Endometrial cancer and associated risk factors among non-pregnant women with abnormal uterine bleeding in Kampala, Uganda: a 7-year experience from a Single Institution.

Abstract

Introduction: Endometrial cancer is the most common malignancy of among postmenopausal women in high income countries, however, its prevalence has been reported to be raising even in low-and middle-income countries due to change in lifestyle behaviors. We aimed to determine the prevalence of endometrial cancer and its associated factors among non-pregnant women with abnormal uterine bleeding.

Methods: After obtaining ethical approval from the Research Ethical Committee of the Makerere college of Health Sciences, we retrospectively retrieved and analyzed the paraffin embedded tissue blocks of 159 patients who were non-pregnant women and they were presenting with abnormal uterine bleeding from January 2012 to December 2018. The clinical and pathological information was obtained from the patient's files. Statistical analysis was done using SPSS version 23.0. Binary logistic regression analysis was applied in determining the risk factors of endometrial cancer. A two-tailed p -value <0.05 was considered significant.

Results: The overall mean age of the patients was 36.4 ± 13.7 years and the vast majority 71.1% (113/159) of the patients were premenopausal women. The prevalence of endometrial cancer was 11.9% (19/159). Being postmenopausal (AOR = 7.7, 95% CI = 2.155 - 27.666, p = 0.003), having menarche below 12 years (AOR = 4.5, 95% CI = 0.217-0.390, p<0.001), being obese (AOR = 2.5, 95% CI = 0.305-0.822, p = 0.01), and being nulliparous (AOR = 5.4, 95% CI = 0.292-0.957, p = 0.009) were significantly associated with endometrial cancer. However, use of contraceptive pills, family history of reproductive cancers, having hypertension and/or diabetes mellitus all were not associated with endometrial cancer.

Conclusion: Our study has further proven that, there is a significant proportion of non-pregnant women with AUB who have endometrial cancer. Using the clinical parameters such as age of the patient and age at menarche, nulliparity and obesity, it may help in increasing the index of clinical suspicion in daily clinical practice to diagnosing endometrial cancer among women with AUB at early stage. This will help in improving the prognosis of the patients.