Making the Diagnosis
There's no screening test for endometrial cancer. It's true that these tumors are sometimes detected by the cervical Pap smear test (see the "Cervical Cancer" condition article), but this screening test is hit-and-miss when it comes to endometrial cancer; it merely catches endometrial cells that have been dislodged and swept down to the cervix. Transvaginal ultrasound and endometrial sampling that are used for diagnosis (see below) are being studied for their value as screening tests.
The only reliable diagnostic test for endometrial cancer is a tissue biopsy (sample). Tissue sampling from the endometrium (endometrial biopsy), usually performed in the physician's office, is the surest diagnostic procedure. Another method of tissue sampling is a D&C (dilation of the cervix and curettage, which is scraping of the uterine lining). However, a D&C requires anesthesia and may be unsuitable for a woman who is very elderly or has serious medical problems. A transvaginal ultrasound is another procedure that may help diagnose this cancer, but the results are less certain than a biopsy.
The vast majority of uterine cancers are detected when a woman notices abnormal vaginal bleeding. Abnormal bleeding should never be ignored, especially in a postmenopausal woman. Any woman over the age of 40 with abnormal vaginal bleeding should consult her doctor to help decide whether further testing is needed. Taking estrogen supplements occasionally causes harmless abnormal uterine bleeding, but a doctor should always be consulted in any case.
A D&C obviously isn't appropriate for random or routine screening, but some high-risk women might want to consider having an endometrial biopsy or transvaginal ultrasound performed every year. Women at high risk include those taking strong estrogen supplements that aren't balanced with progesterone, obese women, and women taking tamoxifen (a breast cancer medication).
Since these tests are not universally recommended, women should discuss with their doctors whether screening is appropriate in their circumstances.