The relation between age, time since menopause, and endometrial cancer in women with postmenopausal bleeding

Abstract

The objective is to assess among women with postmenopausal bleeding the relationship of age and time since menopause on one hand and the presence of endometrial cancer and atypical hyperplasia on the other hand. In a multicenter prospective cohort study, 614 women presenting with postmenopausal bleeding were included. Women underwent transvaginal sonography and, in cases where the endometrial thickness was >4 mm, endometrial sampling. Splines were used to assess the association between each of the continuous variables and (pre)malignancy of the endometrium. Subsequently, univariate and multivariate analysis were performed. The average age for women without (pre)malignancy was 61.7 years (SD 9.8). As malignant and premalignant cases were found to have similar age, these subgroups were merged in the analyses. Age was an independent predictor of (pre)malignancy. In women younger than 55 years, the odds ratio was 1.9 (95% CI: 1.1-3.3) for each year under 55 years of age and 1.03 (95% CI: 1.00-1.06) for each year over 55 years of age. The risk of (pre)malignancy of the endometrium was 4.9% in women less than 3 years postmenopausal versus 19.7% in women more than 20 years postmenopausal. However, in a multivariate analysis only age contributed to the prediction of risk. This study demonstrates that, in postmenopausal women with vaginal bleeding, the risk of (pre)malignancy of the endometrium is low in women under 50 years of age, increases considerably until 55 years of age, and rises only modestly with further advancing age. Future studies should explore whether these findings can be incorporated in the diagnostic work-up of women with postmenopausal bleeding.

Clinical Outcomes of Patients With Insufficient Sample From Endometrial Biopsy or Curettage

“…Considering the relatively low incidence of endometrial cancer, repeating the sampling procedure in every case is not justified (14)(15)(16). Considering the relatively low incidence of endometrial cancer, repeating the sampling procedure in every case is not justified (14)(15)(16).…”

Cost-effectiveness of diagnostic strategies for the management of abnormal uterine bleeding (heavy menstrual bleeding and post-menopausal bleeding): a decision analysis

“…For example, the probability of endometrial cancer in women with PMB rises from 1% in women younger than 50 years to 23.8% in women older than 80 years and the incidence of malignancy is, regardless of age, higher in women with PMB and obesity (18%) or diabetes (21%) compared with women without one of these risk factors. [75][76][77][78][79][80][81] The attractiveness of integrating the clinical process with diagnostic testing is that unnecessary testing can be avoided and that the accuracy, effectiveness and, ultimately, cost-effectiveness of current management approaches can be improved upon. In light of this, we developed two multivariable prediction models using IPD to estimate the risk of endometrial cancer in patients with PMB, taking into account their clinical characteristics, 73 to be used along with the established testing technologies within this economic analysis.…”

“…Individual patient risk factors for the development of endometrial cancer have been recognised for some time and these include obesity, diabetes and advancing age. [75][76][77][78][79][80][81] There has been recent interest in the integration of information easily obtainable from the preceding clinical history and examination into the overall diagnostic work-up. 64,73,74 Therefore, two multivariable prediction 73 were integrated into the diagnostic work-up.…”

“…These models were developed with data obtained from a prospective cohort study of 614 women presenting with PMB in one university hospital and seven teaching hospitals in the Netherlands. 79 These two models were used in three different diagnostic strategies for PMB to examine whether or not integration of germane clinical information with the currently recommended strategy of first-line testing with TVS 66,69 improves cost-effectiveness. These integrated strategies were: 73 l 'History only' -probability estimates based on characteristics of the women.…”

The First-Line Investigation of Postmenopausal Bleeding

“…The risk was 4.9% in women who were less than 3 years postmenopausal versus 19.7% in women who were more than 20 years postmenopausal. 31 A prospective study, by the same group, including 594 women with PMB (underwent TVS with EB if endometrial thickness was 94 mm) documented that the diagnostic accuracy of TVS thickness measurement in the diagnosis of endometrial hyperplasia and cancer was reduced in diabetic women and obese women, which questioned its clinical value. In the absence of hyperplasia or cancer, women with diabetes or obesity were found to have thicker endometrium than those without these risk factors, whereas in women with hyperplasia or cancer, this difference was not present.…”