Screening Tests for Gynaecological Cancer: Do They Increase Safety?

Screening Tests for Gynaecological Cancer: Do They Increase Safety?

Stamatios Petousis, Chrysoula Margioula-Siarkou, Georgia Margioula-Siarkou, Frederic Guyon, George Mavromatidis
DOI: 10.4018/978-1-7998-4213-2.ch003
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The main screening tests that are used for the prevention and early diagnosis of gynaecological cancer are bimanual pelvic examination, transvaginal and transabdominal ultrasound, cervical cytology testing (Papanicolaou test), clinical breast examination, mammography, breast ultrasound, as well as newer diagnostic methods, such as HPV-DNA test and cancer biomarkers. Even though most of the above methods are widely used in everyday practice in gynaecology, it remains a subject for further discussion which of them should be used as screening tests and whether they increase safety in clinical approach of a patient, considering the danger of overdiagnosis and the role of screening test in personalized management of patients. The purpose of this chapter is to analyze the clinical benefit and safety of diagnostic methods related to prevention of various types of gynaecological cancer and in particular endometrial, ovarian, cervical, and breast cancer.
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Endometrial Cancer

Uterine cancer is the most common gynecological cancer in high-income countries and the second most common gynecological cancer worldwide (after cervical cancer) when both high- and low-income countries are considered (Bray F. et al., 2018). Uterine cancer incidence is highest in North America and Northern Europe, intermediate in Southern Europe and temperate South America, and lowest in Southern and Eastern Asia and most of Africa. This likely reflects prevalence differences in main risk factors associated with uterine cancer, such as obesity and reproductive patterns (Felix A. et al., 2018). In 2017, ∼61,000 new uterine cancer diagnoses were globally reported and nearly 11,000 women were estimated to have died from the disease, primarily affecting postmenopausal women, considering the fact that mean age of diagnosis was 62 years of age (Ginger C. et al., 2019).

Over 90 percent of uterine cancers are endometrial, originating in the epithelium; most of the remainder are mesenchymal, originating in the myometrial muscle or, less commonly, the endometrial stroma (Bray F. et al., 2018). Endometrial cancer is the most common gynaecological cancer and the second most common female malignancy, after breast cancer, in the developed world. In 2012, the number of new cases and deaths due to endometrial cancer worldwide was 319,605 and 76,160 respectively (Raglan O. et al., 2019). Taking into consideration that endometrial carcinomas represent the vast majority of uterine cancers and a leading cause of mortality among women, it is justified that screening policies are currently focusing on detecting risk factors and on early diagnosing this type of uterine cancer.

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