Endometrial Cancer: Risk Factors and Early Diagnosis in Low-Resource Countries

Many risk factors are recognized for the development of endometrial ­cancer (EMC). A strong risk factor for hereditary nonpolyposis colonic cancer is an indication for EMC screening. Any women at risk must be counseled and evaluated in detail about their risk for many cancers, especially colonic and EMC. This is usually done in higher levels of health service rather than in a low resource setting. Also, the data concerning risk have been derived in these higher resource settings and are not necessarily transferable to other populations. For EMC, the screening methods ­comprise an annual transvaginal ultrasound beginning at 30–35 years of age and periodic endometrial sampling. EMC screening is not recommended in any woman with low or moderate risk or those without familial predisposition. Nevertheless, patients should be educated for the signs or symptoms suggesting an endometrial lesion, such as postmenopausal bleeding. An endometrial biopsy with a small cannula is considered an initial diagnostic step. This procedure can be performed in an out-patient setting while uterine curettage is reserved for a woman with inadequate, inconclusive, or hyperplasic tissue from endometrial biopsy. Transvaginal ultrasonography may be useful as an adjunct in selected cases depending on the availability, physician training, or resource setting. Hysteroscopy, as a diagnostic and therapeutic maneuver, requires specialized operative skill and may not be available in limited health care environments.