Should body mass index replace age to drive the decision for endometrial sampling in premenopausal women with abnormal uterine bleeding?

Abstract

Objective

This study aimed to evaluate risk factors for endometrial intraepithelial neoplasia/malignancy in premenopausal women with abnormal uterine bleeding or oligomenorrhea. Specifically, we aimed to elucidate whether body mass index (BMI) or age confers a higher risk.

Study design

A retrospective cohort study was performed at a large academic center examining risk factors for endometrial hyperplasia/malignancy in premenopausal women undergoing endometrial sampling.

Results

Of the 4170 women ages 18–51 who underwent endometrial sampling from 1987 to 2019, 77 (1.85%) were found to have endometrial intraepithelial neoplasia or malignancy. Clinical predictors of EIN/malignancy in this population included obesity (OR: 3.84, 95%, p < .001), Body mass index [(OR30 vs. 25:2.11, p < .001) and OR35 vs. 30: 1.65, p < .001], Diabetes (OR: 3.6, p-value <.001), hormonal therapy use (OR: 2.93, p < .001), personal history of colon cancer (OR: 9.90, p = .003), family history of breast cancer (OR: 2.65, p < .001), family history of colon cancer (OR: 3.81, p < .001), and family history of endometrial cancer (OR: 4.92, p = .033). Age was not significantly associated with an increased risk of disease. Adjusting for other factors, a model using BMI to predict the risk of EIN/malignancy was more discriminative than a model based on age.

Conclusions

Increased BMI, may be more predictive of endometrial hyperplasia/malignancy than age in premenopausal women with abnormal uterine bleeding. Modification of evaluation guidelines in a contemporary demographic setting could be considered.

摘要

目的：本研究旨在评估绝经前异常子宫出血或月经过少女性子宫内膜上皮内瘤变（EIN）/恶变的危险因素。具体地说, 我们的目的是阐明体重指数（BMI）或年龄是否具有更高的风险。

研究设计：在一家大型学术中心进行了一项回溯性队列研究, 调查绝经前接受子宫内膜采样的女性子宫内膜增生/恶变的危险因素。

结果：1987年至2019年, 在4170名年龄在18-51岁的女性中, 77人（1.85%）被发现患有EIN或恶变。该人群中 EIN/恶变的临床预测因子包括肥胖（OR: 3.84, 95%, p<0.001）、体重指数[(OR30 vs. 25: 2.11, p<0.001)和(OR35 vs. 30: 1.65, p<0.001)]、糖尿病（OR: 3.6, p<0.001）、激素治疗（OR: 2.93, p<0.001）、结肠癌个人病史（OR: 9.90, p=0.003）、乳腺癌家族史（OR: 2.65, p<0.001）、结肠癌家族史（OR: 3.81, p<0.001）和子宫内膜癌家族史（OR: 4.92, p=0.033）。年龄与疾病风险的增加并不显著相关。调整其他因素后, 采用BMI预测EIN/恶变风险的模型比基于年龄的模型更具区分性。

结论：在有异常子宫出血的绝经前女性中, BMI增加可能比年龄更能预测子宫内膜增生症/恶变。可以考虑在当代人口统计背景下修改评估指南。

Keywords:

• Endometrial cancer
• endometrial hyperplasia
• endometrial intraepithelial neoplasia (EIN)
• obesity
• body mass index (BMI)
• abnormal uterine bleeding (AUB)
• anovulatory bleeding
• oligomenorrhea

Acknowledgments

The authors wish to acknowledge Dr. Digna Velez-Edwards for assistance with study design and statistical calculation, and the Vanderbilt Institute of Clinical and Translational Research (VICTR) for grant funding for this project.

Presentations

Oral presentation AAGL 48th Global Congress on MIGS, Vancouver, BC, Canada, November 9–13, 2019.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

This work was supported by Vanderbilt Institute for Clinical and Translational Research (VICTR) Grant.