High risk of cervical pathology among women with postmenopausal bleeding and endometrium <or=4.4 mm: long-term follow-up results.

BACKGROUND

To determine the risk of endometrial and cervical pathology during long-term follow-up in women with postmenopausal bleeding and thin endometrium (<or=4.4 mm), and to determine the incidence and significance of re-bleeding.

METHODS

Retrospective study including all women (n=332) with postmenopausal bleeding and thin endometrium examined at the Department of Obstetrics and Gynaecology at Malmö University Hospital from 1992 until 2002. Follow-up was accomplished by searching the medical records, the local registry of cytology and pathology, and the regional cancer registry up to November 15, 2005.

RESULTS

At the first visit, cervical cancer was diagnosed in 1.5% (5/332) and endometrial cancer in 0.9% (3/332) of the women. During follow-up, cervical cancer was detected in 2/313 (0.6%) of the women; no additional case of endometrial cancer was found. In the region, the expected incidence of cervical and endometrial cancer during follow-up was 0.23 (standard incidence ratio [SIR], 8.7; 95% CI 1.1-31.4) and 1.34 (SIR, 0.0; 95% CI 0.0-2.7), respectively. Thirteen percent (41/313) of the women sought medical care because of re-bleeding. Endometrial pathology was found in 16% (4/25) and cervical pathology in 11% (3/28) of these women.

CONCLUSIONS

Cervical cancer was twice as common as endometrial cancer in women with postmenopausal bleeding and a thin endometrium. During follow-up, the risk of endometrial cancer was as expected, whereas the risk of cervical cancer was higher than expected. The results support that the diagnostic focus should be directed at excluding cervical pathology and that repeated diagnostic procedures be performed in cases of re-bleeding.