The Pap test, used successfully for screening for cervical cancer, is too insensitive for detection of endometrial cancer to be used as a screening technique. However, occasionally the Pap test may fortuitously identify endometrial abnormalities. Sampling the fluid which collects in the posterior vaginal fornix, as part of the Pap test, in peri- and postmenopausal women may increase the detection of endometrial lesions. The presence of endometrial cells in a Pap test from a postmenopausal woman, not on exogenous hormones, is abnormal and requires further evaluation. A combined analysis of prospective studies of endovaginal ultrasound to evaluate postmenopausal bleeding demonstrated a high sensitivity for detecting endometrial cancer and endometrial disease.
Abnormal tests require additional evaluation.
Endometrial aspiration has been proposed as a potential screening technique. Although transvaginal sonography can be used to evaluate symptomatic and occult endometrial pathology, the technique has not been shown to be effective as a screening technique in reducing mortality. 9 Recognizing that the relative risk of developing endometrial cancer may be increased approximately 2-3 fold by tamoxifen use, any abnormal uterine bleeding should be completely evaluated. The annualized risk of developing endometrial cancer while taking tamoxifen has been estimated to be 2 per 1,000. An ACOG Committee has interpreted these results as being suggestive that hyperplastic endometrial lesions developing during tamoxifen treatment may seldom evolve into invasive endometrial cancer.