Do you know the key 'red flag' for uterine cancer?

The Australia New Zealand Gynaecological Oncology Group (ANZGOG) has called for greater awareness, investment in prevention and research funding to reverse the rise in case numbers.

Uterine cancer incidence has more than doubled in 25 years, with diagnoses among younger women projected to rise by up to 60% by 2035.

Most – up to 60% – of cases are preventable.

Perth gynaecologist and ANZGOG Board director Professor Paul Cohen said diagnostic delays were resulting in more patients being referred with advanced disease, as well as contributing to more deaths.

"Delays in diagnosis lead to a shift away from a curable, ‘surgery-alone’ pathway into multimodal treatment requiring surgery, radiotherapy, chemotherapy and systemic treatments which have significant toxicities and long-term adverse effects," he told Medical Forum.

"For early-stage (Stage I) disease that is confined to the uterus, a hysterectomy and bilateral salpingo-oophorectomy is often curative with no adjuvant treatment required."

Once disease spreads beyond the uterus, treatment becomes more intensive.

“Surgery followed by radiotherapy, often with chemotherapy for high-grade disease,” Prof Cohen said.

“So, a diagnostic delay can move a patient from a single curative operation into combined-modality treatment, with greater morbidity and recurrence risk.”

Every day in Australia close to 10 women are diagnosed with uterine cancer and two lose their lives from the disease.

Prof Cohen said diagnostic delays were amplified for priority groups including Aboriginal and Torres Strait Islander peoples, patients in regional areas, and those from lower socioeconomic areas or culturally and linguistically diverse backgrounds.

He put this down to limited access to culturally safe care, lower symptom awareness, distrust in services, financial toxicity, and stigma around discussing vaginal bleeding or discharge.

ANZGOG’s State of the Nation - Uterine Cancers Report published in 2025 highlighted a need for greater GP understanding and positioned primary care as a pivotal point to improving outcomes.

Prof Cohen said since abnormal bleeding was the most common presenting symptom and post-menopausal bleeding was the key “red flag”, GP recognition and prompt action has the single biggest impact on stage at diagnosis and in minimising diagnostic delay. All post-menopausal bleeding should be treated as a red flag and investigated immediately.

“There is a need for GP education regarding specific guidelines and referral pathways for abnormal bleeding, and for improving collection of primary care treatment data so that variation in care can be understood and used to support education and training for GPs,” he said.

“Abnormal uterine bleeding should be investigated with transvaginal ultrasound and, where indicated, endometrial sampling, and referred along a clear pathway. Peri- and post-menopausal bleeding should not be attributed to hormonal fluctuation or the menopausal transition until malignancy has been excluded.

“GPs can also lower the threshold for suspicion in women carrying key risk factors, particularly obesity, type 2 diabetes, PMOS, nulliparity, and a family history suggestive of Lynch syndrome, and should weigh body weight explicitly when assessing abnormal bleeding given that obesity is the leading risk factor, yet is not currently embedded in guidelines for its investigation. “

Prof Cohen suggested GPs could seek out on-demand CPD webinars and resources provided by Cancer Council WA and lookout for updates from the Western Australian Gynaecologic Cancer Service Based at King Edward Memorial Hospital regarding referral pathways and the management of heavy menstrual bleeding and related risk factors.