Introduction:
Screening is an investigation of cancer before a person has symptoms. Early cancer detection facilitates early and easy treatment. It is because if the symptoms appear, cancer may have spread in the body. It is important to ascertain that the doctor does not think the patient has cancer if a screening test is suggested. Endometrial cancer forms in the tissues of the endometrium (the inner lining of the uterus). Furthermore, it is associated with increased deaths worldwide. Hence, patients must get periodic endometrial screening.
What Is the Importance of Endometrial Cancer Screening?
Endometrial cancer is the most frequent gynecological cancer and a major disease burden. Further, it is common in postmenopausal women. The uterus seamlessly connects with the cervix, which is the lower part of the uterus that joins with the vagina. Hence, it becomes easy to detect signs of endometrial cancer using the biological material shed from the uterus. Endometrial cancer is diagnosed in women at an average age of 60. Vaginal bleeding after menopause, bleeding between periods, and pelvic pain are the common signs and symptoms. The number of new cases and deaths related to endometrial cancer is increasing year over year.
What Are the Risk Elements of Developing Endometrial Cancer?
Various elements can increase the risk of developing endometrial cancer.
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Taking Tamoxifen for Breast Cancer Prevention: An important side effect of Tamoxifen is the increased risk of uterine cancer (endometrial cancer). However, it happens after chronic (more than two years) use. Furthermore, it also occurs in postmenopausal women with previous uterine pathologies.
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Being Obese or Overweight: Obesity is more strongly associated with endometrial cancer. Moreover, the incidence of endometrial cancer increases with an increase in the body mass index (BMI).
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Eating a High-Fat Diet: Research has found higher rates of endometrial cancer among women who consume more trans fat.
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Taking Estrogen as the Only Medicine: Estrogen therapy as hormone replacement may increase the risk. However, taking estrogen with progesterone does not increase the risk of endometrial cancer.
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Attaining Menopause Later: Having more menstrual cycles in a lifetime raises the risk of endometrial cancer. Starting menstrual periods before age twelve and going through menopause later increases the risk.
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Inherited Colon Cancer: Lynch syndrome is an autosomal dominant cancer-susceptibility disorder. Endometrial cancer risk is elevated in individuals with Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer. Women with Lynch syndrome can have early-onset endometrial cancer. The lifetime risk of endometrial cancer in Lynch syndrome is about 60 percent.
Other risk factors are metabolic syndrome, some ethnicities, family history, and genetic predisposition. Endometrial cancer has several risk factors that do not mandate screening. However, they can increase the chances of getting the disease.
How Is Endometrial Cancer Screening Done?
There is no standard screening test for detecting endometrial cancer. Increased risk does not mean a female will have endometrial cancer. However, it depicts that regular screening exams should be done to detect cancer. Gynecologists recommend yearly endometrial sampling and vaginal ultrasonography in asymptomatic women (without symptoms) with Lynch syndrome. The tests used for endometrial cancer screening are:
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Pelvic Exam: Examination of the vagina, cervix, uterus, ovaries, and rectum is done in a pelvic exam. A doctor inserts a gloved hand or speculum and also examines the outside of the abdomen.
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Papanicolau (Pap) Test: The Pap test is a cervical screening method to detect precancerous and cancerous lesions in the cervix and vagina. A small brush gently removes cells from the cervix and the surrounding area. Pap tests are not used for endometrial cancer screening. However, a Pap test may show an abnormal endometrium. Furthermore, follow-up tests may detect endometrial cancer.
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Transvaginal Ultrasound (TVU): The data available on the validity of TVU for endometrial cancer screening is from patients with abnormal vaginal bleeding. Experts recommend yearly screening with TVU for Lynch syndrome patients starting at age 25. Further, in women taking Tamoxifen, TVU should be done in those having vaginal bleeding. Ultrasound can also visualize endometrial growth and thickness. It can also locate the area for a biopsy. There is no evidence that TVU reduces death from endometrial cancer. About 85 percent of cases of endometrial cancer are diagnosed at an early stage.
- Endometrial Biopsy: Endometrial biopsy, or sampling, is the tissue removed from the endometrium by inserting a brush, curette, or thin tube through the cervix. The tool gently removes a small amount of tissue. Finally, a pathologist screens the tissue for cancer cells. Endometrial sampling is frequently used to examine women with abnormal vaginal bleeding. Similar to TVU, there is insufficient data to prove the reduction of deaths from screening by endometrial sampling.
If a woman has already suffered from endometrial cancer, a different plan is required to check for recurrence. The screening plans apply to women expected to live for at least ten years. They are not for women with a health condition that makes it hard to diagnose or treat endometrial cancer.
What Are the Risks Associated With Endometrial Cancer Screening Tests?
Various screening tests have risks. Likewise, there are risks associated with endometrial cancer screening. The risks of endometrial cancer screening tests are:
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Detection of Endometrial Cancer May Not Help a Woman Live Longer: Screening may not improve a woman’s health or increase the lifespan if advanced endometrial cancer is detected. Further, it cannot help if cancer has already spread to other places in the body.
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False-Negative Test Results: A false negative test result wrongly indicates that a disease is absent. Screening test results can appear normal in the presence of endometrial cancer. A woman with a false-negative test result can defer medical care even if signs and symptoms of endometrial cancer are present.
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False-Positive Test Results: Screening test results may indicate cancer in their absence. A false-positive test result can cause unnecessary concerns. It can also lead to further testing.
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Side Effects Caused by the Screening Test: Screening tests for endometrial cancer can potentially result in side effects such as discomfort, pain, bleeding, infection, and uterine injury.
Conclusion
Current strategies for endometrial cancer screening are limited to high-risk populations and symptomatic women. It is because 90 percent of endometrial cancers have abnormal vaginal bleeding. Screening can be effective if early endometrial lesion detection changes disease outcomes. Furthermore, minimally invasive methods are more appropriate for screening wider populations of asymptomatic women. It is because they are better tolerated by women.
