Screening for endometrial cancer

Although population screening for cervical neoplasia is widely practiced, screening for endometrial neoplasia has only recently been considered. Before development of endometrial carcinoma, the endometrium undergoes progressive neoplastic alterations in a parallel fashion to the premalignant precursors of cervical carcinoma. Screening for endometrial carcinoma may be particularly appropriate because of the existence of a well defined, easily identifiable high risk group and tissue sampling techniques that are accurate, easy to perform, inexpensive, and well tolerated. Women at increased risk of endometrial carcinoma include: obese postmenopausal women, women on postmenopausal estrogen replacement therapy, premenopausal women with a history of anovulatory cycles (including women with polycystic ovarian disease) and women with hepatic cirrhosis. Using endometrial aspiration devices, screening for endometrial hyperplasia and carcinoma may be performed by any physician familiar with intrauterine contraceptive device insertion in the office. The impact of such routine screening of high risk women will be determined only after large screening studies have been accomplished.