Is Age a Risk Factor for Endometrial Hyperplasia or Cancer in Young Women With Abnormal Bleeding? [49

Abstract

OBJECTIVE: Current American College of Obstetricians and Gynecologists guidelines recommend performing endometrial sampling in women with abnormal uterine bleeding (AUB) who are 45 years and older. However, there is little evidence supporting this age cutoff. We thus aimed to determine whether age is an independent risk factor for endometrial hyperplasia or cancer in premenopausal women with AUB. METHODS: A retrospective review was performed on premenopausal women with AUB who underwent endometrial sampling from March 2008 to December 2009. Patients' age; race; bleeding pattern; body mass index (BMI, calculated as weight (kg)/[height (m)]2); parity; hormone use; history of diabetes, hypertension, and polycystic ovary syndrome (PCOS); and family history of cancer were collected. Multivariate logistic regression models were used to assess the significance of age for development of endometrial hyperplasia or cancer, controlling for those factors significant on bivariate analysis. RESULTS: A total of 673 patients were eligible, 96 of whom had endometrial hyperplasia or cancer (14.2%). Based on bivariate analysis findings, age, nulliparity, bleeding pattern, increased BMI, PCOS, and diabetes were entered in the multivariate analysis. Logistic regression confirmed a strong association between endometrial hyperplasia or cancer and nulliparity (adjusted odds ratio [OR] 3.2, 95% confidence interval [CI] 1.5–6.7; P=.001) as well as increased BMI (adjusted OR/1-unit increase in BMI 1.03, 95% CI 1.00–1.07; P=.044). The association between age and endometrial hyperplasia or cancer was no longer significant on multivariate analysis (P>.05). CONCLUSION: Our data do not support a specific age cutoff for performing endometrial sampling in premenopausal women with AUB and stress the importance of nulliparity and obesity in risk factor–guided endometrial sampling strategies.