Background: Endometrial polyps are frequently detected during routine gynecologic imaging, yet their true malignant potential— particularly in asymptomatic women—remains a central concern in oncologic risk assessment. While most polyps are benign, the wide variability in reported malignancy rates has led to aggressive surgical management practices. This study evaluates the oncologic risk profile of asymptomatic endometrial polyps and examines whether current surgical intervention patterns align with actual malignancy risk.

Methods: A retrospective cohort study was conducted on 172 women diagnosed with endometrial polyps at a tertiary medical center between 2011 and 2018. Clinical presentation, hysteroscopic findings, histopathology, and perioperative complications were analyzed. Associations between malignancy and established oncologic risk factors—including age, menopausal status, breast cancer history, and Tamoxifen exposure—were assessed using Student’s t test and Pearson’s chi squared test.

Results: Of 172 polyps removed, 163 (94.8%) were benign and 8 (4.7%) were malignant. No malignancies were identified among asymptomatic women, whereas symptomatic women with vaginal bleeding demonstrated an 8.8% malignancy rate (p=0.007). Asymptomatic patients were more likely to have a history of breast cancer (p=0.04) and Tamoxifen use (p=0.048), yet these factors did not translate into increased malignancy in the absence of symptoms. Surgical management carried measurable risks, including uterine perforation (1.75%), hospitalization (2.33%), and transfusion (0.6%).

Conclusion: This study demonstrates that asymptomatic endometrial polyps carry negligible malignant potential, even among women with traditional oncologic risk factors such as breast cancer history or Tamoxifen exposure. In contrast, hysteroscopic removal introduces procedural risks that exceed the observed cancer risk in this population. These findings underscore the need for oncology aligned, risk stratified management, supporting conservative surveillance rather than routine surgical intervention for incidentally detected polyps. Symptomatic presentation—particularly abnormal bleeding—remains the most clinically meaningful predictor of malignancy.