Screening for Uterine Cancer

Even though uterine cancer is the fourth most common cancer among women in Singapore and even though the number of cancers has increased from 8 per 100,000 population in 1993 to 11.7 per 100,000 population in 2006, there is no recommended screening for women of average risk for uterine cancer.

Those who are at an increased (but not high) risk for uterine cancer include women who have received unopposed estrogen, such as in HRT for menopause, women of late menopause, those women on Tamoxifen, women who’ve had no children, women who fail to ovulate as a cause of infertility, women with obesity, diabetes or hypertension. Women at high risk for uterine cancer have known hereditary non-polyposis colorectal cancer.

Average risk women get no screening unless they have abnormal vaginal bleeding, such as bleeding between periods or bleeding after menopause. The reason average women are not checked is that the screening of asymptomatic women has not been shown to decrease mortality from this type of cancer. Screening involves a relatively invasive test such as an endometrial sampling along with a trans-vaginal ultrasound. Pap tests are found to be insensitive to detecting endometrial cancer and are not recommended.

Women with hereditary non-polyposis colorectal cancer syndrome have a high risk of having cancer of the endometrium. The lifetime risk is between 27 and 71 percent. This means that all women with hereditary non-polyposis colorectal cancer syndrome should be screened annually with an endometrial sampling and a trans-vaginal ultrasound. These women should be informed about their risk for endometrial cancer and should have a test done if they develop any symptoms between screening tests.

The good news is that when endometrial cancer is found, it is usually found in a favorable and early stage so that a hysterectomy, along with radiation or chemotherapy, if necessary, often takes care of eh problem completely. Women should be encouraged to tell their physician anytime they develop signs and symptoms of endometrial cancer, such as lower abdominal pain and bleeding from the vaginal area.

Those with a positive endometrial scraping should have a hysteroscopy and endometrial biopsy. A hysteroscopy is a camera study of the uterus that looks for cancerous polyps or bleeding areas. If this is positive for cancer using a hysteroscopically-guided biopsy, then a hysterectomy and exploratory surgery for positive lymph nodes or positive cancerous tissue out of the uterus is performed.