Cytologically Benign Endometrial Cells Associated with Hyperplasia and Cancer After Age 40
(ChemotherapyAdvisor) – Cancer is more common after menopause among women over age 40 years found to have cytologically benign endometrial cells (CBEC), but CBEC assessment might be justified for premenopausal women over age 40 years -- even when abnormal bleeding is not established, suggests a retrospective study published in the American Journal of Obstetrics and Gynecology.
“Cancer was more common in postmenopausal women with assessed CBEC while hyperplasia was comparably distributed between premenopausal and postmenopausal women,” reported lead author Petra M. Casey, MD, of the Mayo Clinic's Department of Obstetrics and Gynecology in Rochester, Minnesota, and coauthors.
Except in the proliferative phase of the menstrual cycle, CBEC findings have been found to be associated with endometrial cancer. The study team reviewed the medical records of 281 women over age 40 years who had a history of CBEC during 2005 to 2010 for assessment of endometrial biopsies, ultrasounds, hysteroscopy, and outcomes, the authors reported. Of the 281 women assessed, 330 (39.4%) were premenopausal and 328 (46%) were postmenopausal.
Endometrial cancer rates were significantly higher (6.0%) among postmenopausal women than premenopausal patients (0.8%; P=0.019), whereas hyperplasia findings were not (3.3% vs. 3.9%, respectively, n.s.).
Abnormal bleeding was noted in most, but not all, women with endometrial cancer and hyperplasia; 4 of the 20 women with endometrial pathology (20%) had no abnormal bleeding noted in medical records. Importantly, 1 of those 4 women was premenopausal. (This may represent an underestimate of the actual number of cancers diagnosed among premenopausal, CBEC-positive patients with no abnormal bleeding, because bleeding status was not recorded in the medical records of 21 of the 330 premenopausal patients included in the study.)
The findings therefore “support CBEC assessment regardless of menopausal status or abnormal bleeding,” the authors wrote.
The authors noted a trend toward elevated body-mass index (BMI) among premenopausal, CBEC-positive women found to have endometrial pathology (χ2 P=0.065).