Screening Strategies for Endometrial Cancer: A Systematic Review of Current Practices and Perspectives

Background: Endometrial cancer (EC) is the most common gynecological malignancy, and its incidence has recently increased. Several screening tools have been developed, including the Papanicolaou (Pap) smear, cervical methylation test, traditional transvaginal ultrasound (TVU), three-dimensional TVU (3D-TVU), circulating tumor DNA (ctDNA), and direct endometrial sampling. Each screening methods differ in characteristics, cost, and accuracy. Methods: A systematic review was conducted to assess publications offering different perspectives on screening methods for EC and to identitify viable methods in practice, using PubMed and Google Scholar for studies published between 1995 and 2024. In addition, different strategies were summarized, and their cost-effectiveness was evaluated. Results: Known detection methods include various screening tools. Herein, we provide a comparison of current early diagnostic and screening tools for EC and their accuracy, and review existing knowledge on screening methods while identifying viable methods for clinical practice. Currently, no optimal screening method exists for EC. Conclusion: With the increasing global incidence of EC, the demand for effective EC screening is more noteworthy. Concerning cost-effectiveness, convenience, and complications, it has been suggested that TVU or DNA methylation testing in cervical samples may be preferable options. Additionally, differential diagnosis of other etiologies and patient education regarding red-flag signs are also important.