title: Ultrasonographic detection of asymptomatic endometrial cancer in postmenopausal patients offers no prognostic advantage over symptomatic disease discovered by uterine bleeding.
abstract: The aim of this study was to investigate whether endometrial carcinoma (EC) screening by transvaginal sonography (TVS) has a prognostic advantage over symptomatic EC. In a retrospective study, 190 postmenopausal patients with symptomatic EC and 123 asymptomatic patients with suspicious endometrium detected by TVS were analysed regarding clinical, socio-economic and histopathological findings. Total bleeding time and the International Federation of Gynecology and Obstetrics (FIGO) tumour stage were evaluated with respect to their effect on survival. In 123 asymptomatic patients with suspicious endometrium, 16 (13%) EC, 61 (50%) polyps, 21 (17%) hyperplasias, 23 (19%) atrophias, 1 (0.8%) myoma and 1 (0.8%) metastasis were found. TVS findings in asymptomatic patients resulted in unnecessary operations, which were associated with considerable costs totalling at least 116256. Compared with screened asymptomatic patients, symptomatic patients were significantly (P<0.05) older, more frequently obese, and hypertensive, had a larger proportion of cases living in rural areas and visited their gynaecologists rarely. The bleeding time of symptomatic patients strongly correlated with the tumour stage (P<0.0001). Depending on the bleeding time, the 5-year disease-free survival and overall survival rates were 77% and 86% (no bleeding), 83% and 98% (<8 weeks), 74% and 90% (8-16 weeks), and 62% and 69% (>16 weeks), respectively. The corresponding tumour stage-related data for disease-free and overall survival were 100% (Ia; both rates), 87% and 95% (Ib), 66% and 93% (Ic), 63% and 78% (II) and 36% (III/IV; both rates), respectively. Postmenopausal vaginal bleeding represents an early symptom of EC, but it is not always perceived as problematic by the patients. There is no prognostic advantage for screened compared with symptomatic patients, who had bleeding of shorter than 8 weeks. Moreover, patients who are at a high risk for EC tend to avoid TVS screening. Finally, endometrial screening often results in unnecessary operations, which are associated with increased morbidity and costs.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Rostock, Post Box 10 08 88, 18055, Rostock, Germany. bernd.gerber@med.uni-rostock.de
authors.forename: B
authors.initials: B
authors.lastname: Gerber
authors.forename: A
authors.initials: A
authors.lastname: Krause
authors.forename: H
authors.initials: H
authors.lastname: Müller
authors.forename: T
authors.initials: T
authors.lastname: Reimer
authors.forename: T
authors.initials: T
authors.lastname: Külz
authors.forename: G
authors.initials: G
authors.lastname: Kundt
authors.forename: K
authors.initials: K
authors.lastname: Friese
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000191:economics; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging / Q000191:economics / Q000209:etiology*