Model predicts endometrial hyperplasia, cancer risk in women with abnormal uterine bleeding

Key takeaways:

• Age, nulliparity, polyps and shorter sampling intervals may predict endometrial hyperplasia and cancer.
• Risk scores of 9 to 11 vs. 0 to 8 were tied to increased risks for endometrial hyperplasia and cancer.

Endometrial hyperplasia and endometrial cancer have a low incidence for women with recurrent abnormal uterine bleeding, with predictive factors being older age, nulliparity, polyp history and shorter intervals between samplings, data show.

“Significant risk factors for endometrial cancer after benign endometrial sampling included no history of use of oral contraceptive pills, personal history of colorectal cancer, presence of endometrial polyps and morbid obesity. The risk increased 8.1- and 17.9-fold when one or two or more risk factors were present, respectively,” Unyamanee Veeranaraphanit, MD, from the department of obstetrics and gynecology and the department of family and preventive medicine at Prince of Songkla University in Thailand, and colleagues wrote in Obstetrics & Gynecology. “However, the estimated risk and factor-specific cancer probabilities are unknown.”

Veeranaraphanit and colleagues conducted a retrospective cohort study of 456 women with recurrent abnormal uterine bleeding (mean age, 49.5 years) who had benign endometrial sampling results from 2013 to 2021. Researchers developed predictive models for endometrial hyperplasia and endometrial cancer from the significant factors associated with both conditions and calculated risk scores from odds of each significant predictive factor.

The area under the curve for the risk score model was 73.1%, with a mean absolute error of 0.01.

Overall, endometrial hyperplasia was detected in 8.3% of women, and endometrial cancer was detected in 2.2% of women. The average interval between first and second endometrial samplings was 25.1 months.

The following factors were significantly associated with endometrial hyperplasia and endometrial cancer:

• older than 45 years (OR = 2.86; 95% CI, 1.31-7.03);
• nulliparity (OR = 3.5; 95% CI, 1.76-6.85);
• endometrial polyp history (OR = 3.69; 95% CI, 1.93-7.05); and
• an interval of less than 12 months between samplings (OR = 2.36; 95% CI, 1.25-4.42).

Women who scored 9 to 11 points for predictive factors had 57.1% increased risks for endometrial hyperplasia and endometrial cancer, whereas scores of 0 to 3 or 5 to 8 had increased risks of 4.7% and 15.5%, respectively.

“Future research should aim to rectify the gaps in data, especially concerning endometrial thickness in postmenopausal patients,” the researchers wrote. “Ultrasound evaluation of endometrial thickness could prove to be a significant predictor of endometrial hyperplasia and endometrial cancer in recurrent postmenopausal bleeding cases.”