Endometrial Cancer and Pre-Malignant Conditions in Young Women: Survey of Endometrial Sampling Practices by Canadian Gynecologists
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Objective: To identify the physician-, patient- and health-system-related factors that influence gynecologists’ decision to recommend endometrial sampling in young women (less than 40 years) with abnormal uterine bleeding Study methods: A mail-based survey study was conducted using the Salant-Dillman method with 4 points of contact over 9 weeks. All Canadian obstetrician/gynecologists were initially surveyed (N=1746), receiving either French or English questionnaires. Eligible respondents were gynecologists practicing in Canada who treat these young women (N=834). Order response bias was taken into consideration by mailing two versions of the survey. Categorical data were analyzed using Pearson’s Chi-square statistics. A logistic regression with mixed effect model was performed to determine the odds of sampling the endometrium, using physician as random factor. Results: Overall response rate was 56.5%. The majority of respondents were generalists (83.6%). 70.3% of respondents have had young patients with malignant or pre-malignant endometrial conditions. Physicians ≤ 39 years have had less experience with these patients (59.6%, p=0.002) as have physicians practicing in communities without ob/gyn residents (35.2%, p=0.006). Sampling method was predominantly by office pipelle (79.7%), with younger physicians and female respondents employing this method most frequently (p=0.0001). In case scenarios which explored the importance of four patient-related risk factors (obesity, irregular cycles, nulliparity and older age), on the decision to sample, 98.8% of respondents would sample a young woman presenting with all four risk factors, as opposed to 8.8% who would sample if the patient did not have any of these characteristics. Obesity and irregular cycles was the next most important combination of risk factors prompting sampling in 87.3% of physicians. In the logistic regression, the odds ratio to proceed with endometrial sampling was 2.23 (95% CI 1.64-3.03) if a physician had previous experience with young women diagnosed with endometrial cancer or a pre-malignant condition, and was 1.45 (95% CI 1.05-2.01) if the physician was female. Conclusion: Patient and physician factors influenced the decision to proceed with sampling the endometrium of young women with abnormal uterine bleeding, whereas the health-system factors studied in this survey did not seem to play a strong role.