Article: Rise in endometrial cancer affects Black women more than white women

Contents

ARTICLE AT A GLANCE

What is this article about?

This article is about the growing number of cases of and deaths from endometrial cancer in the United States, especially among Black women. The New York Times article draws on the research of differences in death rates among people of different races and ethnicities. More than 65,000 people are expected to develop endometrial cancer in 2022. Just 15 years ago, 39,000 people were diagnosed with this cancer.

Endometrial cancer develops in the lining of the uterus. Related deaths are increasing by almost 2 percent a year. This increase is greater among Black, Asian and Hispanic women. Black women are twice as likely as white women to die of endometrial cancer, and this gap is widening. Black women are more likely to develop an aggressive type of endometrial cancer but that does not fully account for the disparity in survival.

The article highlights differences in diagnosis and treatment and points to possible causes. Ultrasound is used to diagnose endometrial cancer but it is not as effective at finding the more aggressive type, which is more common among Black women. Nor is ultrasound as useful at detecting cancer in women who are premenopausal or who have fibroids, which are also common among Black women. Treatment for endometrial cancers varies as well. Based on other studies, Black and Hispanic women are less likely to have a hysterectomy (surgery to remove the uterus), a lymph node biopsy to see if cancer has spread or to receive chemotherapy.

Why is this article important?

This article draws attention to a type of cancer that is rarely talked about and the disparity in its diagnosis, treatment and outcomes among different groups. The writer brings in many voices to sound an alarm about the growing numbers of women with this disease, especially within the Black community. It is noteworthy that endometrial cancer is typically diagnosed at an early stage.  However, it is more likely to be diagnosed at an advanced stage in Black women. Doctors expect endometrial cancer to become the third most commonly diagnosed cancer among women. Raising awareness of the disease and symptoms can increase the chances of finding it earlier at a stage with better treatment outcomes.

What is endometrial cancer?

The uterus has two layers: the endometrium (the lining layer) and the myometrium (the muscle layer). Uterine sarcoma is a rare form of uterine cancer that starts in the muscle layer.

The New York Times article focused on endometrial cancer. Endometrial cancer starts in the endometrium. There are several different types of endometrial cancer:

• Endometrioid adenocarcinomas are the most common type of endometrial cancers
• Carcinosarcomas are an aggressive type of endometrial cancer that is more common among Black women.
• Papillary serous carcinomas are also aggressive. These rare cancers are slightly more likely to occur in women with a BRCA1 mutation.
• Clear cell carcinomas are another rare type of endometrial cancer.

Symptoms of endometrial cancer

It’s important to know the symptoms of endometrial cancer so it can be recognized and treated as early as possible. The most common signs of endometrial cancer are:

• unusual vaginal bleeding, especially after menopause
• pelvic or abdominal pain
• bloating
• abdominal distension
• difficulty eating
• increased urinary frequency or urgency
• pain during sex

Because many people are unaware that these symptoms can indicate cancer, they can go unnoticed, allowing the cancer to grow. It is also important to know that abnormal periods are common during perimenopause, the years leading up to menopause. As a result, women and their healthcare providers don’t always recognize bleeding or spotting as a sign of endometrial cancer during this time.   

Endometrial cancer can be very treatable when it is found early. However, experts do not recommend routine endometrial cancer screening for women of average risk. Women should report any of the signs of endometrial cancer listed above to their doctor.

Who gets endometrial cancer?

Endometrial cancer affects people with a uterus, including women and transgender men who have a uterus. The risk of endometrial cancer increases with age. The average age of diagnosis is 60, although women and transgender men with an inherited mutation may develop endometrial cancer earlier. Endometrial cancer is less common in women under age 45.

Doctors once thought that Black women were less likely to get endometrial cancer. Recent research shows the opposite is true—it is more common and more likely to be found at a later stage. This shift in awareness comes as new studies focus on incidence among women who have not had hysterectomies, a procedure more common among Black women.

Endometrial cancer risk is linked to the hormone estrogen. Your risk of endometrial cancer may be higher if you are overweight, have never been pregnant, are infertile, have had more periods due to early onset menstruation or late menopause, or have taken estrogen without progesterone for an extended period. Other risk factors include having type 2 diabetes (possibly because of the link to weight), a diet high in animal fat, a history of radiation therapy to the pelvis, tamoxifen use (increases risk slightly) or a history of breast or ovarian cancer. These risk factors do not account for the race differences discussed in the article.

Endometrial cancer risk can run in families. Women born with mutations in the genes linked to endometrial cancer have a high lifetime risk and are more likely to develop cancer at a young age. The genes linked to endometrial cancer risk include:

Lynch syndrome genes

• MLH1
• MSH2
• MSH6
• PMS2
• EPCAM

Other genes:

• PTEN
• STK11
• Women and transgender men with BRCA1 mutations may have a small, yet slightly increased risk for a rare and aggressive type of endometrial cancer called papillary serous carcinoma. Read more in our XRAY review here. 

Screening for endometrial cancer

Routine screening is not recommended for healthy women with an average risk for endometrial cancer.

All women, regardless of their risk level should be aware of the signs of endometrial cancer and should report any symptoms to their doctor. Follow-up for symptoms typically includes a transvaginal ultrasound to identify any growths and an endometrial biopsy to test tissue for cancer.

National expert guidelines recommend that women at high risk talk with their doctor about the benefits, risks and costs of transvaginal ultrasound and endometrial biopsy for early detection.
 

What does this mean for me?

Endometrial cancer is on the rise but it is still less common than breast, lung or colon cancer. Because there is no routine screening for women at average risk for endometrial cancer, it is important for anyone with a uterus, especially women over 45 or with a family history or inherited mutation associated with endometrial cancer, to watch for symptoms, especially abnormal bleeding.

If your risk of endometrial cancer is higher due to Lynch Syndrome or another mutation that runs in your family, family history or other risk factors, talk with your doctor about your options for screening and prevention. The National Comprehensive Cancer Network has guidelines for screening women with inherited mutations linked to endometrial cancer. If you do not have a higher risk due to a known genetic mutation but you are still concerned about endometrial cancer, talk with your doctor. There may be ways you can reduce your risk, such as losing weight if you are overweight or eating less animal fat. If you are of childbearing age, you may want to consider endometrial cancer risk when choosing birth control. Some forms of the pill or an IUD may be protective.

You can help raise awareness of endometrial cancer by talking about it with your friends and family. This is especially important within the Black community where endometrial cancer is more often found at an advanced stage. FORCE and partners at SHARE and Black Health Matters are part of a campaign supported by Eisai, called SPOT HER. This campaign focuses on the signs and risks of endometrial cancer.  

If you or someone you care about has been diagnosed with endometrial cancer, consider discussing genetic testing and tumor testing to learn if it was caused by an inherited mutation. Also, consider getting a second opinion to ensure that you or they are getting high-quality care, including access to clinical trials.

Reference

Rabin, RC, Endometrial cancer is on the rise, especially among Black women. The New York Times, June 17, 2022.

Additional references:

• Clarke MA, Devesa SS, Hammer A, Wentzensen N. Racial and Ethnic Differences in Hysterectomy-Corrected Endometrial Corpus Cancer Mortality by Stage and Histologic Subtype. Journal of the American Medical Association Oncology. 2022;8(6):895–903. doi:10.1001/jamaoncol.2022.0009
• American Cancer Society Facts and Figures, 2007 and 2022. Accessed July 21, 2022.
• American Cancer Society. “Can endometrial cancer be found early?” https://www.cancer.org/cancer/endometrial-cancer/detection-diagnosis-staging/detection.html. Accessed July 21, 2022.

Disclosure: FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.

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posted 8/16/22