Risk factors for endometrial hyperplasia and cancer among women with abnormal bleeding

Objective: To identify independent risk factors for endometrial neoplasia i n women with abnormal perimenopausal or postmenopausal bleeding and to use those factors to develop and test a predictive model. Methods: We conducted a case-control study of women with abnormal perimenop ausal or postmenopausal bleeding who had endometrial samplings; cases had e ndometrial cancer or complex hyperplasia and controls had benign endometria l histologies. Multivariate logistic regression models identified factors a ssociated with risks of endometrial neoplasia. The predictive abilities of our models and a published model were assessed wing the area under receiver operating characteristic (ROC) curves, for which an area of 1.0 indicated perfect positive predictive ability and an area of 0.5 was expected by chan ce. Results: There were 57 cases of endometrial hyperplasia or cancel and 137 c ontrols. Parity was related inversely (odds ratio [OR] 0.70; 95% confidence interval [CI] 0.56, 0.88; P = .002) and weight directly (OR 1.02 per kg; 9 5% CI 1.01, 1.04; P = .018) to the risk of endometrial neoplasia. Age (OR 1 .04 per year; 95% CI 1.00, 1.08; P = .06) and diabetes (OR 3.50; 95% CI 0.9 9, 12.33; P = .052) were significant marginally. The area under the ROC cur ve for our model was 0.75, indicating moderate predictive ability; the area under the ROC curve for the published model was lower at 0.66. Conclusion: Current clinical predictive models based on case-control studie s do not have sufficient predictive ability to determine if women with abno rmal perimenopausal or postmenopausal bleeding should have diagnostic testi ng. (Obstet Gynecol 1999;93:594-8. (C) 1999 by The American College of Obst etricians and Gynecologists.).