Detection of endometrial carcinoma and hyperplasia in asymptomatic women.

Occult endometrial carcinoma is a detectable disease using commercially available sampling devices and cytohistologic techniques. A cohort of 2586 asymptomatic women (98% past the age of 45, 78% caucasian) was screened. Of these women, 1567 were screened twice, and 187 were screened three times. The prevalence and incidence rates of endometrial carcinoma, as defined in the present study, including four missed cases, were 6.96 per 1000 and 1.71 per 1000 women years, respectively. The prevalence rate was 7.38 per 1000 for caucasian women and 5.40 per 1000 for women of other races. An epidemiologic evaluation suggested that the onset of menopause past the age of 49 was the only statistically significant risk factor, whereas race, parity, estrogen intake, and obesity, as calculated by the Quetelet index, were not statistically significant. The present study strongly suggests that in asymptomatic women past the age of 50, endometrial hyperplasia does not necessarily precede or accompany the development of endometrial carcinoma. Two distinct mechanisms may be responsible for the onset of endometrial cancer: endometrial hyperplasia occurring in the symptomatic and younger woman; and endometrial adenocarcinoma occurring ab initio in the older patient.

Endometrial carcinoma and its precursors: detection and screening.

This article summarizes the current status of an endometrial cancer detection program in asymptomatic women based on personal experience with 2007 examinees seen during 1979 and 1980. This ongoing feasibility study has shown that occult endometrial carcinoma occurs in approximately 5 of 1000 women age 45 and above and that the disease can be identified by the sampling techniques described in this paper. The identification of high-risk groups is emerging from this prospective study and may lead to a cost-efficient detection protocol that may prove applicable to large scale population screening. The benefits of this study in terms of lowered morbidity and mortality from endometrial carcinoma cannot be documented as yet and require several additional years of follow-up. Perhaps the principal benefit of this study is that it has provided prevalence data for endometrial carcinoma in a hitherto unscreened asymptomatic population against which all future efforts at endometrial cancer detection will have to be measured.

Screening of asymptomatic women for endometrial cancer.

This report describes the preliminary results of a feasibility study of detection of endometrial carcinoma in an asymptomatic population of women aged 45 and above. The initial sample of 1,280 women was evaluated by several cytologic smear techniques and by two endometrial sampling methods assigned by computer. The clinical approaches and the techniques used are detailed. During this initial period of study, eight histologically proved endometrial cancers were diagnosed, two of which were deeply invasive. With one exception, the eight patients were either obese or had a history of treatment with conjugated estrogens. A relatively small number of women with endometrial hyperplasia of various types were also identified. The accuracy of the detection methods and their long-term impact on morbidity and mortality cannot be assessed as yet. Incidentally, a small number of cancers and precancerous states of organs other than the endometrium have also been diagnosed.