Screening for Common Gynecologic Malignancies

Gynecologic malignancies, including cervical, endometrial, and ovarian cancers (the most common), are a substantial cause of cancer-related morbidity and mortality worldwide, with the prognosis linked to the stage at diagnosis. The aim of screening is to help detect premalignant or early-stage malignant lesions to reduce mortality. Imaging has a limited role in primary screening for the most common gynecologic cancers and usually enters the patient care workflow after a positive screening test or abnormal laboratory results are obtained. Population-level screening for cervical cancer in individuals at average risk involves cytologic analysis and testing for high-risk human papillomavirus (HPV), with modified guidelines for patients at increased risk (ie, those with HIV infection, chronic immunosuppression, a history of high-grade cervical dysplasia, prior HPV-related lower genital tract malignancies, or in utero exposure to diethylstilbestrol [DES]). Routine population-level screening for endometrial and ovarian cancers in patients at average risk is not recommended; evaluation is driven by symptoms. Screening for endometrial cancer in patients at risk (eg, those with Lynch syndrome) includes clinical evaluation and assessment of endometrial thickness at transvaginal US. US-based screening for ovarian cancer in individuals at high risk (eg, those with BRCA gene mutations) is reserved for selected patients (eg, those who defer risk-reducing bilateral salpingo-oophorectomy), who undergo transvaginal US screening and serum biomarker level testing. When gynecologic malignancy is suspected based on symptoms, physical examination, or abnormal laboratory results, imaging aids in lesion detection and characterization, staging, treatment planning, and posttreatment surveillance. Imaging findings are increasingly integrated into formal staging systems, including the International Federation of Gynecology and Obstetrics classification system for cervical and endometrial cancer, which highlights the radiologist's role in multidisciplinary care. The authors summarize current and emerging screening strategies for cervical, endometrial, and ovarian cancers and the integration of imaging into the screening workflow. ^©RSNA, 2026 Supplemental material is available for this article.