New urine and vaginal fluid test could help rule out womb cancer in postmenopausal women

Doctors have developed a simple test that could help rule out womb cancer in women who experience bleeding after menopause.

The approach has the potential to transform care for thousands of women each year and spare them from invasive and uncomfortable tests that can also be costly for healthcare systems.

Every year, hundreds of thousands of women worldwide are diagnosed with womb cancer. Bleeding after menopause triggers an urgent cancer referral but only about 5% to 10% of women who report bleeding have an underlying cancer.

Currently, the tests for womb cancer – an internal ultrasound scan, a biopsy of the womb lining and hysteroscopy, in which a camera is passed into the womb – are all invasive and costly.

The new test, developed at the University of Manchester and Manchester University NHS foundation trust, looks at cells collected from the urine and vaginal fluid. It is cheap and non-invasive.

In a study assessing the test, 1,864 women attending seven hospitals in north-west England with postmenopausal bleeding gave a urine sample and a vaginal fluid sample before their routine tests.

Of these women, 5% (99 of the 1,864) were diagnosed with womb cancer via a biopsy or surgery. Using the new test, cytologists unaware of the women’s diagnoses identified 80 of the 99 womb cancers and correctly returned a negative result for 93% of women who did not have womb cancer.

The findings were published in the journal Lancet Obstetrics, Gynaecology, & Women’s Health.

Researchers said the test was not accurate enough to rule cancer out on its own but could fast-track women at the highest risk for urgent investigation while sparing lower-risk women immediate invasive testing, with repeat sampling or full assessment if symptoms continued.

They cautioned that the samples in the study were assessed by highly trained specialist cytologists, so it was not known whether the same accuracy could be reproduced in other settings, and that the test had not been studied in women without symptoms.

Researchers said the test could be used to triage women suspected of having womb cancer, to “support rapid diagnosis, provide quick reassurance and reduce the burden of invasive testing for women with postmenopausal bleeding”.

Prof Emma Davidson, of the University of Manchester and Manchester University NHS foundation trust, said: “Bleeding after the menopause is understandably alarming for women because it can be a sign of cancer, but the vast majority of those investigated will not have the disease.

“At the moment, many women face invasive, uncomfortable tests that can be stressful as well as costly for health services before cancer can be ruled out. Our study shows that a simple test using urine and vaginal samples could help identify the women most likely to have cancer while safely reassuring many others much earlier in the diagnostic pathway.

“If further studies confirm these findings in routine practice, this approach has the potential to transform care for thousands of women every year.”