title: Endometrial cancer after endometrial ablation vs medical management of abnormal uterine bleeding.
abstract: OBJECTIVE
  To investigate whether endometrial ablation is associated with increased risk or delayed diagnosis of endometrial cancer compared with medical management of abnormal uterine bleeding.
  
  
  METHODS
  Multi-centered retrospective cohort study (Canadian Task Force classification II-2).
  
  
  METHODS
  The study was performed using data from The Health Improvement Network, a representative population-based cohort of patients in 495 outpatient general practitioner practices in the United Kingdom.
  
  
  METHODS
  Women aged >25 years with abnormal uterine bleeding diagnosed between June 1994 and September 2010.
  
  
  METHODS
  Endometrial ablation, medical management, or both.
  
  
  RESULTS
  A total of 234 721 women met study inclusion and exclusion criteria, 4776 of whom underwent endometrial ablation and the remaining 229 945 received medical management. Cox models compared endometrial cancer rates between ablation and medical management groups using hazard ratios. To investigate a possible diagnostic delay, the median time from bleeding diagnosis to endometrial cancer diagnosis in women in whom endometrial cancer developed was compared using the Mann-Whitney U test. All statistical tests were 2-tailed, with α = .05. During a median observation period of 4.07 years (interquartile range [IQR], 1.88-7.17), endometrial cancer developed in 3 women in the ablation group and 601 women in the medical management group (ablation hazard ratio, 0.45; 95% confidence interval, 0.15-1.40; p = .17). Median time to diagnosis was 237 in the ablation group, and 299 days in the medical management group (ablation IQR, 155-1350; medical management IQR, 144-1133.5; p = .99). Adjusted and sensitivity analyses did not change the results.
  
  
  CONCLUSIONS
  No difference was observed in endometrial cancer rates, and there was no delay in diagnosis when comparing endometrial ablation vs medical management. Further studies are needed to investigate the effect of previous ablation exposure on histology or cancer stage at manifestation of endometrial cancer.
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia. Electronic address: Robert.Dood@uphs.upenn.edu.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Dood
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Clarisa R
authors.initials: CR
authors.lastname: Gracia
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Mary D
authors.initials: MD
authors.lastname: Sammel
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Haynes
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Suneeta
authors.initials: S
authors.lastname: Senapati
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Strom
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D057210:Delayed Diagnosis; D055356:Endometrial Ablation Techniques / Q000009:adverse effects; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D008595:Menorrhagia / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D006113:United Kingdom; D014594:Uterine Neoplasms / Q000175:diagnosis* / Q000601:surgery
keywords: Endometrial ablation techniques; Endometrial neoplasms; Menorrhagia; Uterine neoplasms