some diagnostic/prognostic value in EC [3]. However, CA125 level is elevated in a number of physiological and pathological conditions, such as age [4,5], pregnancy [6], menstruation [4,6], and in gynaecological and nongynaecological disorders, such as endometriosis [6], benign ovarian cysts [6], pelvic in ammatory disease [6], peritonitis [6], pancreatitis [6], and pneumonia [6].…”