Doctors warn women, especially Black women, about signs of uterine cancer

Women — listen up. Doctors at the UW Medicine want you to know what to look for when it comes to a certain cancer: endometrial cancer.

You may have not heard of it, but it impacts one in every 37 women, and makes up 95% of uterine cancers.

“It’s actually the most common gynecological cancer in the United States. It’s more common than cervical cancer, yet everybody knows about their pap,” said Dr. Kemi Doll, an associate professor of obstetrics and gynecology at UW Medicine.

Then, there’s the racial disparity. Black women who are diagnosed with endometrial cancer have an over 90% higher mortality — or are nearly twice as likely to die — after an endometrial cancer diagnosis.

“It’s really shocking, it’s alarming,” Doll said. She said when the difference is that significant, it means there are likely multiple factors going on.

Doctors at UW Medicine are working to close that gap and make treatment more equitable, starting with educating women on what symptoms to look for.

Endometrial cancer is not related to endometriosis, which is when a tissue that’s normally inside the uterus grows outside the organ, causing pain and other problems.

The cancer is when that same tissue inside the uterus becomes malignant.

“There are lot of women who are infected every year and there is so much early detection and treatment and cures available, but not if women have never heard of it,” Doll said.

SYMPTOMS

The cancer primarily impacts women post-menopause, though it’s becoming more common in younger women in their 30s and 40s. Dr. Doll says the cardinal symptom is if your cycles have stopped, but you start having bleeding again.

“It’s also really important for women to know with bleeding, it doesn’t have to be a lot. So a lot of times we hear from our women, it was only a couple of drops of blood, or it really wasn’t that severe,” Doll said.

“I just really want to make sure women know if they’re a later age in life and they should have really stopped having periods, and they’re bleeding again — it doesn’t matter how much it is, they need to come in for evaluation,” she said.

Here’s the next problem. Doctors usually look for signs of uterine cancer with an ultrasound, but Doll says studies show the test is less effective at catching the cancer in Black women.

“Because of fibroids that are more common in Black women, and the types of endometrial cancer that some women can get, are not as easily detectible with the ultrasound approach,” Doll said.

She urges patients to advocate for a biopsy —an outpatient procedure that’s the most accurate way to detect the cancer.

“It’s like a super-sized pap,” Doll said. “It’s very, very safe, it’s a very quick procedure, and ultimately, it can save lives,” she said.

SYMPTOMS IN YOUNGER WOMEN

About 7% of endometrial cancer impacts women under 45 years old. For younger women, Doll says you should pay attention to really significant changes in your cycle.

“So they go from being normal to being wildly irregular. A lot of times we tend to think this is just stress, this will pass, this will go away, and we really normalize that, Doll said. She said when problems with cycles aren’t able to be regulated by various methods like hormones, it could be a sign of an underlying issue.

“It is always OK to ask for an endometrial biopsy to make sure there isn’t an underlying issue with a possible cancer,” Doll said.

RACIAL DISPARITY

The stark mortality difference in Black women when it comes to endometrial cancer is something Doll says many doctors are unaware of, too. She said some providers also don’t know some more aggressive forms of endometrial cancer are more common in Black women, and can be harder to detect with an ultrasound.

“Unfortunately, when Black women do report these as a symptom, they’re met with reassurance,” Doll said. “We’ve got to talk about this cancer more,” she said.

Doll points out another reason for the disparity — there are studies that show differences in how providers care for Black women.

“We literally know from the data that Black women are the least likely to be treated appropriately for pain,” Doll said.

But she says there are many reasons to be hopeful. When caught early, the survival rate of uterine cancer is over 80%.

“We really need to make sure everybody would understand what to do about these symptoms. Just like we know what to do if a women reports a breast lump,” Doll said.

There is also a growing area of research to better understand the racial disparity when it comes to endometrial cancer.

“So hopefully in five years or 10 years, we don’t need to be talking about 90% mortality difference,” Doll said.