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Risk Factors for Endometrial Hyperplasia and Cancer Among Women With Abnormal Bleeding

From the Departments of Gynecology and Obstetrics and Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, Ohio.

Address reprint requests to: Anne M. Weber, MD, Department of Gynecology and Obstetrics, Cleveland Clinic Foundation, 9500 Euclid Avenue, A81, Cleveland, OH 44195, E-mail: webera{at}cesmtp.ccf.org

Objective: To identify independent risk factors for endometrial neoplasia in women with abnormal perimenopausal or postmenopausal bleeding and to use those factors to develop and test a predictive model.

Methods: We conducted a case-control study of women with abnormal perimenopausal or postmenopausal bleeding who had endometrial samplings; cases had endometrial cancer or complex hyperplasia and controls had benign endometrial histologies. Multivariate logistic regression models identified factors associated with risks of endometrial neoplasia. The predictive abilities of our models and a published model were assessed using the area under receiver operating characteristic (ROC) curves, for which an area of 1.0 indicated perfect positive predictive ability and an area of 0.5 was expected by chance.

Results: There were 57 cases of endometrial hyperplasia or cancer and 137 controls. Parity was related inversely (odds ratio [OR] 0.70; 95% confidence interval [CI] 0.56, 0.88; P = .002) and weight directly (OR 1.02 per kg; 95% CI 1.01, 1.04; P = .018) to the risk of endometrial neoplasia. Age (OR 1.04 per year; 95% CI 1.00, 1.08; P = .06) and diabetes (OR 3.50; 95% CI 0.99, 12.33; P = .052) were significant marginally. The area under the ROC curve for our model was 0.75, indicating moderate predictive ability; the area under the ROC curve for the published model was lower at 0.66.

Conclusion: Current clinical predictive models based on case-control studies do not have sufficient predictive ability to determine if women with abnormal perimenopausal or postmenopausal bleeding should have diagnostic testing.