Factors predicting type II histology in endometrial biopsies among postmenopausal minority women at a safety-net hospital
Timmons D, Fein L, McCarter K, Huang M, Carugno JA, Gelman J, Strong A, Schlumbrecht M. Factors Predicting Type II Histology in Endometrial Biopsies Among Postmenopausal Minority Women at a Safety-Net Hospital. J Womens Health (Larchmt). 2020 Dec 1. doi: 10.1089/jwh.2020.8443. Epub ahead of print. PMID: 33259765
Background: Rates of type II endometrial cancers (EC) are increasing in the United States, especially in minority women. The purpose of this project was to examine a primarily minority and low socioeconomic status patient population in a public hospital to identify risk factors associated with the finding of type II histology in endometrial biopsies (EMBs).
Materials and Methods: A retrospective chart review was performed of patients who underwent an EMB between 2010 and 2016. Included patients were postmenopausal women older than 50 years with biopsy-proven EC. Basic demographic data were analyzed, along with indication for EMB and ultrasound findings. Statistics were completed using analysis of variance and logistic regression with significance set at p < 0.05.
Results: Four hundred sixty-one EMB results were reviewed. Around 17.4% (n = 80) resulted in a diagnosis of EC, with 45% (n = 36) being type II histology. Average age was 62.5 (standard deviation [SD] = 7.63), and the majority (64%) were Hispanic. Type II malignancies were diagnosed in 17% of Caucasians, 41% of Hispanics, and 61% of blacks/Haitians (p = 0.03). Factors associated with type II tumors in univariable models included older age (odds ratio [OR] 1.10 [confidence interval; CI 1.03-1.18], p = 0.007), black/Haitian (vs. Caucasian) race (OR 8.75 [CI 0.86-88.70], p = 0.066), obesity (OR 0.39 [0.15-0.98], p = 0.044), and number of years since menopause (OR 1.06 [CI 1.01-1.12], p = 0.027), although none remained independently predictive in the multivariable analysis.
Conclusion: This minority population of postmenopausal women with EC had a greater prevalence of type II histologies. Understanding this pattern may be helpful in expediting the workup for abnormal symptoms in these women and prompt a higher level of suspicion for EC.