The importance of screening in oncogynecology

Authors: F. Frühauf;  J. Sláma;  M. Zikán
Authors‘ workplace: Gynekologicko-porodnická klinika 1. LF UK a VFN, Praha, přednosta prof. MUDr. A. Martan, DrSc.
Published in: Ceska Gynekol 2014; 79(6): 491-498


Cervical cancer can be greatly prevented by the active search for precancerous lesions, by the effective screening. The DNA detection of high-risk human papillomavirus seems to be suitable primary screening tool, more effective than smear for cervical cytology.

Organised mass screening for endometrial cancer is not held. The reason is very low prevalence of atypical hyperplasia and endometrial carcinoma in asymptomatic women and relatively low mortality rate, which is not influenced by the detection in asymptomatic stage. It is advisible to instruct all women to seek the gynecologist immediately in case of abnormal uterine bleeding and to emphasize the health education in population. Optimal protocol of the screening for hereditary endometrial malignities is debated currently.

There is no effective screening for ovarian cancer in general population. Firstly, the global prevalence of the disease is low. Secondly, there is no screening modality to detect precursor lesions of the majority of malignant ovarian tumors (type II). Different strategies are tested as screening for hereditary ovarian cancer, but they cannot alternate profylactic surgery (bilateral salpingo-oophorectomy).

screening, cervical cancer, endometrial cancer, ovarian cancer


1. Amant, F., Moerman, P., Neven, P., et al. Endometrial cancer. Lancet, 2005, 366, 9484, p. 491–505.

2. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. ACOG committee opinion. No. 336: Tamoxifen and uterine cancer. Obstet Gynecol, 2006, 107, 6, p. 1475–1478.

3. Auranen, A., Joutsiniemi, T. A systematic review of gynecological cancer surveillancevin women belonging to hereditary nonpolyposis colorectal cancer (Lynch syndrome) families. Acta Obstet Gynecol Scand, 2011, 90, 5, p. 437–444.

4. Andrae, B., Kemetli, L., Sparen, P., et al. Screening-preventable cervical cancer risks: evidence from a nationwide audit in Sweden. J Natl Cancer Inst, 2008, 100, 9, p. 622–629.

5. Bonadona, V., Bonaiti, B., Olschwang, S., et al. Cancer risks associated with germline mutations in MLH1, MSH2 and MSH6 genes in Lynch syndrome. JAMA, 2011, 305, 22, p. 2304–2310.

6. Berrington de Gonzalez, A., Curtis, RE., Kry, SF., et al. Proportion of second cancers attributable to radiotherapy treatment in adults: a cohort study in the US SEER cancer registries. Lancet Oncol, 2011, 12, 4, p. 353–360.

7. Bland, AE., Calingaert, B., Secord, AA., et al. Relationship between tamoxifen use and high risk endometrial cancer histologic types. Gynecol Oncol, 2009, 112, 1, p. 150–154.

8. Breijer, MC., Peeters, JA., Opmeer, BC., et al. Capacity of endometrial thickness measurement to diagnose endometrial carcinoma in asymptomatic postmenopausal women: a systematic review and meta-analysis. Ultrasound Obstet Gynecol, 2012, 40, 6, p. 621–629.

9. Buys, SS., Partridge, E., Black, A., et al. Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening randomized controlled trial. JAMA, 2011, 305, 22, p. 2295–2303.

10. Buys, SS., Partridge, E., Greene, MH., et al. Ovarian cancer screening in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial: findings from the initial screen of a randomized trial. Am J Obstet Gynecol, 2005, 193, 5, p. 1630–1639.

11. Castle, PE., Sideri, M., Jeronimo, J., et al. Risk assessment to guide the prevention of cervical cancer. Am J Obstet Gynecol, 2007, 197, 4, p. 356 e1–6.

12. Castle, PE., Stoler, MH., Wright, TC., Jr., et al. Performance of carcinogenic human papillomavirus (HPV) testing and HPV16 or HPV18 genotyping for cervical cancer screening of women aged 25 years and older: a subanalysis of the ATHENA study. Lancet Oncol, 2011, 12, 9, p. 880–890.

13. Cuzick, J., Clavel, C., Petry, KU., et al. Overview of the European and North American studies on HPV testing in primary cervical cancer screening. Int J Cancer, 2006, 119, 5, p. 1095–1101.

14. Dreyer, G. Screening for gynaecologic cancers in genetically predisposed women. Best Pract Res Clin Obstet Gynaecol, 2012, 26, 2, p. 267–282.

15. Dušek, L. Epidemiologie zhoubných nádorů v České republice. 2010.

16. Emons, G., Huschmand-Nia, A., Krauss, T., et al. Hormone replacement therapy and endometrial cancer [review]. Onkologie, 2004, 27, 2, p. 207–210.

17. Epstein, E., Skoog, L., Isberg, PE., et al. An algorithm including results of gray-scale and power Doppler ultrasound examination to predict endometrial malignancy in women with postmenopausal bleeding. Ultrasound Obstet Gynecol, 2002, 20, 4, p. 370–376.

18. Fisher, B., Costantino, JP., Redmond, CK., et al. Endometrial cancer in tamoxifen-treated breast cancer patients: findings from the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-14. J Natl Cancer Inst 1994, 86, 7, p. 527–537.

19. Gerber, B., Krause, A., Muller, H., et al. Ultrasonographic detection of asymptomatic endometrial cancer in postmenopausal patients offers no prognostic advantage over symptomatic disease discovered by uterine bleeding. Eur J Cancer, 2001, 37, 1, p. 64–71.

20. Gredmark, T., Kvint, S., Havel, G., Mattsson, LA. Histo-pathological findings in women with postmenopausal bleeding. Brit J Obstet Gynaecol, 1995, 102, 2, p. 133–136.

21. Greene, MH., Piedmonte, M., Alberts, D., et al. A prospective study of risk-reducing salpingo-oophorectomy and longitudinal CA 125 screening among women at increased genetic risk of ovarian cancer: design and baseline characteristics: a Gynecologic Oncology Group study. Cancer Epidemiol Biomarkers Prev, 2008, 17, 3, p. 594–604.

22. Gull, B., Carlsson, S., Karlsson , B., et al. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding: is it always necessary to perform an endometrial biopsy? Am J Obstet Gynecol, 2000, 182, 3, p. 519–515.

23. Gull, B., Karlsson, B., Milsom, I., et al. Can ultrasound replace dilatation and curretage? A longitudinal evaluation of postmenopausal bleeding and transvaginal sonographic measurement ad predictors of endometrial cancer. Am J Obstet Gynecol, 2003, 188, 2, p. 401–408.

24. Hermsen, BB., Olivier, RI., Verheijen, RH., et al. No efficacy of annual gynaecological screening in BRCA1/2 mutation carriers; an observational follow-up study. Br J Cancer, 2007, 96, 9, p. 1335–1342.

25. Herzog, TJ., Monk, BJ. Reducing the burden of glandular carcinomas of the uterine cervix. Am J Obstet Gynecol, 2007, 197, 6, p. 566–571.

26. Khan, MJ., Castle, PE., Lorincz, AT., et al. The elevated 10-year risk of cervical precancer and cancer in women with human papillomavirus (HPV) type 16 or 18 and the possible utility of type-specific HPV testing in clinical practice. J Natl Cancer Inst, 2005, 97, 14, p. 1072–1079.

27. Kjaer, S., Hogdall, E., Frederiksen, K., et al. The absolute risk of cervical abnormalities in high-risk human papillomavirus-positive, cytologically normal women over a 10-year period. Cancer Res, 2006, 66, 21, p.10630–10636.

28. Kobayashi, H., Yamada, Y., Sado, T., et al. A randomized study of screening for ovarian cancer: a multicenter study in Japan. Int J Gynecol Cancer, 2008, 18, 3, p. 414–420.

29. Leyden, WA., Manos, MM., Geiger, AM., et al. Cervical cancer in women with comprehensive health care access: attribut-able factors in the screening process. J Natl Cancer Inst, 2005, 97, 9, p. 675–683.

30. Menon, U., Gentry-Maharaj, A., Hallett, R., et al. Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Lancet Oncol, 2009, 10, 4, p. 327–340.

31. Menon, U., Griffin, M., Gentry-Maharaj, A. Ovarian cancer screening – current status, future directions. Gynecol Oncol, 2014, 132, 2, p. 495.

32. Moyer, VA., U.S. Preventive Services Task Force. Screening for ovarian cancer: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2012, 157, 12, p. 900–904.

33. Neven, P., Vergote, I. Tamoxifen, screening and new oestrogen receptor modulators. Best Pract Res Clin Obstet Gynaecol, 2001, 15, 3, p. 365–380.

34. Opolskiene, G., Sladkevicius, P., Valentin, L. Prediction of endometrial malignancy in women with postmenopausal bleeding and sonographic endometrial thickness ≥ 4.5 mm. Ultrasound Obstet Gynecol, 2011, 37, 2, p. 232–240.

35. Opolskiene, G., Sladkevicius, P., Valentin, L. Ultrasound assessment of endometrial morphology and vascularity to predict endometrial malignancy in women with postmenopausal bleeding and sonographic endometrial thickness > or = 4.5 mm. Ultrasound Obstet Gynecol, 2007, 30, 3, p. 332–340.

36. Polin, SA., Ascher, SM. The effect of tamoxifen on the genital tract. Cancer Imaging, 2008, 8, p. 135–145.

37. Quinn, M., Babb, P., Jones, J., Allen, E. Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics. BMJ, 1999, 318, 7188, p. 904–908.

38. Rijkaart, DC., Berkhof, J., Rozendaal, L., et al. Human papillomavirus testing for the detection of high-grade cervical intraepithelial neoplasia and cancer: final results of the POBASCAM randomised controlled trial. Lancet Oncol, 2012, 13, 1, p. 78–88.

39. Ronco, G., Giorgi-Rossi, P., Carozzi, F., et al. Efficacy of human papillomavirus testing for the detection of invasive cervical cancers and cervical intraepithelial neoplasia: a randomised controlled trial. Lancet Oncol, 2010, 11, 3, p. 249–527.

40. Rosenthal, AN., Fraser, L., Manchanda, R., et al. Results of annual screening in phase I of the United Kingdom Familial Ovarian Cancer Screening Study highlight the need for strict adherence to screening schedule. J Clin Oncol, 2013, 31, 1, p. 49–57.

41. SEER Cancer statistics review, National Cancer Institute. 2011.

42. Silverberg, SG., Kurman, RJ., Nogales, F., et al. Tumour of the uterine corpus. In Tavassoli, FA., Devillee P. Pathology and genetics of tumour of the breast and female genital organs. Lyon: IARC Press, 2003, p. 217–287.

43. Skates, SJ., Mai, P., Horick, NK., et al. Large prospective study of ovarian cancer screening in high-risk women: CA 125 cut-point defined by menopausal status. Cancer Prev Res (Phila), 2011, 4, 9, p. 1401–1408.

44. Smith-Bindman, R., Weiss, E., Feldstein, V. How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding. Ultrasound Obstet Gynecol, 2004, 24, 5, p. 558–565.

45. Stirling, D., Evans, DG., Pichert, G., et al. Screening for familial ovarian cancer: failure of current protocols to detect ovarian cancer at an early stage according to the international Federation of gynecology and obstetrics system. J Clin Oncol, 2005, 23, 24, p. 5588–5596.

46. Timmerman, A., Opmeer, BC., Khan, KS., et al. Endometrial thickness measurement for detecting endometrial cancer in women with postmenopausal bleeding: a systematic review and meta-analysis. Obstet Gynecol, 2010, 116, 1, p. 160–167.

47. Van den Bosch, T., Van Schoubroeck, D., Domali, E., et al.A thin and regular endometrium on ultrasound is very unlikely in patients with endometrial malignancy. Ultrasound Obstet Gynecol, 2007, 29, 6, p. 674–679.

48. Vasen, HF., Blanco, I., Aktan-Collan, K., et al. Revised guidelines for the clinical management of Lynch syndrome (HNPCC): recommendations by a group of European experts. Gut, 2013, 62, 6, p. 812–823.

49. Whitlock, EP., Vesco, KK., Eder, M., et al. Liquid-based cytology and human papillomavirus testing to screen for cervical cancer: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med, 2011, 155, 10, p. 687–97, W214–5.

50. Wright, TC., Jr., Stoler, MH., Sharma, A., et al. Evaluation of HPV-16 and HPV-18 genotyping for the triage of women with high-risk HPV+ cytology-negative results. Am J Clin Pathol, 2011, 136, 4, p. 578–586.

Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine
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