Is there a survival advantage in diagnosing endometrial cancer in asymptomatic postmenopausal patients? An Israeli Gynecology Oncology Group study.
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.
['Gemer|Ofer|O|', 'Segev|Yakir|Y|', 'Helpman|Limor|L|', 'Hag-Yahia|Nasreen|N|', 'Eitan|Ram|R|', 'Raban|Oded|O|', 'Vaknin|Zvi|Z|', 'Leytes|Sophia|S|', 'Ben Arie|Alon|A|', 'Amit|Amnon|A|', 'Levy|Tally|T|', 'Namazov|Ahmed|A|', 'Volodarsky|Michael|M|', 'Ben Shachar|Inbar|I|', 'Atlas|Ilan|I|', 'Bruchim|Ilan|I|', 'Lavie|Ofer|O|']
D018262:Adenocarcinoma, Clear Cell D000368:Aged D058070:Asymptomatic Diseases D001706:Biopsy D018269:Carcinoma, Endometrioid D002296:Carcinosarcoma D002423:Cause of Death D017024:Chemotherapy, Adjuvant D018572:Disease-Free Survival D055088:Early Detection of Cancer D016889:Endometrial Neoplasms D004717:Endometrium D005260:Female D006801:Humans D007044:Hysterectomy D033162:Incidental Findings D007557:Israel D008197:Lymph Node Excision D008875:Middle Aged D060787:Neoplasm Grading D009367:Neoplasm Staging D018297:Neoplasms, Cystic, Mucinous, and Serous D010388:Pelvis D011127:Polyps D017698:Postmenopause D016016:Proportional Hazards Models D018714:Radiotherapy, Adjuvant D012189:Retrospective Studies D000074868:Salpingo-oophorectomy D015996:Survival Rate D014463:Ultrasonography D014592:Uterine Hemorrhage
endometrial cancer asymptomatic polyp postmenopausal bleeding ultrasound