Incidence of malignancy in Jewish women with postmenopausal bleeding

Postmenopausal bleeding is associated with a relatively high incidence of malignancy. The lowest incidence reported in the literature was observed among Jewish women in Jerusalem, more than 21 years ago (1). A similar survey of Jewish women admitted to our Department for postmenopausal bleeding during 1962-74 is presented. Fifty-five of 397 cases (13.8%) of postmenopausal bleeding were due to malignancy. There were 34 women with endometrial carcinoma, 11 with cervical carcinoma, five with ovarian carcinoma, four with uterine sarcoma and one with vaginal sarcoma. In 86% of cases, benign pathological states were found, 42.8% being associated with atrophic endometrium. An active endometrium was found in 56 patients (14%), and in two of them the endometrium was secretory. Estrogen therapy was not an important causative factor in these cases. The low incidence of malignancy seems to be due to the fact that cervical carcinoma is less common among Jewish women. Nevertheless, 20% of the malignant tumors in this series were invasive epidermoid carcinomas of the cervix. The need for a cytologic screening program in this country must therefore be reevaluated.