Regular endometrial biopsies are not worth it

Women on estrogen therapy usually take an additional hormone, progestin, if they have an intact uterus. This has been the standard advice ever since it became known that estrogen causes an increased incidence of endometrial (uterine) cancer. While progestin is believed to offer protection against this possibility, the drug can cause bleeding. But vaginal bleeding is also a sign of endometrial cancer, so gynecologists often perform an endometrial biopsy before a woman embarks on estrogen/progestin therapy in order to rule out the presence of an existing cancer. This is a fairly uncomfortable office procedure in which the doctor removes cells from the endometrium, or lining of the uterus, and sends the specimen to a laboratory for evaluation. Some gynecologists advise yearly endometrial biopsies for women taking long-term estrogen/progestin therapy to make sure the bleeding isn't a sign of cancer. Unfortunately, there is no scientific evidence to support the practice. In its 1996 report, the U.S. Preventive Services Task Force noted that the endometrial biopsy has never been adequately assessed for its ability to prevent endometrial cancer.

A new study tested the use of the endometrial biopsy as a means of screening mid-life women about to go on hormone therapy (American Journal of Obstetrics & Gynecology, February 1997). Nearly 3,000 women were given biopsies, and the research team, headed by Dr. M.O. Korhonen, University of South Alabama, Mobile, found that the incidence of endometrial cancer found was too minuscule (0.07 %) to justify the routine use of this procedure. This study had the largest number of participants screened prior to hormone therapy.

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