Occult Uterine Cancer in Presumed Benign Hysterectomies: A Population-Based Study [6D]

INTRODUCTION: To inform proper surgical planning and policy discussion regarding uterine power morcellation, this study estimated the prevalence of occult uterine cancer in a large population-based sample of women undergoing hysterectomy for presumed benign indications. METHODS: Women who underwent a hysterectomy in 10/1/2003-12/31/2013 were identified from the New York Statewide Planning and Research Cooperative System database which includes all inpatient and outpatient hospital discharges in the state. We excluded women with a history or admitting diagnosis of gynecologic cancer or endometrial hyperplasia, or received hysterectomy for non-gynecologic indications. Diagnosis of uterine cancer within 28 days after the index hysterectomy was determined based on linked state cancer registry data. RESULTS: We identified 233,979 women who underwent a presumed benign hysterectomy. The prevalence of occult uterine cancer was 1.00% (95% confidence interval [CI] 0.96-1.04%), including 0.78% (95% CI 0.74-0.81%) for endometrial carcinoma and 0.22% (95% CI 0.20-0.24%) for uterine sarcoma. The prevalence for leiomyosarcoma was 0.15% (95% CI 0.13-0.17%). The rate of occult uterine cancer ranged from 0.27% in laparoscopic supracervical hysterectomy to 1.96% in total abdominal hysterectomy; and varied from 0.15% in women undergoing hysterectomy for endometriosis to 0.64% for uterine fibroids and 8.64% for postmenopausal bleeding. After adjusting for surgical indication, the risk of occult uterine cancer was significantly higher in older women (e.g., odds ratio=25.98 for age ≥60 years versus <40 years, P<.001). CONCLUSION: The risk of occult uterine cancer in presumed benign hysterectomy was 1%. Older women and those who underwent total abdominal hysterectomy or with postmenopausal bleeding were at higher risk.