Endometrial Hyperplasia as an Actionable Precursor to Endometrial Cancer: Narrative Review

Abstract

Purpose. The aim of this paper is to evaluate endometrial hyperplastic disorders as an actionable precursor to EC from a public health perspective, analyzing risk determinants, early detection triage mechanisms, and population-based prevention strategies. Material and Methods. We employed general scientific methodologies, including comprehensive literature search, analytical review, synthesis, and generalization. Relevant studies were retrieved from the PubMed and Google Scholar electronic databases using terms “endometrial cancer”, “endometrial hyperplasia”, “epidemiology”, “abnormal uterine bleeding”, “risk factors”, “early detection”, “screening” and “prevention”. Results. EH constitutes a spectrum of abnormal endometrial proliferative changes ranging from benign glandular overgrowth to precancerous lesions, among which atypical EH/EIN represents an actionable pre-malignant phase along the continuum toward EC. Effective secondary prevention relies on elevating public awareness of AUB as an urgent diagnostic signal. Broadening access to outpatient diagnostic triage using transvaginal ultrasound and endometrial sampling enables prompt identification of precursor lesions while avoiding costly, invasive inpatient curettage. Mitigating the population burden of EC requires integrating metabolic health management into primary care, establishing risk-stratified clinical pathways, and integration of cascade genetic testing for families at high risk of hereditary cancer syndromes. Conclusions. Atypical EH/EIN is a critical, actionable target for secondary prevention of endometrial cancer. Effectively mitigating population disease burden requires embedding metabolic risk management into primary care, expanding outpatient diagnostic triage for AUB, and establishing national precursor registries alongside cascade genetic testing to address healthcare disparities.