Is there a survival advantage in diagnosing endometrial cancer in asymptomatic postmenopausal patients? An Israeli Gynecology Oncology Group study


      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.


      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.


      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).


      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.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Siegel R.L.
        • Miller K.D.
        • Jemal A.
        Cancer statistics, 2018.
        CA Cancer J Clin. 2018; 68: 7-30
        • Koh W.J.
        • Greer B.E.
        • Abu-Rustum N.R.
        • et al.
        Uterine neoplasms, version 1.2014.
        J Natl Compr Canc Netw. 2014; 12: 248-280
        • Smith R.A.
        • Andrews K.S.
        • Brooks D.
        • et al.
        Cancer screening in the United States, 2017: a review of current American Cancer Society guidelines and current issues in cancer screening.
        CA Cancer J Clin. 2017; 67: 100-121
        • Jacobs I.
        • Gentry-Maharaj A.
        • Burnell M.
        • et al.
        Sensitivity of transvaginal ultrasound screening for endometrial cancer in postmenopausal women: a case-control study within the UKCTOCS cohort.
        Lancet Oncol. 2011; 12: 38-48
        • Ferrazzi E.
        • Zupi E.
        • Leone F.P.
        • et al.
        How often are endometrial polyps malignant in asymptomatic postmenopausal women? A multicenter study.
        Am J Obstet Gynecol. 2009; 200: 235.e1-235.e6
        • Machtinger R.
        • Korach J.
        • Padoa A.
        • et al.
        Transvaginal ultrasound and diagnostic hysteroscopy as a predictor of endometrial polyps: risk factors for premalignancy and malignancy.
        Int J Gynecol Cancer. 2005; 15: 325-328
        • Costa-Paiva L.
        • Godoy JR., C.E.
        • Antunes Jr., A.
        • Caseiro J.D.
        • Arthuso M.
        • Pinto-Neto A.M.
        Risk of malignancy in endometrial polyps in premenopausal and postmenopausal women according to clinicopathologic characteristics.
        Menopause. 2011; 18: 1278-1282
        • Antunes Jr., A.
        • Costa-Paiva L.
        • Arthuso M.
        • Costa J.V.
        • Pinto-Neto A.M.
        Endometrial polyps in pre- and postmenopausal women: factors associated with malignancy.
        Maturitas. 2007; 57: 415-421
        • Smith-Bindman R.
        • Weiss E.
        • Feldstein V.
        How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding.
        Ultrasound Obstet Gynecol. 2004; 24: 558-565
        • Visser N.C.M.
        • Reijnen C.
        • Massuger L.F.A.G.
        • Nagtegaal I.D.
        • Bulten J.
        • Pijnenborg J.M.A.
        Accuracy of endometrial sampling in endometrial carcinoma: a systematic review and meta-analysis.
        Obstet Gynecol. 2017; 130: 803-813
        • Munro M.G.
        • Christianson L.A.
        Complications of hysteroscopic and uterine resectoscopic surgery.
        Clin Obstet Gynecol. 2015; 58: 765-797
        • Obermair A.
        • Nanzal E.
        • Schreiner-Frech I.
        • et al.
        Influence of delayed diagnosis on established prognostic factors in endometrial cancer.
        Anticancer Res. 1996; 16: 947-949
        • Amant F.
        • Moerman P.
        • Neven P.
        • Timmerman D.
        • Van Limbergen E.
        • Vergote I.
        Endometrial cancer.
        Lancet. 2005; 366: 491-505
        • Gerber B.
        • Krause A.
        • Müller H.
        • et al.
        Ultrasonographic detection of asymptomatic endometrial cancer in postmenopausal patients offers no prognostic advantage over symptomatic disease discovered by uterine bleeding.
        Eur J Cancer. 2001; 37: 64-71
        • Kimura T.
        • Kamiura S.
        • Yamamoto T.
        • Seino-Noda H.
        • Ohira H.
        • Saji F.
        Abnormal uterine bleeding and prognosis of endometrial cancer.
        Int J Gynaecol Obstet. 2004; 85: 145-150
        • Seebacher V.
        • Schmid M.
        • Polterauer S.
        • et al.
        The presence of postmenopausal bleeding as prognostic parameter in patients with endometrial cancer: a retrospective multi-center study.
        BMC Cancer. 2009; 9: 460
        • Barak F.
        • Kalichman L.
        • Gdalevich M.
        • et al.
        The influence of early diagnosis of endometrioid endometrial cancer on disease stage and survival.
        Arch Gynecol Obstet. 2013; 288: 1361-1364
        • Elit L.M.
        • O'Leary E.M.
        • Pond G.R.
        • et al.
        Impact of wait times on survival for women with uterine cancer.
        J Clin Oncol. 2014; 32: 27-33
        • Marchetti M.
        • Vasile C.
        • Chiarelli S.
        Endometrial cancer: asymptomatic endometrial findings. Characteristics of postmenopausal endometrial cancer.
        Eur J Gynaecol Oncol. 2005; 26: 479-484
        • Dreisler E.
        • Stampe Sorensen S.
        • Ibsen P.H.
        • Lose G.
        Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20-74 years.
        Ultrasound Obstet Gynecol. 2009; 33: 102-108
        • Breijer M.C.
        • Peeters J.A.
        • Opmeer B.C.
        • et al.
        Capacity of endometrial thickness measurement to diagnose endometrial carcinoma in asymptomatic postmenopausal women: a systematic review and meta-analysis.
        Ultrasound Obstet Gynecol. 2012; 40: 621-629
        • Scrimin F.
        • Wiesenfeld U.
        • Galati E.F.
        • Monasta L.
        • Ricci G.
        Hysteroscopic chasing for endometrial cancer in a low-risk population: risks of overinvestigation.
        Arch Gynecol Obstet. 2016; 293: 851-856
        • Jørgensen K.J.
        • Gøtzsche P.C.
        • Kalager M.
        • Zahl P.H.
        Breast cancer screening in Denmark: A cohort study of tumor size and overdiagnosis.
        Ann Intern Med. 2017; 166: 313-323
        • Welch H.G.
        • Prorok P.C.
        • O'Malley A.J.
        • Kramer B.S.
        Breast-cancer tumor size, overdiagnosis, and mammography screening effectiveness.
        N Engl J Med. 2016; 375: 1438-1447
        • Autier P.
        • Boniol M.
        • Koechlin A.
        • Pizot C.
        • Boniol M.
        Effectiveness of and overdiagnosis from mammography screening in the Netherlands: population based study.
        BMJ. 2017; 359: j5224

      Linked Article

      • Early diagnosis in endometrial cancer minimizes the impact of treatments
        American Journal of Obstetrics & GynecologyVol. 219Issue 6
        • Preview
          We read with interest the paper from the Israeli Gynecology Oncology Group published by Gemer et al.1 The authors investigated whether asymptomatic postmenopausal patients have a survival benefit in comparison with symptomatic patients. Analyzing a large amount of data of women with endometrial cancer, the authors observed that women receiving an incidental diagnosis of endometrial cancer have no better outcomes than patients with compelling symptoms (ie, vaginal bleeding).
        • Full-Text
        • PDF