Photo Credit: Manchester University
Scientific Frontline: Extended "At a Glance" Summary: The DETECT Diagnostic Test
The Core Concept: A non-invasive diagnostic test that analyzes cells from urine and vaginal fluid to identify endometrial (womb) cancer in women experiencing postmenopausal bleeding.
Key Distinction/Mechanism: Unlike current standard practices, which rely on uncomfortable, invasive, and costly hospital investigations to rule out cancer, this test utilizes cytopathology to examine easily collected bodily fluids, correctly identifying over 80 percent of cancers.
Major Frameworks/Components:
- Cytology: Microscopic examination of cells from urine and vaginal fluid samples by specialist cytopathologists.
- High Sensitivity for Aggressive Cancers: Demonstrated a 95.8 percent identification rate for high-grade tumors and a 96.4 percent rate for cancers that had spread beyond the uterus.
- High Negative Predictive Value: Achieved a 98.8 percent negative predictive value, meaning a negative test result strongly indicates the absence of womb cancer.
- Health Equity: The test showed a 100 percent detection rate with 96 percent specificity in Black women, a demographic historically impacted by poorly calibrated current tests and a doubled mortality rate from womb cancer in the UK.
Branch of Science: Oncology, Gynecology, Cytopathology, Diagnostic Medicine.
Future Application: The test could be implemented as a triage tool in primary care and community settings, safely reassuring the majority of women who do not have cancer while fast-tracking those who need urgent invasive procedures.
Why It Matters: Currently, 90 to 95 percent of women investigated for postmenopausal bleeding do not have cancer but still undergo stressful, painful procedures; this test promises a faster, more patient-friendly, and equitable diagnostic pathway.
University of Manchester researchers have found that 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 postmenopausal bleeding.
Their study indicates that 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, also based at Manchester University NHS Foundation Trust (MFT) and supported by the National Institute for Health and Care Research (NIHR) Biomedical Research Center (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.
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 United Kingdom.
The researchers state the new test could therefore 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 to speed up diagnosis and provide reassurance for many women.
Womb cancer affects nearly 10,000 women in the United Kingdom each year, but only 5% to 10% of women investigated for postmenopausal bleeding will have cancer.
Despite this, most undergo invasive hospital tests that can be uncomfortable, costly, and sometimes require repeating.
Previous studies led by Manchester researchers have suggested that 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, noninvasive 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 undergoing their routine clinical investigations, participants provided a urine sample and a vaginal fluid sample, which were examined for abnormal cells by specialist cytopathologists who were blinded to 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% of cancers and achieved a negative predictive value of 98.8% 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% of high-grade tumors and 96.4% of cancers that had already spread beyond the uterus.
It also detected 100% of cancers in Black women with 96% 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.
Lead researcher Professor Emma Davidson from the University of Manchester and honorary consultant in gynecological oncology at MFT stated, “Bleeding after 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.”
Professor Davidson, who is also Cancer Prevention and Early Detection Theme co-lead at the NIHR BRC: Manchester, 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.”
Funding: The study was funded by the Jon Moulton Charity Trust, and the women were recruited from gynecology clinics at seven hospital sites across North West England: St. Mary’s Hospital, Trafford General Hospital, Wythenshawe Hospital, Royal Oldham Hospital, North Manchester General Hospital, Fairfield General Hospital, and Tameside Hospital.
Published in journal: Obstetrics, Gynaecology and Women's Health
Authors: Eleanor R. Jones, Nadira Narine, Helena O'Flynn, Kelechi Njoku, Chloe E. Barr, Suzanne Carter, Lisa Cornwall, Sylvia Vinay, Catherine Fullwood, Jamie C. Sergeant, David Shelton, Durgesh Rana, Detect Study Team, and Emma J. Davidson
Source/Credit: Manchester University | Michael Addelman
Edited by: Scientific Frontline
Reference Number: ongy092326_01
