Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2018 Sep 1;178(9):1210-1222.
doi: 10.1001/jamainternmed.2018.2820.

Association of Endometrial Cancer Risk With Postmenopausal Bleeding in Women: A Systematic Review and Meta-analysis

Megan A Clarke  1 , Beverly J Long  2 , Arena Del Mar Morillo  1 , Marc Arbyn  3 , Jamie N Bakkum-Gamez  2 , Nicolas Wentzensen  1
Affiliations
Meta-Analysis

Association of Endometrial Cancer Risk With Postmenopausal Bleeding in Women: A Systematic Review and Meta-analysis

Megan A Clarke et al. JAMA Intern Med. .

Abstract

Importance: As the worldwide burden of endometrial cancer continues to rise, interest is growing in the evaluation of early detection and prevention strategies among women at increased risk. Focusing efforts on women with postmenopausal bleeding (PMB), a common symptom of endometrial cancer, may be a useful strategy; however, PMB is not specific for endometrial cancer and is often caused by benign conditions.

Objective: To provide a reference of the prevalence of PMB in endometrial cancers and the risk of endometrial cancer in women with PMB.

Data sources: For this systematic review and meta-analysis, PubMed and Embase were searched for English-language studies published January 1, 1977, through January 31, 2017.

Study selection: Observational studies reporting the prevalence of PMB in women with endometrial cancer and the risk of endometrial cancer in women with PMB in unselected populations were selected.

Data extraction and synthesis: Two independent reviewers evaluated study quality and risk of bias using items from the Newcastle-Ottawa Quality Assessment Scale and the Quality Assessment of Diagnostic Accuracy Studies tool. Studies that included highly selected populations, lacked detailed inclusion criteria, and/or included 25 or fewer women were excluded.

Main outcomes and measures: The pooled prevalence of PMB in women with endometrial cancer and the risk of endometrial cancer in women with PMB.

Results: A total of 129 unique studies, including 34 432 unique patients with PMB and 6358 with endometrial cancer (40 790 women), were analyzed. The pooled prevalence of PMB among women with endometrial cancer was 91% (95% CI, 87%-93%), irrespective of tumor stage. The pooled risk of endometrial cancer among women with PMB was 9% (95% CI, 8%-11%), with estimates varying by use of hormone therapy (range, 7% [95% CI, 6%-9%] to 12% [95% CI, 9%-15%]; P < .001 for heterogeneity) and geographic region (range, 5% [95% CI, 3%-11%] in North America to 13% [95% CI, 9%-19%] in Western Europe; P = .09 for heterogeneity).

Conclusions and relevance: Early detection strategies focused on women with PMB have the potential to capture as many as 90% of endometrial cancers; however, most women with PMB will not be diagnosed with endometrial cancer. These results can aid in the assessment of the potential clinical value of new early detection markers and clinical management strategies for endometrial cancer and will help to inform clinical and epidemiologic risk prediction models to support decision making.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Prevalence of Postmenopausal Bleeding (PMB) in Women With Endometrial Cancer
The pooled prevalence of PMB is indicated by the dotted line. ES indicates effect size; LR, likelihood ratio; and diamond, pooled risk.
Figure 2.
Figure 2.. Risk of Endometrial Cancer in Women With Postmenopausal Bleeding
The pooled risk of endometrial cancer in all 92 studies is indicated by the dotted line. ES indicates effect size.
Figure 3.
Figure 3.. Risk of Endometrial Cancer in Women With Postmenopausal Bleeding
Figure 3 is a continuation of Figure 2. The pooled risk of endometrial cancer in all 92 studies is indicated by the dotted line. ES indicates effect size; LR, likelihood ratio; and diamond, pooled risk.
Figure 4.
Figure 4.. Risk of Endometrial Cancer in Women With Postmenopausal Bleeding in Studies That Excluded Women Using HT
The pooled risk of endometrial cancer in all 92 studies is indicated by the dotted line. ES indicates effect size; HT, hormone therapy; LR, likelihood ratio; and diamond, pooled risk.
See this image and copyright information in PMC

Comment in

References

    1. Ferlay J, Soerjomataram I, Dikshit R, et al. . Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359-E386. doi:10.1002/ijc.29210 - DOI - PubMed
    1. Setiawan VW, Yang HP, Pike MC, et al. ; Australian National Endometrial Cancer Study Group . Type I and II endometrial cancers: have they different risk factors? J Clin Oncol. 2013;31(20):2607-2618. doi:10.1200/JCO.2012.48.2596 - DOI - PMC - PubMed
    1. Jamison PM, Noone AM, Ries LA, Lee NC, Edwards BK. Trends in endometrial cancer incidence by race and histology with a correction for the prevalence of hysterectomy, SEER 1992 to 2008. Cancer Epidemiol Biomarkers Prev. 2013;22(2):233-241. doi:10.1158/1055-9965.EPI-12-0996 - DOI - PubMed
    1. Torre LA, Islami F, Siegel RL, Ward EM, Jemal A. Global cancer in women: burden and trends. Cancer Epidemiol Biomarkers Prev. 2017;26(4):444-457. doi:10.1158/1055-9965.EPI-16-0858 - DOI - PubMed
    1. Wartko P, Sherman ME, Yang HP, Felix AS, Brinton LA, Trabert B. Recent changes in endometrial cancer trends among menopausal-age US women. Cancer Epidemiol. 2013;37(4):374-377. doi:10.1016/j.canep.2013.03.008 - DOI - PMC - PubMed

Publication types