Simple test could take the pain out of womb cancer check

A new test to identify cells collected from urine and vaginal fluid could help rule out womb and other cancers in most women who experience bleeding after the menopause, say researchers at Manchester University NHS Foundation Trust (MFT) and The University of Manchester.

Their study published in Lancet Obstetrics, Gynaecology and Women’s Health, found the test could potentially reduce the need for invasive hospital investigations, easing anxiety during what can be a distressing time for many women.

The research team which is, supported by the National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC): Manchester, showed that the new test can detect womb cancer, also known as endometrial cancer, with high accuracy.

Postmenopausal bleeding currently triggers urgent investigation for possible cancer, often involving a series of uncomfortable, invasive and costly tests, even though most women will not ultimately receive a cancer diagnosis.

Lead researcher Professor Emma Davidson from The University of Manchester and Honorary Consultant in Gynaecological Oncology at Saint Mary’s Hospital, part of MFT, 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.”

Further work from the group, also published in the same journal today, showed that current tests are poorly calibrated for people from Black ethnic backgrounds, leading to health inequalities in diagnosis, treatment and patient outcomes.

However, the new test was particularly effective at detecting aggressive and advanced cancers, and performed exceptionally well in Black women, who are twice as likely to die from womb cancer as White women in the UK. 

Prof Davidson, who is also Cancer Prevention and Early Detection Theme Co-Lead at the NIHR BRC: Manchester, continued: “We are excited that these results also show the new test could potentially help to reduce health inequities and improve outcomes for previously disadvantaged groups, including those who are unable to tolerate routine procedures.” 

The test could eventually be used in primary care and other community settings, helping speed up diagnosis and provide reassurance for many women. 

Womb cancer affects nearly 10,000 women in the UK each year, but only 5–10% of women investigated for bleeding after the menopause will have cancer. 

Despite that, most undergo invasive hospital tests that can be uncomfortable, costly and sometimes need repeating. 

Previous studies led by Manchester researchers have suggested cancer cells can be detected in urine and vaginal fluid samples. 

The DETECT study – as it is known – was designed to assess whether these simple, non-invasive tests could accurately identify women at risk while safely reassuring others.

The study involved 1,864 women attending hospitals *with postmenopausal bleeding, making it one of the largest evaluations of this approach to date.

Before having their routine clinical investigations, participants provided a urine sample and a vaginal fluid sample, which were examined for abnormal cells by specialist cytopathologists who did not know the women’s diagnoses.

A total of 115 women were found to have cancer, including 99 cases of womb cancer and a smaller number of other pelvic cancers.

When urine and vaginal cytology (cell sample) results were combined, the test correctly identified more than 80 per cent of cancers and achieved a negative predictive value of 98.8 per cent for womb cancer, meaning women with a negative result were highly unlikely to have the disease.

The vaginal test performed slightly better than the urine test alone, although both showed promising diagnostic accuracy.

The test detected almost all aggressive cancers, identifying 95.8 per cent of high-grade tumours and 96.4 per cent of cancers that had already spread beyond the uterus. 

It also picked up 100 per cent of cancers in Black women with 96 per cent specificity, meaning that the test showed near perfect performance in this small subgroup of women.

The findings suggest the approach could become a valuable triage tool, helping clinicians decide which women need urgent invasive investigations while providing reassurance for many others.

Prof Davidson added: “Further studies are now needed to assess how the test would perform in routine clinical practice and whether it can reduce the number of invasive procedures women undergo.

“If successfully introduced into healthcare settings, the test could offer a faster, less invasive and more patient-friendly route to diagnosing womb cancer.”