Screening and Prevention of Carcinoma Endometrium


Carcinoma endometrium is the most common malignancy of the female genital tract in the developed world and the fourth most common cancer in women after breast, lung, and colorectum. The estimated new cases from endometrial cancer in the United States are 52,630 and deaths are 8,590 [1]. It is the second most common malignancy of the female genital tract in the developing world. The incidence in developing countries and Japan are four to five times lower than the developed world. In India, the rates are as low as 4.3 per 100,000 [2]. In recent years incidence in India is increasing – double the incidence as per recent cancer registry data. Due to increasing magnitude of the problem, screening and steps of prevention are of great importance.


Endometrial Cancer Lynch Syndrome Vaginal Bleeding Endometrial Thickness Endometrial Hyperplasia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Cancer facts & figures 2014: annual publication of the American Cancer Society. AtlantaGoogle Scholar
  2. 2.
    Balasubramaniam G, Sushama S, Rasika B, Mahantshetty U. Hospital-based study of endometrial cancer survival in Mumbai, India. Asian Pac J Cancer Prev. 2013;14(2):977–80.PubMedCrossRefGoogle Scholar
  3. 3.
    Geldenhuys L, Murray ML. Sensitivity and specificity of the Pap smear for glandular lesions of the cervix and endometrium. Acta Cytol. 2007;51(1):47–50.PubMedCrossRefGoogle Scholar
  4. 4.
    Moatamed NA, Le LT, Levin MR, Govind R, Apple SK. In Papanicolaou smears, benign appearing endometrial cells bear no significance in predicting uterine endometrial adenocarcinomas. Diagn Cytopathol. 2013;41(4):335–41.PubMedCrossRefGoogle Scholar
  5. 5.
    Smith-Bindman R, Weiss E, Feldstein V. How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding. Ultrasound Obstet Gynecol. 2004;24(5):558–65.PubMedCrossRefGoogle Scholar
  6. 6.
    Smith-Bindman R, Kerlikowske K, Feldstein VA, Subak L, Scheidler J, Segal M, et al. Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA. 1998;280(17):1510–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Burke W, Petersen G, Lynch P, Botkin J, Daly M, Garber J, et al. Recommendations for follow-up care of individuals with an inherited predisposition to cancer. I. Hereditary nonpolyposis colon cancer. Cancer Genetics Studies Consortium. JAMA. 1997;277(11):915–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Berek JS, Hacker NF. Berek and Hacker’s gynecologic oncology. 5th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health; 2010. p. 396.Google Scholar
  9. 9.
    Fleischer AC, Wheeler JE, Lindsay I, Hendrix SL, Grabill S, Kravitz B, et al. An assessment of the value of ultrasonographic screening for endometrial disease in postmenopausal women without symptoms. Am J Obstet Gynecol. 2001;184(2):70–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Saatli B, Yildirim N, Olgan S, Koyuncuoglu M, Emekci O, Saygılı U. The role of endometrial thickness for detecting endometrial pathologies in asymptomatic postmenopausal women. Aust N Z J Obstet Gynaecol. 2014;54(1):36–40.PubMedCrossRefGoogle Scholar
  11. 11.
    Archer DF, McIntyre-Seltman K, Wilborn Jr WW, Dowling EA, Cone F, Creasy GW, et al. Endometrial morphology in asymptomatic postmenopausal women. Am J Obstet Gynecol. 1991;165(2):317–20. discussion 320–2.PubMedCrossRefGoogle Scholar
  12. 12.
    Gull B, Karlsson B, Milsom I, Granberg S. Can ultrasound replace dilation and curettage? A longitudinal evaluation of postmenopausal bleeding and transvaginalsonographic measurement of the endometrium as predictors of endometrial cancer. Am J Obstet Gynecol. 2003;188(2):401–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Fung MF, Reid A, Faught W, Le T, Chenier C, Verma S, et al. Prospective longitudinal study of ultrasound screening for endometrial abnormalities in women with breast cancer receiving tamoxifen. Gynecol Oncol. 2003;91(1):154–9.PubMedCrossRefGoogle Scholar
  14. 14.
    American College of Obstetricians and Gynecologists. Tamoxifen and uterine cancer. Committee opinion no. 601. Obstet Gynecol. 2014;123:1394–7.Google Scholar
  15. 15.
    Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah M, Cronin WM, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst. 1998;90:1371–88.PubMedCrossRefGoogle Scholar
  16. 16.
    Cheng WF, Lin HH, Torng PL, Huang SC. Comparison of endometrial changes among symptomatic tamoxifen-treated and nontreated premenopausal and postmenopausal breast cancer patients. Gynecol Oncol. 1997;66:233–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Achiron R, Lipitz S, Sivan E, Goldenberg M, Horovitz A, Frenkel Y, et al. Changes mimicking endometrial neoplasia in postmenopausal, tamoxifen-treated women with breast cancer: a transvaginal Doppler study. Ultrasound Obstet Gynecol. 1995;6:116–20.PubMedCrossRefGoogle Scholar
  18. 18.
    Bertelli G, Venturini M, Del Mastro L, Garrone O, Cosso M, Gustavino C, et al. Tamoxifen and the endometrium: findings of pelvic ultrasound examination and endometrial biopsy in asymptomatic breast cancer patients. Breast Cancer Res Treat. 1998;47:41–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Love CD, Muir BB, Scrimgeour JB, Leonard RC, Dillon P, Dixon JM. Investigation of endometrial abnormalities in asymptomatic women treated with tamoxifen and an evaluation of the role of endometrial screening. J Clin Oncol. 1999;17:2050–4.PubMedGoogle Scholar
  20. 20.
    Markovitch O, Tepper R, Aviram R, Fishman A, Shapira J, Cohen I. The value of sonohysterography in the prediction of endometrial pathologies in asymptomatic postmenopausal breast cancer tamoxifen-treated patients. Gynecol Oncol. 2004;94:754–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Berliere M, Charles A, Galant C, Donnez J. Uterine side effects of tamoxifen: a need for systematic pretreatment screening. Obstet Gynecol. 1998;91:40–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Berliere M, Radikov G, Galant C, Piette P, Marbaix E, Donnez J. Identification of women at high risk of developing endometrial cancer on tamoxifen. Eur J Cancer. 2000;36 suppl 4:S35–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Vosse M, Renard F, Coibion M, Neven P, Nogaret JM, Hertens D. Endometrial disorders in 406 breast cancer patients on tamoxifen: the case for less intensive monitoring. Eur J Obstet Gynecol Reprod Biol. 2002;101:58–63.PubMedCrossRefGoogle Scholar
  24. 24.
    Chalas E, Costantino JP, Wickerham DL, Wolmark N, Lewis GC, Bergman C, et al. Benign gynecologic conditions among participants in the Breast Cancer Prevention Trial. Am J Obstet Gynecol. 2005;192:1230–7. discussion 1237–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Barakat RR, Wong G, Curtin JP, Vlamis V, Hoskins WJ. Tamoxifen use in breast cancer patients who subsequently develop corpus cancer is not associated with a higher incidence of adverse histologic features. Gynecol Oncol. 1994;55(2):164–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Fornander T, Hellström AC, Moberger B. Descriptive clinicopathologic study of 17 patients with endometrial cancer during or after adjuvant tamoxifen in early breast cancer. J Natl Cancer Inst. 1993;85(22):1850–5.PubMedCrossRefGoogle Scholar
  27. 27.
    Barakat RR, Gilewski TA, Almadrones L, Saigo PE, Venkatraman E, Hudis C, et al. Effect of adjuvant tamoxifen on the endometrium in women with breast cancer: a prospective study using office endometrial biopsy. J Clin Oncol. 2000;18(20):3459–63.PubMedGoogle Scholar
  28. 28.
    Berry E, Lindheim SR, Connor JP, Hartenbach EM, Schink JC, Harter J, Eickhoff JC, Kushner DM. Sonohysterography and endometrial cancer: incidence and functional viability of disseminated malignant cells. Am J Obstet Gynecol. 2008;199(3):240.e1–8.CrossRefGoogle Scholar
  29. 29.
    Duffy S, Jackson TL, Lansdown M, Philips K, Wells M, Pollard S, et al. The ATAC adjuvant breast cancer trial in postmenopausal women: baseline endometrial subprotocol data. BJOG. 2003;110(12):1099–106.PubMedCrossRefGoogle Scholar
  30. 30.
    Bradley WH, Boente MP, Brooker D, Argenta PA, Downs LS, Judson PL, et al. Hysteroscopy and cytology in endometrial cancer. Obstet Gynecol. 2004;104(5 Pt 1):1030–3.PubMedCrossRefGoogle Scholar
  31. 31.
    Gumus II, Keskin EA, Kiliç E, Aker A, Kafali H, Turhan NO. Diagnostic value of hysteroscopy and hysterosonography in endometrial abnormalities in asymptomatic postmenopausal women. Arch Gynecol Obstet. 2008;278(3):241–4.PubMedCrossRefGoogle Scholar
  32. 32.
    Zhu HL, Liang XD, Wang JL, Cui H, Wei LH. Hysteroscopy and directed biopsy in the diagnosis of endometrial carcinoma. Chin Med J (Engl). 2010;123(24):3524–8.Google Scholar
  33. 33.
    ACOG Committee Opinion. Routine cancer screening. Number 185, September 1997 (replaces no. 128, October 1993). Committee on gynecologic practice. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 1997;59(2):157–61.Google Scholar
  34. 34.
    Korhonen MO, Symons JP, Hyde BM, Rowan JP, Wilborn WH, et al. Histologic classification and pathologic findings for endometrial biopsy specimens obtained from 2964 perimenopausal and postmenopausal women undergoing screening for continuous hormones as replacement therapy (CHART 2 study). Am J Obstet Gynecol. 1997;176(2):377–80.PubMedCrossRefGoogle Scholar
  35. 35.
    Watson P, Vasen HF, Mecklin JP, Järvinen H, Lynch HT. The risk of endometrial cancer in hereditary nonpolyposis colorectal cancer. Am J Med. 1994;96(6):516–20.PubMedCrossRefGoogle Scholar
  36. 36.
    Aarnio M, Sankila R, Pukkala E, Salovaara R, Aaltonen LA, de la Chapelle A, et al. Cancer risk in mutation carriers of DNA-mismatch-repair genes. Int J Cancer. 1999;81(2):214–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Vasen HF, Wijnen JT, Menko FH, Kleibeuker JH, Taal BG, Griffioen G, et al. Cancer risk in families with hereditary nonpolyposis colorectal cancer diagnosed by mutation analysis. Gastroenterology. 1996;110(4):1020–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Dunlop MG, Farrington SM, Carothers AD, Wyllie AH, Sharp L, Burn J, et al. Cancer risk associated with germline DNA mismatch repair gene mutations. Hum Mol Genet. 1997;6(1):105–10.PubMedCrossRefGoogle Scholar
  39. 39.
    Lancaster JM, Powell CB, Kauff ND, Cass I, Chen LM, Lu KH, et al. Society of Gynecologic Oncologists Education Committee statement on risk assessment for inherited gynecologic cancer predispositions. Gynecol Oncol. 2007;107(2):159–62.PubMedCrossRefGoogle Scholar
  40. 40.
    Boks DE, Trujillo AP, Voogd AC, Morreau H, Kenter GG, Vasen HF, et al. Survival analysis of endometrial carcinoma associated with hereditary nonpolyposis colorectal cancer. Int J Cancer. 2002;102(2):198–200.PubMedCrossRefGoogle Scholar
  41. 41.
    Vasen HF, Mecklin JP, Khan PM, Lynch HT. The international collaborative group on hereditary non-polyposis colorectal cancer (ICG-HNPCC). Dis Colon Rectum. 1991;34(5):424–5.PubMedCrossRefGoogle Scholar
  42. 42.
    Smith RA, Cokkinides V, Eyre HJ. American Cancer Society guidelines for the early detection of cancer, 2005. CA Cancer J Clin. 2005;55(1):31–44. quiz 55–6, 2005 Jan–Feb.PubMedCrossRefGoogle Scholar
  43. 43.
    Helder-Woolderink JM, De Bock GH, Sijmons RH, Hollema H, Mourits MJ. The additional value of endometrial sampling in the early detection of endometrial cancer in women with Lynch syndrome. Gynecol Oncol. 2013;131(2):304–8.PubMedCrossRefGoogle Scholar
  44. 44.
    Critchley HO, Warner P, Lee AJ, Brechin S, Guise J, Graham B. Evaluation of abnormal uterine bleeding: comparison of three outpatient procedures within cohorts defined by age and menopausal status. Health Technol Assess. 2004;8(34):iii–iv. 1–139.PubMedCrossRefGoogle Scholar
  45. 45.
    Vessey MP, Painter R. Endometrial and ovarian cancer and oral contraceptives–findings in a large cohort study. Br J Cancer. 1995;71(6):1340–2.PubMedCentralPubMedCrossRefGoogle Scholar
  46. 46.
    Smith JS, Green J, Berrington de Gonzalez A, Appleby P, Peto J, Plummer M, et al. Cervical cancer and use of hormonal contraceptives: a systematic review. Lancet. 2003;361(9364):1159–67.PubMedCrossRefGoogle Scholar
  47. 47.
    Weiderpass E, Adami HO, Baron JA, Magnusson C, Lindgren A, Persson I. Use of oral contraceptives and endometrial cancer risk (Sweden). Cancer Causes Control. 1999;10(4):277–84.PubMedCrossRefGoogle Scholar
  48. 48.
    Nelson LR, Bulun SE. Estrogen production and action. J Am Acad Dermatol. 2001;45(3 Suppl):S116–24.PubMedCrossRefGoogle Scholar
  49. 49.
    Paxton RJ, King DW, Garcia-Prieto C, Connors SK, Hernandez M, Gor BJ, Jones LA. Associations between body size and serum estradiol and sex hormone-binding globulin levels in premenopausal African American women. J Clin Endocrinol Metab. 2013;98(3):E485–90.PubMedCentralPubMedCrossRefGoogle Scholar
  50. 50.
    Troisi R, Potischman N, Hoover RN, Siiteri P, Brinton LA. Insulin and endometrial cancer. Am J Epidemiol. 1997;146(6):476–82.PubMedCrossRefGoogle Scholar
  51. 51.
    Parker ED, Folsom AR. Intentional weight loss and incidence of obesity-related cancers: the Iowa Women’s Health Study. Int J Obes Relat Metab Disord. 2003;27(12):1447–52.PubMedCrossRefGoogle Scholar
  52. 52.
    Du M, Kraft P, Eliassen AH, Giovannucci E, Hankinson SE, De Vivo I. Physical activity and risk of endometrial adenocarcinoma in the Nurses’ Health Study. Int J Cancer. 2014;134(11):2707–16.PubMedCentralPubMedCrossRefGoogle Scholar
  53. 53.
    Keum N, Ju W, Lee DH, Ding EL, Hsieh CC, Goodman JE, et al. Leisure-time physical activity and endometrial cancer risk: doses response meta-analysis of epidemiological studies. Int J Cancer. 2014;135(3):682–94.PubMedCrossRefGoogle Scholar
  54. 54.
    Schouten LJ, Goldbohm RA, van den Brandt PA. Anthropometry, physical activity, and endometrial cancer risk: results from the Netherlands Cohort Study. J Natl Cancer Inst. 2004;96(21):1635–8.PubMedCrossRefGoogle Scholar
  55. 55.
    Littman AJ, Voigt LF, Beresford SA, Weiss NS. Recreational physical activity and endometrial cancer risk. Am J Epidemiol. 2001;154(10):924–33.PubMedCrossRefGoogle Scholar
  56. 56.
    Colbert LH, Lacey Jr JV, Schairer C, Albert P, Schatzkin A, Albanes D. Physical activity and risk of endometrial cancer in a prospective cohort study (United States). Cancer Causes Control. 2003;14(6):559–67.PubMedCrossRefGoogle Scholar
  57. 57.
    McTiernan A. Mechanisms linking physical activity with cancer. Nat Rev Cancer. 2008;8(3):205–11.PubMedCrossRefGoogle Scholar
  58. 58.
    Laughlin GA, Ix JH, Cummins K, Allison MA, Daniels LB. Extremes of an aromatase index predict increased 25-year risk of cardiovascular mortality in older women. Clin Endocrinol (Oxf). 2012;77(3):391–8.CrossRefGoogle Scholar
  59. 59.
    Calle EE, Kaaks R. Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer. 2004;4(8):579–91.PubMedCrossRefGoogle Scholar
  60. 60.
    Pike MC, Pearce CL, Wu AH. Prevention of cancers of the breast, endometrium and ovary. Oncogene. 2004;23:6379–91.PubMedCrossRefGoogle Scholar
  61. 61.
    Salazar-Martinez E, Lazcano-Ponce EC, Gonzalez Lira-Lira G, Escudero-De los Rios P, Salmeron-Castro J, Hernandez-Avila M. Reproductive factors of ovarian and endometrial cancer risk in a high fertility population in Mexico. Cancer Res. 1999;59(15):3658–62.PubMedGoogle Scholar
  62. 62.
    Berek JS. Berek and Novak’s gynecology. 14th ed. Philadelphia: Lippincott Williams and Willkins; 2007. p. 466.Google Scholar
  63. 63.
    Lacey JV, Jr Ioffe OB, Ronnett BM, Rush BB, Richesson DA, Chatterjee N. Endometrial carcinoma risk among women diagnosed with endometrial hyperplasia: the 34-year experience in a large health plan. Br J Cancer. 2008;98(1):45–53.PubMedCentralPubMedCrossRefGoogle Scholar
  64. 64.
    Berek JS. Berek and Novak’s gynecology. 14th ed. Philadelphia: Lippincott Williams and Willkins; 2007. p. 1348.Google Scholar
  65. 65.
    Furness S, Roberts H, Marjoribanks J, Lethaby A. Hormone therapy in postmenopausal women and risk of endometrial hyperplasia. Cochrane Database Syst Rev. 2012;8, CD000402.PubMedGoogle Scholar
  66. 66.
    Brinton LA, Felix AS. Menopausal hormone therapy and risk of endometrial cancer. J Steroid Biochem Mol Biol. 2014;142:83–9.PubMedCentralPubMedCrossRefGoogle Scholar
  67. 67.
    International Agency for Research on Cancer: IARC Handbooks of Cancer Prevention. Volume 8: fruit and vegetables. Lyon: International Agency for Research on Cancer; 2003.Google Scholar
  68. 68.
    Bandera EV, Kushi LH, Gifkins DM, et al. WCRF systematic literature review: the association between food, nutrition, and physical activity and the risk of endometrial cancer and underlying mechanisms. Washington, DC: World Cancer Research Fund, American Institute for Cancer Research; 2006.Google Scholar
  69. 69.
    Horn-Ross PL, John EM, Canchola AJ, Stewart SL, Lee MM. Phytoestrogen intake and endometrial cancer risk. J Natl Cancer Inst. 2003;95(15):1158–64.PubMedCrossRefGoogle Scholar
  70. 70.
    Xu WH, Zheng W, Xiang YB, Ruan ZX, Cheng JR, Dai Q, et al. Soya food intake and risk of endometrial cancer among Chinese women in Shanghai: population based case–control study. BMJ. 2004;328(7451):1285.PubMedCentralPubMedCrossRefGoogle Scholar
  71. 71.
    Zeleniuch-Jacquotte A, Gallicchio L, Hartmuller V, Helzlsouer KJ, McCullough ML, Setiawan VW, et al. Circulating 25-hydroxyvitamin D and risk of endometrial cancer: cohort consortium vitamin D pooling project of rarer cancers. Am J Epidemiol. 2010;172(1):36–46.PubMedCentralPubMedCrossRefGoogle Scholar
  72. 72.
    Neuhouser ML, Wassertheil-Smoller S, Thomson C, Aragaki A, Anderson GL, Manson JE, et al. Multivitamin use and risk of cancer and cardiovascular disease in the Women’s Health Initiative cohorts. Arch Intern Med. 2009;169(3):294–304.PubMedCrossRefGoogle Scholar
  73. 73.
    Kushi LH, Doyle C, McCullough M, Rock CL, Demark-Wahnefried W, Bandera EV, et al. American Cancer Society 2010 nutrition and physical activity guidelines advisory. American Cancer Society guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin. 2012;62(1):30–67.PubMedCrossRefGoogle Scholar

Copyright information

© Springer India 2015

Authors and Affiliations

  1. 1.Department of Surgical and Gynaecologic OncologyWelcare HospitalKochiIndia
  2. 2.Department of Surgical and Gynecologic OncologyWelcare Hospital and Lakeshore Hospital and Research CentreKochiIndia

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