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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.

      Key words

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      Linked Article

      • Early diagnosis in endometrial cancer minimizes the impact of treatments
        American Journal of Obstetrics & GynecologyVol. 219Issue 6
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          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).
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