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Consultant360Q&A with NCI’s Dr. Megan Clarke: Postmenopausal Bleeding as a Red Flag for Cancer

A new study published in JAMA Internal Medicine reveals that 90% of women diagnosed with endometrial cancer experience postmenopausal bleeding as an early symptom. Dr. Megan Clarke and colleagues at the National Cancer Institute investigated this correlation, highlighting the diagnostic significance of postmenopausal bleeding for early cancer detection when survival rates are highest.


Key Points:

  • Postmenopausal bleeding occurring one year or more after the last menstrual period requires medical evaluation, as it may indicate underlying pathology despite benign causes like hormone replacement therapy and vaginal atrophy being common
  • Early-stage endometrial cancer detection yields a 95% five-year survival rate, compared to less than 45% for late-stage diagnoses, emphasizing the critical importance of timely evaluation
  • Clinical assessment of postmenopausal bleeding should incorporate risk factors including age, obesity, unopposed estrogen use, type 2 diabetes, polycystic ovary syndrome, and family history of gynecologic cancer
  • Diagnostic options include transvaginal ultrasound as an initial evaluation tool for low-risk patients, with endometrial biopsy recommended for high-risk cases or persistent bleeding
  • Current research focuses on developing new technologies and biomarkers to differentiate high-risk from low-risk postmenopausal bleeding cases, including investigation of tampon sampling as an alternative detection strategy

“…in endometrial cancer, our study demonstrated that even women with early stage disease are symptomatic with postmenopausal bleeding, representing a unique opportunity for early detection of endometrial cancers when they are highly amenable to treatment.”
— Megan Clarke, PhD, MHS, Cancer Prevention Fellow in the Division of Cancer Epidemiology and Genetics at the National Cancer Institute


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