China · Precision Gyn-Oncology Society · 2025 · Expert Consensus

Three-Level Prevention of Endometrial Cancer — Chinese Consensus 2025

子宫内膜癌三级预防策略中国专家共识（2025 年版）
Primary: risk-factor control · Secondary: screening & early diagnosis (incl. methylation Se 87.0–94.5%) · Tertiary: comprehensive treatment & rehabilitation
Precision Gyn-Oncology Committee (CMCHS) · Shanghai Society of Gynecologic Oncology
Chin J Pract Gynecol Obstet 2025(10) · NSFC 82273233
Level 1
etiology · risk factors
Level 2
screening · early diagnosis
Level 3
treatment · rehabilitation
Se 87–94.5%
methylation screening

1Background & Framework

  • Burden: EC most common gynecologic malignancy; #1 in Beijing/Shanghai/Guangzhou.
  • Model: cervical 3-level prevention mature; EC system needs unification.
  • Goal: reduce incidence · raise early diagnosis · improve survival & QoL.

2Primary Prevention — Risk Factors

45+ y
risk rises sharply
Obesity
metabolic syndrome
Lynch
genetic risk
  • Modifiable: obesity · metabolic syndrome · unopposed estrogen · lifestyle (diet/exercise).
  • Hormonal: estrogen exposure (ovulatory dysfunction · estrogen-producing tumors).
  • Genetic: Lynch syndrome mutation carriers — high-risk surveillance.
  • Aim: prevent disease before onset, esp. in high-risk groups.
Early
menarche
Late
menopause
Nulliparity
infertility
Weight
key lever
Metabolic
key lever
Genetic
screening
  • Multidisciplinary: gynecology · endocrinology · genetics · nutrition collaborate.
  • Lifestyle: exercise & diet control reduce obesity-driven estrogen excess.
  • Metabolic: manage diabetes/metabolic syndrome — key modifiable targets.
  • Counseling: genetic counseling & Lynch surveillance in high-risk families.
  • Hormonal: balance estrogen exposure; progestin protection where indicated.
Primary
etiology
Secondary
screening
Tertiary
treatment
Fig 1 · Primary
Lifestyle & risk-factor control + genetic counseling.
Fig 2 · Secondary
TVS · cytology · methylation · biopsy — early detection.
Fig 3 · Tertiary
MDT treatment · rehab · long-term follow-up.

3Secondary Prevention — Methylation Screening

2
approved products (incl. Origin-Poly)
4
gene combinations
4
sampling routes
  • Approved kits: Wuhan Kaideweisi & Beijing Origin-Poly (CDO1/CELF4) — officially approved.
  • Combinations: CDO1/AJAP1/GALR1 · CDO1/CELF4 · BHLHE22/CDO1/HAND2 · BHLHE22/CDO1/CELF4.
  • Sampling: uterine/cervical brush · vaginal tampon · urine.
  • Performance: Se 87.0–94.51% · Sp 86.0–95.5% — superior to traditional strategies; community validation ongoing.
Sensitivity
87.0–94.51%
Specificity
86.0–95.5%
High-risk groups: >45 y · obesity/metabolic syndrome · postmenopausal bleeding/abnormal discharge · Lynch/family history.

4Three-Level Prevention Flowcharts (Fig 1–3)

Fig1 primary prevention
Fig 1 · Primary
Risk-factor control, lifestyle & genetic counseling.
Fig2 secondary prevention
Fig 2 · Secondary
TVS → cytology/methylation → biopsy (gold standard) → hysteroscopy targeted biopsy.
Fig3 tertiary prevention
Fig 3 · Tertiary
Surgery · RT/CT · hormonal · immuno · targeted; rehab & follow-up.
7
secondary tools
4
treatment modalities
MDT
tertiary core
  • Secondary tools: history risk assessment · TVS · cytology · methylation · biopsy · hysteroscopy · imaging staging.
  • Molecular testing: refines diagnosis, guides individualized treatment & prognosis.
  • Tertiary core: MDT precision treatment + palliative care + regular follow-up & rehab.
  • Community step: methylation screening needs community-population validation next.
Clinical Significance