Researchers at the University of Manchester and Manchester University NHS Foundation Trust have developed a non-invasive test using urine and vaginal samples to help rule out womb cancer in women experiencing postmenopausal bleeding. Published in Lancet Obstetrics, Gynaecology, & Women’s Health, the DETECT study evaluated 1,864 women across seven hospitals.
Bleeding after menopause triggers urgent cancer referrals across health systems, yet only a small fraction of those evaluated ultimately receive a diagnosis. Medical investigators in northwest England sought to replace or streamline current diagnostic pathways—which rely on internal ultrasound scans, biopsies of the womb lining, and hysteroscopy—with a simpler, non-invasive alternative.
Womb cancer, also known as endometrial cancer or cancer of the uterus, affects nearly 10,000 women in the UK each year. While only about 5% to 10% of women who report postmenopausal bleeding have an underlying malignancy, standard diagnostic procedures remain invasive, costly, and uncomfortable for patients.
The DETECT Study: Methodology and Diagnostic Accuracy
The DETECT study evaluated 1,864 women attending seven hospitals in northwest England who presented with postmenopausal bleeding. Before undergoing routine clinical investigations, participants provided both a urine sample and a vaginal fluid sample.
Specialist cytopathologists who were kept unaware of the patients’ actual diagnoses examined the samples for abnormal cells. Out of the total cohort, 115 women were found to have cancer, which included 99 cases of womb cancer and a smaller number of other pelvic cancers confirmed via biopsy or surgery.
When the results from both the urine and vaginal cell samples were combined, the test correctly identified more than 80% of cancers and achieved a negative predictive value of 98.8% for womb cancer. This high negative predictive value indicates that women who receive a negative result are extremely unlikely to have the disease. Separately, cytologists correctly returned a negative result for 93% of women who did not have womb cancer.
Researchers observed that the vaginal test performed slightly better than the urine test alone, though both demonstrated strong diagnostic promise. Furthermore, the test detected almost all aggressive cancers, identifying 95.8% of high-grade tumours and 96.4% of cancers that had already spread beyond the uterus.
Addressing Health Inequities and High-Risk Subgroups
In addition to evaluating overall accuracy, the research team examined how current diagnostic pathways impact different demographic groups. Parallel work published in the same journal indicated that standard tests are poorly calibrated for people from Black ethnic backgrounds, contributing to persistent health inequalities in diagnosis, treatment, and patient outcomes.
In the UK, Black women are twice as likely to die from womb cancer as White women. Within the study cohort, the new non-invasive test performed exceptionally well in this demographic, picking up 100% of cancers in Black women with 96% specificity, demonstrating near-perfect performance in that small subgroup.
“Bleeding after the 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.”
Prof Emma Davidson, University of Manchester and Manchester University NHS foundation trust
Investigators emphasized that the procedure is not yet accurate enough to rule out cancer entirely on its own. Instead, it is designed to serve as a valuable triage tool in primary care and community settings, fast-tracking patients at the highest risk for urgent hospital investigation while safely reassuring lower-risk women much earlier in the diagnostic pathway.
Next Steps for Clinical Practice
Before the approach can be widely adopted, further studies are required to confirm whether these high levels of accuracy can be reproduced in routine clinical practice outside of specialized research settings where samples were assessed by highly trained specialist cytologists. The test has also not yet been studied in asymptomatic women.
If validated in broader healthcare settings, the non-invasive screening method could reduce the burden of invasive procedures, cut health service costs, and alleviate patient anxiety.
“If further studies confirm these findings in routine practice, this approach has the potential to transform care for thousands of women every year.”
Prof Emma Davidson, University of Manchester and Manchester University NHS Foundation Trust
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