Urine and vaginal fluid test could spare many women invasive womb cancer checks

In a study of 1,864 women with postmenopausal bleeding, Manchester researchers found a simple cell test ruled out womb cancer with a negative predictive value of 98.8%.

Bleeding after the menopause triggers urgent investigation for cancer, often through invasive and costly tests, yet only 5 to 10% of women investigated turn out to have cancer. Researchers at The University of Manchester, with Manchester University NHS Foundation Trust and the NIHR Manchester Biomedical Research Centre, have tested a simpler approach, reporting their findings in Lancet Obstetrics, Gynaecology and Women's Health.

The DETECT study involved 1,864 women attending hospital with postmenopausal bleeding. Before routine investigations, each gave urine and vaginal fluid samples, which specialist cytopathologists examined for abnormal cells without knowing the diagnoses. Of the 115 women found to have cancer, 99 had womb cancer. Combined, the two samples identified more than 80% of cancers and gave a negative predictive value of 98.8% for womb cancer.

The test identified 95.8% of high-grade tumours and 96.4% of cancers that had spread beyond the uterus. It also detected every cancer among Black women in the study, a small subgroup, with 96% specificity. Black women in the UK are twice as likely as White women to die from womb cancer, and a companion paper found current tests are poorly calibrated for them.

Lead researcher Professor Emma Davidson said the test "could help identify the women most likely to have cancer while safely reassuring many others much earlier in the diagnostic pathway." The team says further studies are needed to see how it performs in routine practice, but it could eventually be used in primary care and community settings.

Source: the original release from University of Manchester, reporting research published in Lancet Obstetrics, Gynaecology and Women's Health. Summarised by GRP Research News.