Open Collections

Abstract

Endometrial cancer (EC) is the most common gynecological cancer in Canada, with no improvements in survival rates observed for the past thirty years. There are currently no recommendations for a screening test for endometrial cancer, even though earlier detection would lead to improved outcomes. The Progesterone Challenge Test (PCT) is a non-invasive hormonal test which was proposed in 1980 to be used as a screening tool to identify postmenopausal individuals with excess estrogen. The PCT entails administering a short course of progestogen and monitoring for a positive test result of menstrual-like (withdrawal) bleeding. Individuals who experience withdrawal bleeding need to undergo an endometrial biopsy to rule out potential pathology. This thesis assesses the diagnostic accuracy of the PCT as a tool to detect endometrial pathology based on existing literature (Aim 1). I also investigated the preliminary results from an ongoing clinical study that assesses the feasibility and acceptability of a protocol that directs high-risk participants to undergo the PCT and various prevention interventions (Aim 2). In a systematic review of the literature, I assessed the diagnostic accuracy of the PCT by evaluating the data published in 19 articles. The meta-analysis demonstrated that the PCT is both a sensitive and specific test for the detection of endometrial pathology. A negative PCT result was completely accurate in ruling out endometrial pathology, whereas 34% of those with a positive test had underlying pathology (95% CI: 16% -54%). A preliminary analysis of the data from an ongoing trial show that the PCT is an acceptable test. However, to date, the data from the trial has yet to reach the minimum thresholds we established for feasibility and should be reassessed upon study completion. Overall, the PCT is a non-invasive and accurate test to detect endometrial pathology in an asymptomatic postmenopausal population. The acceptability and feasibility of the PCT should continue to be assessed. Future work should focus on the acceptability of this test from a healthcare provider standpoint and the effectiveness of this triaging test in preventing EC.