Koss L G
Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
J Cell Biochem Suppl. 1995;23:165-73. doi: 10.1002/jcb.240590922.
Endometrial carcinoma is commonly diagnosed as a consequence of abnormal uterine bleeding. In a study published in 1962, it was documented that endometrial cancer may be detected by vaginal pool smears in asymptomatic postmenopausal women. As a consequence of these observation, a systematic search for occult endometrial carcinoma was initiated in 1979, supported by a contract from the National Cancer Institute. The techniques used in this study and the problems encountered in the diagnosis of occult endometrial carcinoma will be discussed. Within 3-1/2 years of this study encompassing 2,586 peri- or postmenopausal women 16 occult endometrial carcinomas were discovered by direct endometrial sampling. Two carcinomas, missed on initial screening, were subsequently documented in this cohort, for a prevalence rate of 6.96 per 1,000. The incidence data based on follow-up examination of 1,754 women was 1.71 per 1,000 woman-years. An elaborate epidemiologic questionnaire was evaluated. Contrary to some prevailing views, obesity, hypertension, and diabetes failed to reach statistical significance as risk factors. The only risk factor of statistical value was delay in the onset of menopause past age 49, observed in about 50% of the cohort. It was noted that the administration of estrogens to women in Quetelet Index groups below means was more likely to be associated with carcinoma than in women in higher Quetelet groups but, again, the difference was not statistically significant. It was noted that in spite of an active search for endometrial hyperplasias, the rate of these lesions was nearly identical to the prevalence and incidence rates for carcinoma. It was postulated that some or perhaps most, endometrial carcinomas in postmenopausal women are not preceded by hyperplasia but originate ab initio in the endometrium.
子宫内膜癌通常因子宫异常出血而被诊断出来。在1962年发表的一项研究中，有记录表明，无症状绝经后女性的阴道池涂片可检测出子宫内膜癌。基于这些观察结果，1979年在国家癌症研究所的一份合同支持下，开始了对隐匿性子宫内膜癌的系统筛查。本文将讨论该研究中使用的技术以及隐匿性子宫内膜癌诊断中遇到的问题。在这项涵盖2586名围绝经期或绝经后女性的研究的3年半时间里，通过直接子宫内膜取样发现了16例隐匿性子宫内膜癌。该队列中随后记录了2例最初筛查时漏诊的癌症，患病率为每1000人中有6.96例。基于对1754名女性的随访检查得出的发病率数据为每1000女性年中有1.71例。一份详尽的流行病学调查问卷得到了评估。与一些普遍观点相反，肥胖、高血压和糖尿病作为风险因素未达到统计学意义。唯一具有统计学价值的风险因素是绝经年龄延迟至49岁以后，约50%的队列中观察到了这一情况。值得注意的是，给体重指数低于平均水平组的女性服用雌激素比给体重指数较高组的女性服用雌激素更有可能与癌症相关，但同样，这种差异没有统计学意义。值得注意的是，尽管积极筛查子宫内膜增生，但这些病变的发生率与癌症的患病率和发病率几乎相同。据推测，绝经后女性的一些或也许大多数子宫内膜癌并非由增生发展而来，而是从子宫内膜开始就原发产生。
