Abstract
BackgroundData on long-term risk of cancer after a postmenopausal bleeding diagnosis are sparse.MethodsWe used Danish medical registries to conduct a population-based cohort study of women with a first hospital-diagnosed postmenopausal bleeding during 1995–2013. We computed the absolute risk of cancer and the standardised incidence ratio (SIR) comparing the observed cancer incidence with that expected in the general population.ResultsAmong 43,756 women with postmenopausal bleeding, the absolute 1- and 5-year risk of endometrial cancer were 4.66% and 5.18%, respectively. The SIR of endometrial cancer was elevated during 0–3 months (SIR = 330.36 (95% CI: 315.43–345.81)), 3–12 months (SIR = 11.39 (95% CI: 9.79–13.17)), 1–5 years (SIR = 2.55 (95% CI: 2.19–2.94)) and >5 years of follow-up (SIR = 1.63 (95% CI: 1.40–1.90)). All selected gynaecological and urological, gastrointestinal and haematological cancers had elevated 0–3 months SIRs. Beyond 1 year of follow-up the SIRs of ovarian and bladder cancer remained elevated with a 1–5-year SIR of 2.15 (95% CI: 1.71–2.65) and 1.45 (95% CI: 1.14–1.80), respectively.ConclusionsIn the Danish population, women with a first hospital-diagnosed postmenopausal bleeding have an increased 0–3 months risk of gynaecological, urological, gastrointestinal and haematological cancers. The SIR of endometrial, ovarian and bladder cancer remained elevated for several years.
Highlights
Data on long-term risk of cancer after a postmenopausal bleeding diagnosis are sparse
Urological cancers Within 0–3 months of follow-up, we found an elevated risk of bladder cancer
In this Danish population-based study, we found that a first-time hospital-diagnosed Postmenopausal bleeding (PMB) is a clinical marker of gynaecological, urological, gastrointestinal and haematological cancer
Summary
Data on long-term risk of cancer after a postmenopausal bleeding diagnosis are sparse. All selected gynaecological and urological, gastrointestinal and haematological cancers had elevated 0–3 months SIRs. Beyond 1 year of follow-up the SIRs of ovarian and bladder cancer remained elevated with a 1–5-year SIR of 2.15 (95% CI: 1.71–2.65) and 1.45 (95% CI: 1.14–1.80), respectively. CONCLUSIONS: In the Danish population, women with a first hospital-diagnosed postmenopausal bleeding have an increased 0–3 months risk of gynaecological, urological, gastrointestinal and haematological cancers. 5–10% of women with hospital-diagnosed PMB has an underlying endometrial cancer.[4,5,6,7,8,9] PMB is most commonly attributed to an intrauterine source, it may originate from other gynaecological or non-gynaecological sources, such as the cervix, vagina, ovaries, bladder, urethra or lower gastrointestinal tract.[10] Occasionally, PMB occurs due to non-structural causes such as coagulopathies as seen in haematologic cancers.[11]
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