The detection method of choice for carcinoma of the endometrium is the same as that described for cancer of the cervix-routine annual pelvic examination, including cytologic study by means of smears.

We do not recommend endometrial aspiration as a routine detection procedure. It is an important aid, however, in the detection of endometrial cancer and should be performed with proper precautions in those women in whom the incidence may be relatively high.

Age Group

Although the Papanicolaou smear program is recommended for women 30 years of age and over because of the age distribution of patients with cervical lesions, findings related to endometrial cancer can be expected mostly in the postmenopausal women in their mid or late fifties.

Accuracy

The vaginal smear, sampling as it does an accumulated pool of cells, including those exfoliated from the endometrium, is the most reliable routine method for detection of endometrial cancer. In the presence of endometrial cancer, the smear is positive or suspicious about 65% of the time.

The cervical smear is a relatively ineffective method for finding endometrial cancer, although it will be positive in a certain percentage of patients (perhaps 40%).

Adding the technique of endometrial aspiration will raise the combined accuracy of screening techniques to the range of 85%. As noted previously, we do not recommend endometrial aspiration as a routine, across-the-board technique for the screening of presumably healthly women. It has its greatest usefulness as a secondary line of defense in patients with a higher risk of endometrial cancer and in the further evaluation of suspicious or equivocal cases. The technique described below (Fig. 58, p. 170) lends itself to application in the office or clinic with relative ease.