Routine Hysterectomies Uncover Unexpected Cancer

Nearly 1 in 100 women who have a hysterectomy for fibroids, menstrual disorders or other noncancerous conditions are found to have undetected uterine cancer, according to recent AHRQ-funded study published in the American Journal of Obstetrics and Gynecology. Researchers analyzed 2003 to 2013 data on about 230,000 women in New York State who had a hysterectomy with no previous cancer diagnosis. Of them, about 1,700 unexpectedly had cancer of the uterine lining and nearly 400 had cancer of the muscular wall of the uterus. Researchers used the results to develop risk prediction models based on ethnicity, age, obesity, medical conditions and personal and family histories to help assess uterine cancer risks. Assessing a patient’s risk of cancer is important for planning the surgical approach and surgical team composition, researchers concluded. Access the abstract

2019 Mar 7. pii: S0002-9378(19)30430-2. doi: 10.1016/j.ajog.2019.02.051. [Epub ahead of print]

Prevalence, characteristics, and risk factors of occult uterine cancer in presumed benign hysterectomy.

Desai VB1, Wright JD2, Gross CP3, Lin H4, Boscoe FP5, Hutchison LM5, Schwartz PE6, Xu X7.

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Abstract

BACKGROUND:

Occult uterine cancer at the time of benign hysterectomy poses unique challenges in patient care. There is large variability and uncertainty in estimated risk of occult uterine cancer in the literature and prior research often did not differentiate/include all subtypes.

OBJECTIVES:

To thoroughly examine the prevalence of occult uterine cancer in a large population-based sample of women undergoing hysterectomy for presumed benign indications and to identify associated risk factors.

STUDY DESIGN:

Using the New York Statewide Planning and Research Cooperative System database, we identified 229,536 adult women who underwent an inpatient or outpatient hysterectomy for benign indications during the period October 1, 2003 to December 31, 2013 at civilian hospitals and ambulatory surgery centers throughout the state. Diagnosis of corpus uteri cancer within 28 days after the index hysterectomy was determined using linked state cancer registry data. We estimated the prevalence of occult uterine cancer (overall and by subtype) and developed and validated risk prediction models using a random split sample approach.

RESULTS:

Overall, 0.96% (95% confidence interval: 0.92-1.00%) of the women had occult uterine cancer, including 0.75% (95% confidence interval: 0.71-0.78%) with endometrial carcinoma and 0.22% (95% confidence interval: 0.20-0.23%) with uterine sarcoma. The prevalence of leiomyosarcoma was 0.15% (95% confidence interval: 0.13-0.17%). Seventy-one percent of the endometrial carcinomas and 58.0% of the uterine sarcomas were at localized stage. The risk for occult uterine cancer ranged from 0.10% in women aged 18-29 years to 4.40% in women aged ≥75 years; and varied from 0.14% in women undergoing hysterectomy for endometriosis to 0.62% for uterine fibroids and 8.43% for postmenopausal bleeding. The risk of occult uterine cancer was also significantly associated with race/ethnicity, obesity, comorbidity, and personal history of malignancy. Prediction models incorporating these risk factors had high negative predictive values (99.8% for endometrial carcinoma and 99.9% for uterine sarcoma) and good rule-out accuracy despite low positive predictive value.

CONCLUSIONS:

In women undergoing hysterectomy for presumed benign indications, 0.96% had unexpected uterine cancer. Patient characteristics such as age, surgical indication, and medical history may help guide risk stratification.