Association of endometrial cancer risk with postmenopausal bleeding in women: A systematic review and meta-analysis

JAMA Internal Medicine Aug 10, 2018

Clarke MA, et al. - Researchers determined the prevalence of postmenopausal bleeding (PMB) in endometrial cancers and the risk of endometrial cancer in women with PMB via this systematic review and meta-analysis. They reported the occurrence of PMB in approximately 90% of women with endometrial cancer; however, a diagnosis of endometrial cancer was made in only 9% of women with PMB. A variance in these estimates was evident by geographic region, hormone use, and calendar time. These data offer a base for assessing early detection strategies for endometrial cancer and can support risk-informed decision making in clinical management of PMB.


  • This systematic review and meta-analysis included English-language studies published January 1, 1977 through January 31, 2017 identified from PubMed and Embase.
  • They selected observational studies reporting the prevalence of PMB in women with endometrial cancer and the risk of endometrial cancer in women with PMB in unselected populations, and excluded studies that included highly selected populations, lacked detailed inclusion criteria, and/or included 25 or fewer women.
  • By using items from the Newcastle-Ottawa Quality Assessment Scale and the Quality Assessment of Diagnostic Accuracy Studies tool, study quality and risk of bias were assessed by two independent reviewers.
  • Main outcomes and measures included the pooled prevalence of PMB in women with endometrial cancer and the risk of endometrial cancer in women with PMB.


  • This analysis included a total of 129 unique studies, including 34,432 unique patients with PMB and 6,358 with endometrial cancer (40,790 women).
  • Regardless of tumor stage, the pooled prevalence of PMB among women with endometrial cancer was 91% (95% CI, 87%-93%).
  • According to findings, 9% was the pooled risk of endometrial cancer among women with PMB (95% CI, 8%-11%), variation in the estimates was noted by use of hormone therapy (range, 7% [95% CI, 6%-9%] to 12% [95% CI, 9%-15%]; P<.001 for heterogeneity) and geographic region (range, 5% [95% CI, 3%-11%] in North America to 13% [95% CI, 9%-19%] in Western Europe; P=.09 for heterogeneity).
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