Venus* never forgot the advice her obstetrician-gynecologist gave her after going through menopause.
“If you ever have any type of bleeding, see a doctor.”
Those words came to mind in February 2022 when Venus noticed a small amount of blood even though she was no longer having menstrual periods. She quickly scheduled an appointment with her GP.
The doctor ordered an ultrasound, and when the results came back, he told her there was nothing to worry about: she didn’t have cancer. However, a few days later, Venus decided to ask for a second opinion during her routine appointment with the gynecologist.
That doctor ordered a biopsy. Within a week, Venus learned she had endometrial cancer.
Endometrial cancer is on the rise
Endometrial cancer occurs when cancer cells enter the endometrium, or the lining of the uterus. Also known as uterine cancer, endometrial cancer is cancer of the uterus.
The most common reproductive cancer between women or persons assigned female at birth.
It is also one of the few cancers with an increasing diagnosis and death rate: cases are increasing by about 1% each year in white women and by 2% to 3% each year in women of all other racial and ethnic groups. The American Cancer Society estimates that more than 67,000 new cases are diagnosed each year and that 13,250 women die each year from endometrial cancer.
Postmenopausal women are most at risk, with the average age of diagnosis being 60. Black women are more likely to be diagnosed with endometrial cancer than white women, and are more likely to die from the disease.
Read: Why are black women more likely to die from endometrial cancer? >>
Researchers have been working to find out why endometrial cancer rates are increasing for all women and why
Black women have worse outcomesA possible explanation may be that Obesity rates have been increasing since 1990. And obesity is one of the main Risk factor for endometrial cancersince fatty tissue can increase estrogen levels.
Another factor that researchers believe may be linked to the rising rates of endometrial cancer worldwide is related to lower birth rates and the fact that women are giving birth for the first time at older ages. This is because pregnancy and breast milk production are protective factors against endometrial cancer.
An important discovery was that
Two rare but aggressive forms of endometrial cancer called serous carcinoma and carcinosarcomaTumors are more likely to be diagnosed in Black women than in white women. And these cancers lead to worse outcomes than other forms of endometrial cancer. Black women also often have other factors that make their cancers harder to treat. They are more likely to have a subtype of uterine cancer with a specific mutation that is less likely to benefit from treatment. Nearly 70% of Black patients had this higher-risk subtype, while only 35% of white patients did. In addition, Black women’s tumors often have fewer mutations. Tumors with fewer mutations are less likely to respond to certain forms of immunotherapy, meaning Black patients benefit less from these treatments that are highly effective for others.
“Serous carcinoma and carcinosarcoma are more aggressive types of uterine or endometrial cancer,” said Jayne Morgan, MD, a physician and health equity expert. “Having more aggressive types of endometrial cancer and cancers that have less of a chance of responding to immunotherapy “There are two factors that make this cancer more deadly for black women.”
Social determinants of health that can lead to worse outcomes for all conditions may also play a role in the increase in endometrial cancer diagnoses and mortality rates. Lack of access to health care due to Socioeconomic factors As with income, education and type of work, as well as mistrust in the health system, these can lead to misdiagnosis or late diagnosis. Therefore, when cancer is discovered, it may be at an advanced stage.
Obesity, type 2 diabetes and lifestyles that do not include much physical activity can also Increases the risk of developing endometrial cancer.
Know the symptoms of endometrial cancer
“The most common symptom of uterine cancer is abnormal vaginal bleeding,” Morgan said. “Certainly if you’re past menopause and you’re having vaginal bleeding, that should be a red flag.”
Other symptoms may include heavier menstrual bleeding, more frequent periods, bleeding between periods and thickening of the uterine lining. Morgan said any persistent pelvic pain or pressure, unintentional weight loss or urinary problems such as frequent urination and difficulty urinating could also be warning signs.
“There are certain things that women should pay attention to and think, ‘Oh, this could be something more serious,’” Morgan said.[I’m] I’m not saying it’s definitely endometrial cancer, but it’s something that could be a sign or a signal that they need to get more checkups.”
A circle of support
Venus knows she could have been among the growing number of Black women with a late-stage diagnosis.
Because she listened to her OB-GYN’s instructions about postmenopausal bleeding and sought a second opinion when she was told she did not have cancer, her health care providers (HCPs) were able to detect her endometrial cancer early. in stage IAShe had a total hysterectomy to remove her uterus, but did not have to undergo chemotherapy. Since then, she has been in remission and visits her doctor every six months to make sure the disease has not returned.
“I was fortunate to have an appointment with the gynecologist,” Venus said. “While I was very grateful that the primary care physician tried to move the process along, a cancer diagnosis should not be made based on an ultrasound alone.”
Venus later learned that her primary care doctor was using a screening tool that focuses on the thickness of the uterine lining to determine if a biopsy would be necessary. Doctor of Medicine, Kemi DollGynecologic oncologist at Washington University School of Medicine and founder of ECANA: African American Endometrial Cancer Action Network, led a study They say this tool often misses endometrial cancer in black women.
Although Venus felt physically fine after her diagnosis and surgery, the ordeal took a toll on her mental health. It was also difficult when her trusted gynecologist and surgeon left their practice and she had to find new providers.
Venus said ECANA was a major source of support when she first reached out to the organization and joined it late last year. When Venus found another health care professional, she was comforted to know that her new provider had worked with Doll in the past.
Venus has also found strength in sharing her story to help other women gain more awareness about endometrial cancer.
“If you are a woman who has gone through menopause and you see that you are bleeding, make an appointment immediately,” she said. “Don’t put it off. If they only offer you an ultrasound, ask for a biopsy. I am so glad my gynecologist insisted on that. It is only by the grace of God that I am here to be able to talk about what I experienced.”
*Last name omitted for privacy reasons
This educational resource was created with support from Merck.
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