Evidence
Alert

Womb cancer could be detected early with an inexpensive new blood test

A simple, low-cost blood test offers great potential as a tool for diagnosing womb cancer, and for screening high-risk women. The test gives almost instant results and in a new study, it picked up changes in the womb that could lead to cancer (pre-cancerous growths).

In the UK, womb cancer is the fourth most common cancer in women. Survival is improving but it remains the eighth most common cause of cancer death in UK women. Current diagnostic procedures are expensive, invasive, or lack accuracy.

This study investigated a technique involving infrared light to determine the ‘molecular fingerprint’ of blood samples, to find out whether it could be useful for detecting womb cancer. The researchers looked for key differences in samples from women that could confirm whether they had womb cancer or precancerous growths that might develop into the disease.

Across all stages of womb cancer, the test detected disease with a high degree of accuracy, especially in early-stage disease. The study confirms that an innovative, non-invasive technique could help to identify womb cancer early.

What’s the issue?

Around 9,500 women are diagnosed with womb cancer in the UK every year. Since the early 1990s, numbers have increased by 55%, mainly because of an increase in obesity.

Early detection increases the chances that the disease can be treated successfully and may allow management that spares fertility. In 2016, the NHS set out the ambitious target that diagnosis should be established within 28 days of attending primary care.

Most women with womb cancer have abnormal vaginal bleeding, which prompts their referral for further investigations. Diagnosis currently involves a transvaginal ultrasound scan, followed by a biopsy which may require a general anaesthetic. The process is invasive, expensive and lacks accuracy. In some cases, the disease may have reached an advanced stage before it causes any signs or symptoms.

There is a need for simple, effective new tools to help detect womb cancer in women with or without symptoms of the disease.

What’s new?

The researchers analysed blood samples collected from 652 women: 342 women with womb cancer; 68 with precancerous growths in their womb lining; and 242 healthy women. They adjusted the data for patient characteristics including age, obesity, and diabetes, which are linked with an increased risk of womb cancer.

A screening test needs to have high sensitivity and be very likely to detect the disease when it is present. It also needs to have high specificity so that it does not suggest cancer by mistake in healthy women. This causes unnecessary distress and leads to unnecessary investigations.

Overall, this study showed that the new technique has the potential to detect womb cancer with:

  • 87% sensitivity – it could pick out womb cancer in 87 out of 100 samples from women who had the disease
  • 78% specificity – it incorrectly suggested cancer in 22 out of 100 samples from healthy women.

The results were better for detecting type 1 cancer, the most common subtype:

  • 91% sensitivity
  • 81% specificity.

The test was most accurate for detecting the precancerous growths in the womb that can lead to cancer. It had:

  • 100% sensitivity
  • 88% specificity.

Why is this important?

This is the largest study to date exploring the potential of this technique as an early detection tool for womb cancer. The results demonstrate that a simple, low-cost blood test can accurately detect womb cancer, as well as precancerous growths that could develop into the disease.

The necessary equipment is portable and gives an immediate result. It could be used within primary care settings as a bedside diagnostic tool. In clinical settings, this test could help ensure that invasive or expensive follow-up procedures are offered only to women at high risk of developing the disease. This would reduce pressure on cancer diagnostic services.

The test also has potential as a screening tool to help identify women with precancerous growths that could later develop into womb cancer – helping to prevent the disease early and spare their fertility.

What’s next?

Even larger studies are now needed to confirm the results in the general population and in high-risk groups. These include women with obesity or certain genetic conditions that can increase the risk of the disease.

Future clinical trials following healthy women at high-risk of womb cancer for many years will be needed. They will establish whether this approach offers benefits over current diagnostic procedures for the early detection of womb cancer.

You may be interested to read

The full paper: Paraskevaidi M, and others. Detecting Endometrial Cancer by Blood Spectroscopy: A Diagnostic Cross-Sectional Study. Cancers. 2020;12:1256

Gajjar K, and others. Fourier-transform infrared spectroscopy coupled with a classification machine for the analysis of blood plasmaor serum: a novel diagnostic approach for ovariancancer. Analyst. 2013;138:3917-3926

Cancer Research UK. Patient information about womb cancer. 2020

Funding

This study was supported by the Rosemere Cancer Foundation and the NIHR Manchester Biomedical Research Centre. It was partly funded by NIHR Clinical Scientist Fellowships and an Academic Clinical Fellowship.

Commentaries

Study author

Of course, as with every new diagnostic technique, there are several more phases before this test can be routinely used in the clinic. But if it is successfully validated in further research, such a blood test has the potential to be developed into a quick, bedside tool for womb cancer. This would permit diagnosis at a single one-stop clinic. It would minimise the risk of non-compliance, repeat visits and overburdening of services, particularly in the post-COVID era.

Maria Paraskevaidi, Research Associate, School of Pharmacy and Biomedical Sciences, University of Central Lancashire & Department of Metabolism, Digestion and Reproduction, Imperial College London

Gynaecologist comment

This is a promising new non-invasive test for the early diagnosis of womb cancer. This type of innovation will be particularly important in helping to achieve the new NHS standards for the fast-tracking of cancer diagnoses. All of us working in cancer diagnostics in big, busy departments are fully aware of the burden and size of this challenge.

It needs to be decided where the test would be most beneficial. It could be used in general practice to decide which patients need to be referred to secondary care. Or it could be used within hospitals for patients who have had uncertain results from other tests. We will need to know whether it reduces time to diagnosis, how patients view it, and the financial implications. I suspect it will reduce costs if fewer patients are referred and fewer expensive tests are needed. It would have been so useful during the COVID-19 pandemic.

Christina Founta, Consultant Gynaecologist with a special interest in gynaecological cancer, Guy’s and St Thomas’ NHS Foundation Trust, London

Conflicts of Interest

None declared.