Risk assessment for endometrial cancer in women with abnormal vaginal bleeding: Results from the prospective IETA-1 cohort study

Jan Yvan Verbakel*, Ruben Heremans, Laure Wynants, Elisabeth Epstein, Bavo De Cock, Maria Angela Pascual, Francesco Paolo Giuseppe Leone, Povilas Sladkevicius, Juan Luis Alcazar, Catherine Van Pachterbeke, Ligita Jokubkiene, Robert Fruscio, Tom Bourne, Ben Van Calster, Dirk Timmerman, Thierry Van den Bosch, IETA consortium

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


OBJECTIVE: To investigate the association between personal history, anthropometric features and lifestyle characteristics and endometrial malignancy in women with abnormal vaginal bleeding.

METHODS: Prospective observational cohort assessed by descriptive and multivariable logistic regression analyses. Three features-age, body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters), and nulliparity-were defined a priori for baseline risk assessment of endometrial malignancy. The following variables were tested for added value: intrauterine contraceptive device, bleeding pattern, age at menopause, coexisting diabetes/hypertension, physical exercise, fat distribution, bra size, waist circumference, smoking/drinking habits, family history, use of hormonal/anticoagulant therapy, and sonographic endometrial thickness. We calculated adjusted odds ratio, optimism-corrected area under the receiver operating characteristic curve (AUC), R2 , and Akaike's information criterion.

RESULTS: Of 2417 women, 155 (6%) had endometrial malignancy or endometrial intraepithelial neoplasia. In women with endometrial cancer median age was 67 years (interquartile range [IQR] 56-75 years), median parity was 2 (IQR 0-10), and median BMI was 28 (IQR 25-32). Age, BMI, and parity produced an AUC of 0.82. Other variables marginally affected the AUC, adding endometrial thickness substantially increased the AUC in postmenopausal women.

CONCLUSION: Age, parity, and BMI help in the assessment of endometrial cancer risk in women with abnormal uterine bleeding. Other patient information adds little, whereas sonographic endometrial thickness substantially improves assessment.

Original languageEnglish
Pages (from-to)103-110
Number of pages8
JournalInternational Journal of Gynecology & Obstetrics
Issue number1
Early online date19 Jan 2022
Publication statusPublished - Oct 2022


  • endometrial neoplasms
  • endometrium
  • uterine hemorrhage

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