Screening Often Misses Endometrial Cancer in Black Women

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A noninvasive method of screening for endometrial cancer often fails to detect signs of it in Black women, a new study says.

The findings raise questions about the use of transvaginal ultrasound (TVUS) to determine the need for a biopsy in these patients, according to the authors.

“Black women have an over 90% higher [death] rate after diagnosis of endometrial cancer when compared with white women in the U.S.,” said lead researcher Dr. Kemi Doll, a gynecologic oncologist with the University of Washington School of Medicine. “This is a long-standing disparity that we have yet to make meaningful progress to address.”

She noted that other research has focused on evaluating access to health care, while this study aimed to evaluate screening guidelines.

Endometrial cancer begins in the cells that form the lining of the uterus, known as the endometrium. Endometrial cancer is the fourth most common cancer in the United States, with nearly 62,000 newly diagnosed cases and more than 12,000 deaths in 2019.

Black women have a higher risk of death from endometrial cancer because they’re more likely to be diagnosed at advanced stages and to have high-risk cancer.

TVUS is a procedure in which an ultrasound probe is inserted into the vagina to thoroughly examine the female reproductive organs. The exam looks at the thickness of the endometrium. Cancer is suspected and a biopsy is usually scheduled if the lining is 4 millimeters or greater, Doll said.

“But not all endometrial cancer increase the lining thickness,” she said in a university news release. “In addition, non-cancerous fibroids can make the lining harder to measure.”

Doll and her colleagues used U.S.-wide data to create a simulated group of more than 367,000 women with postmenopausal bleeding, including nearly 37,000 with endometrial cancer. The group included both Black women and white women.

The researchers found that TVUS endometrial thickness screening missed over four times more cases of endometrial cancer among Black women than white women. This is because Black women are more likely to have fibroids and other non-endometrial growths, according to the researchers.

“This puts Black women at a higher risk of false-negative results,” Doll said. “That is unacceptable in a group that is already the most vulnerable to the worst outcomes of endometrial cancer.”

The study findings were published July 15 in the journal JAMA Oncology.

While a real-world study is needed to confirm these findings, Doll said health care providers need to understand the potential for missed diagnoses by using only TVUS.

She advised Black women with fibroids to discuss a biopsy with their health care provider, instead of relying only on TVUS screening.

More information

The U.S. National Cancer Institute has more on endometrial cancer screening.

SOURCE: University of Washington School of Medicine, news release, July 15, 2021

Source: HealthDay

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