A new study published in the ‘British Journal of Cancer’ has evaluated the effectivity and cost-effectiveness of the use of molecular tests of cytology and/or biopsy samples to detect endometrial cancer in women with postmenopausal bleeding, in comparison with the current diagnostic standard and with a national health service perspective. The results obtained support the use of molecular tests for the diagnosis of endometrial cancer and highlight the potential benefits of this strategy in reducing the number of undetected cancer cases in early stages, as well as reducing the number of unnecessary hysterectomies (operation to remove uterus of a woman) and thus improve the well-being of patients.
Molecular tests are widely used in medicine for the diagnosis of genetic diseases, viral and bacterial infections, as well as for the detection and monitoring of certain types of cancer. They also play an important role in scientific research, personalized medicine, and molecular biology. These tests are often highly sensitive and specific, meaning that they can accurately and reliably detect the presence or absence of the target sequence in a sample, what makes them a valuable tool in the field of medical diagnosis and biomedical research.
The study has been led by the epidemiologists from the Catalan Institute of Oncology, the Bellvitge Biomedical Research Institute (IDIBELL) and CIBERESP, Paula Peremiquel, Mireia Diaz and Laura Costas, and has had the participation of researchers from the Cancer Epidemiology Research Program, the Medical Oncology Service and the Hereditary Cancer Program and with the collaboration of other institutions such as the Gynecology Service of the Bellvitge University Hospital, and the CIBERONC, among others.
New diagnostic approaches to avoid false negatives
The incidence of endometrial cancer is increasing due to several factors, such as metabolic syndrome, obesity or the aging of the population. In this context, ‘abnormal’ uterine bleeding is a common symptom of endometrial cancer that ends up affecting 90% of women with this type of tumor, but only 9% of women who present bleeding suffer from this disease. Therefore, all women with postmenopausal bleeding require additional evaluation to identify and treat this condition.
Currently, in order to diagnose endometrial cancer, physicians perform transvaginal ultrasound and endometrial biopsy sampling. However, this method has some limitations, such as the biopsy failure rate and the possibility of obtaining ‘false negatives’ due to blind sampling of the uterus. For this reason, to address these limitations, new diagnostic approaches are being developed that use genomics, epigenomics, and proteomics in endometrial and cervico-vaginal samples to detect endometrial cancer early.
These new techniques benefit from the anatomical continuity of the uterine cavity with the cervix and have high sensitivity and specificity, offering a promising new horizon. For the corresponding author of this study, an expert in disease modeling and health economic analysis from ICO and IDIBELL, and CIBERESP, Mireia Diaz, “the implementation of new diagnostic methods is usually associated with a higher cost, so it is essential to compare the relative costs and health effects of different strategies to determine which ones are more efficient.”
A more effective test that can avoid unnecessary hysterectomies
The results suggest that the molecular approach is more effective, as molecular testing has the potential to decrease the number of undetected endometrial cancer cases by 65%, which may lead to earlier detection and better outcomes for patients. The study has also shown that molecular tests have the potential to reduce the number of hysterectomies by an average of 21% in women without endometrial cancer but who have bleeding from other causes, especially in advanced ages. Finally, the strategy that includes molecular markers has proven to be more cost-effective than the current strategy if the cost of the test is less than or equal to 310 euros.
“The results of this study support the use of molecular tests for the diagnosis of endometrial cancer in women with postmenopausal bleeding and highlight the potential benefits of this strategy in terms of decreasing the number of undetected cases as well as to reduce the number of unnecessary hysterectomies, and therefore improvements in quality and patient outcomes,” explains the first author of the article, Paula Peremiquel, and adds, “our findings provide valuable information since they allow the modification of diagnostic algorithms and make them more effective and efficient for the diagnosis of endometrial cancer.”
The Bellvitge Biomedical Research Institute (IDIBELL) is a biomedical research center created in 2004. It is participated by the Bellvitge University Hospital and the Viladecans Hospital of the Catalan Institute of Health, the Catalan Institute of Oncology, the University of Barcelona and the City Council of L’Hospitalet de Llobregat.
IDIBELL is a member of the Campus of International Excellence of the University of Barcelona HUBc and is part of the CERCA institution of the Generalitat de Catalunya. In 2009 it became one of the first five Spanish research centers accredited as a health research institute by the Carlos III Health Institute. In addition, it is part of the “HR Excellence in Research” program of the European Union and is a member of EATRIS and REGIC. Since 2018, IDIBELL has been an Accredited Center of the AECC Scientific Foundation (FCAECC).