Excerpted by the National Guideline Clearinghouse (NGC):
Recommendations for Women at Average Risk
Based on a thorough review of the literature, there is no indication that screening for endometrial cancer is warranted for women who have no identified risk factors. There have been no large prospective randomized controlled scientific studies designed to measure the effectiveness of screening, probably because most endometrial cancer (77%) is diagnosed at an early, favorable stage. Early diagnosis usually results from the presence of alerting symptoms, specifically bleeding. Therefore it is recommended that, at the time of menopause, women at average risk should be informed about risks and symptoms of endometrial cancer, and strongly encouraged to report any unexpected bleeding or spotting to their physicians.
Recommendations for Women at Increased Risk
Based on a thorough review of the literature, there is no indication that screening for endometrial cancer should be recommended for women at increased risk for endometrial cancer because of history of unopposed estrogen therapy, late menopause, tamoxifen therapy, nulliparity, infertility or failure to ovulate, obesity, diabetes, or hypertension. As is the case with average-risk women, individuals at increased risk who develop endometrial cancer tend to present with symptoms at an early, favorable stage. As with average-risk women, at the time of menopause, those at increased risk based on the risk factors identified above, should be informed about the risks and symptoms of endometrial cancer, and strongly encouraged to report any unexpected bleeding or spotting to their physicians. Asymptomatic women at increased risk should also be informed about the potential benefits, risks, and limitations of testing for early endometrial cancer detection, to ensure informed decisions about testing.
Recommendations for Women at High Risk
The American Cancer Society recommends that annual screening for endometrial cancer with endometrial biopsy should be offered by age 35 for women with or at risk for hereditary nonpolyposis colorectal cancer (HNPCC). Women in this high-risk group should be informed about the risks and symptoms of endometrial cancer, and should be informed about potential benefits, risks, and limitations of testing for early endometrial cancer detection.
The population defined as at high risk for endometrial cancer includes women known to carry hereditary nonpolyposis colorectal cancer - associated mutations, women who have a substantial likelihood of being a mutation carrier (i.e., a mutation is known to be present in the family), and women from families with an autosomal dominant predisposition to colon cancer in the absence of genetic testing results, in accordance with the criteria of the Cancer Genetics Studies Consortium Task Force on hereditary nonpolyposis colorectal cancer.
The accepted definition of hereditary nonpolyposis colorectal cancer, based on a 1991 meeting of the International Collaborative Group, includes:
- At least three relatives with histologically verified colorectal cancer, with one a first-degree relative of the other two; the diagnosis of familial adenomatous polyposis should be excluded.
- At least two successive generations should be affected.
- At least one case of colorectal cancer should be diagnosed before age 50 years.
Meetings in 1996 add to this definition:
- Pedigrees with a colon cancer case before the age of 40 years, and
- Pedigrees with a higher incidence of tumors associated with hereditary nonpolyposis colorectal cancer.
At the present time, there are no data indicating that annual screening of women with hereditary nonpolyposis colorectal cancer does or does not detect endometrial cancers at a sufficiently early stage to improve survival compared with diagnosis when symptoms are present. However, because of the high risk of endometrial cancer in this group and because of the potentially life-threatening nature of this disease, screening is recommended.
The best age to begin screening women with the hereditary nonpolyposis colorectal cancer risk factor is not known. Others have proposed that annual screening be initiated at age 25 or between ages 25 and 35. The panel recommends screening begin by age 35. Women with an hereditary nonpolyposis colorectal cancer - associated mutation or with a substantial likelihood of having an hereditary nonpolyposis colorectal cancer - associated mutation should be informed that this recommendation is based on expert opinion in the absence of scientific evidence.
Further, health professionals should counsel women with or at risk for hereditary nonpolyposis colorectal cancer about preventive measures. Women who are no longer considering child-bearing and who are undergoing surgery for colorectal cancer should be offered the option of having a prophylactic hysterectomy at the same time, which may reduce the risk of endometrial cancer. Prophylactic oophorectomy to reduce the risk of ovarian cancer should also be offered.
