Novel Approaches to Diagnostics for Women at High Risk for Endometrial Cancer: A Holistic Approach

Endometrial cancer (EC) is the most common cancer in US women with increasing incidence driven by epidemic of obesity and metabolic syndrome (MetS). There is an urgent need for early identification of women at high risk for EC and targeting them with effective diagnostic methods. The aim of this research work was to improve diagnostics of EC and its precursors by using holistic approach to diagnostics of EC which includes: (1) improved identification of women at high risk for EC development by identifying the most applicable MetS definition for EC; and (2) identifying factors that can be targeted to increase the success rate of Pipelle biopsy, which is the most common endometrial sampling method US. This research work demonstrated that there is a substantial diversity in MetS definitions as applied to women with EC, potentially limiting the clinical use of MetS due to inconsistencies in the research evidence. It also demonstrated that Pipelle biopsy failure rate is higher than was traditionally thought, with a number of personal and clinical factors affecting the risk of procedure failure. Holistic Model for Diagnosis of EC (HOMDEC) framework was developed based on the findings of this research work, as well as previously published research literature. Utilization of this novel holistic framework in the clinical care for women who are at EC risk has high public health significance, as it can potentially lead to reducing EC mortality due to timely, effective, and patient oriented diagnostics of EC. Further research needs to concentrate on exploring the effects of anxiety and pain during the Pipelle procedure and subsequently working to adapt HOMDEC framework to clinical practice by collaborating with providers and hospital managers