Detection of and screening for endometrial cancer

Endometrial cancer occurs more than twice as frequently as cervical cancer. The main risk factors are age, estrogen use, and obesity. Increasing life expectancy and more liberal use of estrogen to prevent postmenopausal bone loss will probably increase the magnitude of the problem. Endometrial cancer is a heterogeneous disease. Good prognosis is associated with obesity and estrogen use and with carcinomas preceded by precancerous hyperplasia. A bad prognosis may be found in women without major risk factors and is associated with a normal or atrophic endometrium. Because of a high prevalence of asymptomatic disease (6.9 per 1,000) and because the group with a poor prognosis is usually asymptomatic, all postmenopausal women should be screened at least one time. For screening, the use of one of the cytologic instruments is recommended; these instruments are safe, easy to handle, and can be used in the office setting without anesthesia. Yields are comparable to dilation and curettage. Family physicians are encouraged to familiarize themselves with cytologic instruments and to use them for screening postmenopausal women in their office.