Aspiration curettage for asymptomatic patients receiving estrogen

Recent epidemiologic data suggest that patients treated with exogenous estrogens have an increased risk of developing endometrial carcinoma and support the concept that patients taking estrogens must be monitored with special vigor. The hypothesis that endometrial aspiration curettage might be an appropriate modality to accomplish adequate surveillance was tested from January 1, 1976, to January 1, 1977, on a group of 208 consecutive patients undergoing hormonal replacement therapy. Although no patient in the test group experienced abnormal or unusual bleeding, focal adenomatous hyperplasia or a more severe lesion was found in 16.0% of the specimens. Among these were 4 cases of endometrial adenocarcinoma and 2 of atypical adenomatous hyperplasia. This study demonstrated that routine endometrial aspiration curettage of patients receiving exogenous hormone replacement therapy can not only help diagnose very early lesions which are amenable to definitive and completely corrective treatment, but also can uncover significant endometrial pathology before it becomes symptomatic. It further suggests the possibility that the incidence of such pathology among this category of patients might be higher than previously suspected.