Endometrial Cancer Screening

Unlike breast, cervical, and colorectal cancers, there is currently no routine screening test recommended for endometrial cancer in people at average risk who do not have symptoms. Fortunately, endometrial cancer often causes noticeable symptoms at an early stage. Abnormal vaginal bleeding is the most common warning sign, which means many cases are diagnosed when the cancer is still confined to the uterus. Knowing your risk and recognizing symptoms are important parts of detecting endometrial cancer as early as possible.

Is there a routine screening test for endometrial cancer?

No routine screening test has been shown to reduce deaths from endometrial cancer among people at average risk who do not have symptoms. Tests such as endometrial biopsy and transvaginal ultrasound can help diagnose endometrial cancer when symptoms or other concerns are present, but they are not routinely used to screen everyone. Instead, people at average risk should know the potential symptoms of endometrial cancer and report abnormal vaginal bleeding to a healthcare provider.

Can a Pap test detect endometrial cancer?

A Pap test does not screen for endometrial cancer. Pap tests collect cells from the cervix to look for abnormal cervical cell changes that could lead to cervical cancer. Occasionally, abnormal endometrial cells may be detected during a Pap test, but the test is not designed to find endometrial cancer and a normal Pap result does not rule it out. Continue following cervical cancer screening recommendations, but do not rely on Pap testing to detect endometrial cancer.

What is an endometrial biopsy?

An endometrial biopsy removes a small sample of tissue from the lining of the uterus so that it can be examined under a microscope. A healthcare provider inserts a thin tube through the cervix and into the uterus to collect the sample. The procedure can usually be performed in a healthcare provider's office. An endometrial biopsy may be recommended if you have:

• Bleeding after menopause

• Abnormal or unusually heavy vaginal bleeding

• Bleeding between periods

• Certain abnormal findings on an ultrasound

• Other symptoms or risk factors that raise concern for endometrial cancer

A biopsy can determine whether the endometrium contains cancer cells or precancerous changes called endometrial hyperplasia.

What is a transvaginal ultrasound?

A transvaginal ultrasound (TVUS) uses a small ultrasound probe placed inside the vagina to create images of the uterus, endometrium, ovaries, and surrounding structures. In someone who has experienced bleeding after menopause, ultrasound may be used to measure the thickness of the endometrium. An unusually thickened uterine lining may require additional evaluation, such as an endometrial biopsy. However, transvaginal ultrasound is not recommended as a routine screening test for endometrial cancer in people at average risk who do not have symptoms.

What is hysteroscopy?

A hysteroscopy allows a healthcare provider to look directly inside the uterus using a thin, lighted instrument called a hysteroscope. The hysteroscope is passed through the vagina and cervix into the uterus. Hysteroscopy may be used if abnormal bleeding continues, imaging identifies a suspicious area, or an endometrial biopsy does not provide enough information. It can also allow the healthcare provider to collect tissue from a specific area for testing.

Who is at higher risk?

Some people have a higher-than-average risk of developing endometrial cancer. Risk factors include:

• Lynch syndrome

• A strong family history of endometrial or colorectal cancer

• Obesity

• Long-term exposure to estrogen without progesterone

• Certain conditions that cause irregular ovulation

• A history of endometrial hyperplasia

• Taking tamoxifen

Having an increased risk does not necessarily mean that you need routine screening. Your healthcare provider can help determine whether additional monitoring or evaluation is appropriate.

Screening for people with Lynch syndrome

People with Lynch syndrome have a significantly increased risk of endometrial cancer. Because of this higher risk, some expert guidelines recommend discussing periodic endometrial biopsy beginning at a younger age, although it has not been proven that this screening reduces deaths from endometrial cancer. People with Lynch syndrome should also be educated about the symptoms of endometrial cancer and report abnormal bleeding promptly. Risk-reducing hysterectomy may eventually be considered after childbearing is complete.

If you have Lynch syndrome or another inherited cancer syndrome, work with a healthcare team experienced in hereditary cancer risk to develop an individualized plan.

Know the symptoms of endometrial cancer

Recognizing symptoms is particularly important because there is no routine screening test for average-risk people. The most common symptom of endometrial cancer is abnormal vaginal bleeding. Contact your healthcare provider if you experience:

• Any vaginal bleeding or spotting after menopause

• Bleeding between menstrual periods

• Periods that are unusually heavy or prolonged

• A significant change in your usual menstrual bleeding

• Unusual vaginal discharge

• Pelvic pain or pressure

Abnormal bleeding can have many causes other than cancer. However, it should still be evaluated, particularly if you have gone through menopause.

What happens if endometrial cancer is suspected?

If you have abnormal bleeding or another concerning symptom, your healthcare provider may perform a diagnostic evaluation. This may include:

• A review of your symptoms and medical history

• A pelvic examination

• Transvaginal ultrasound

• Endometrial biopsy

• Hysteroscopy

• Dilation and curettage (D&C) in certain situations

If a biopsy identifies cancer, additional testing may be performed to determine the type and extent of the disease and help guide treatment.

When to talk with your healthcare provider

There is currently no routine endometrial cancer screening test recommended for people at average risk without symptoms. Instead, one of the most important things you can do is recognize abnormal bleeding and have it evaluated promptly.

Any vaginal bleeding after menopause should be evaluated by a healthcare provider.

If you have not gone through menopause, talk with your healthcare provider about bleeding that is unusually heavy, occurs between periods, lasts longer than usual, or represents a significant change from your normal menstrual cycle.

If you have Lynch syndrome, a strong family history of endometrial or colorectal cancer, or another factor that significantly increases your risk, ask your healthcare provider whether you need a personalized surveillance or prevention plan.