Detection of endometrial cancer and its precursors

Any approach to the control of endometrial cancer must include a consideration of the individual at high risk; this will include the obese, the infertile, those with failure of ovulation and dysfunctional bleeding; and those postmenopausal women who ae chronic estrogen users. The detection of adenomatous hyperplasia offers us the opportunity to recognize the developmental phase of the disease before invasion is established. The cytologic method of Papanicolaou, used in the conventional way, is inefficient for the detection of endometrial cancer. Cell studies taken by cannula from the endometrial cavity can be more accurate for the diagnosis of invasive cancer but fail in the hands of most pathologists to detect adenomatous hyperplasia. We have found the highest rate of accuracy in the aspiration curettage histologic method, both for endometrial cancer and adenomatous hyperplasia. It is quick, relatively painless in most, and an outpatient procedure that does not require anesthetic. It offers the pathologist a sample that is readily interpreted. Our public education effort must include the warning that a negative Pap smear does not rule out endometrial carcinoma.