Endometrial cancer, the most prevalent gynecologic cancer in the United States, poses a significant health risk, particularly for Black women. Recent research published in JAMA Oncology has raised concerns about the reliability of transvaginal ultrasounds, a common imaging technique used to detect this type of cancer, specifically for Black women.
Study findings: A disparity in detection
The study revealed that nearly 10% of Black women diagnosed with endometrial cancer received misleading results from transvaginal ultrasounds, indicating they were cancer-free when, in fact, they had the disease. This alarming statistic highlights a critical gap in the current diagnostic process, prompting experts to recommend that Black women exhibiting symptoms should bypass ultrasounds and proceed directly to a tissue biopsy for accurate diagnosis.
Understanding endometrial cancer
Endometrial cancer originates in the endometrium, the inner lining of the uterus, and is particularly common among postmenopausal women. With approximately 68K new cases and 13K deaths annually, it is one of the few cancers on the rise. Unfortunately, Black women are often diagnosed at later stages, leading to mortality rates that are twice as high compared to their white counterparts, even when accounting for the stage and type of cancer.
The role of transvaginal ultrasound
Transvaginal ultrasounds utilize sound waves to create images of pelvic organs and are intended to help predict the likelihood of endometrial cancer. However, a recent study found that the thickness of the endometrial lining, which is supposed to indicate cancer risk, was not a reliable predictor. In fact, about 10% of women with endometrial cancer had a lining thickness below the 4-millimeter threshold that typically rules out cancer.
Factors contributing to inaccuracies
Dr. Kemi Doll, the lead author of the study, expressed disappointment but not surprise at these findings. She noted that the presence of fibroids, which are more common in Black women, can distort ultrasound images, leading to inaccurate results. This suggests that the current triage system for determining the need for biopsies may not be as effective for Black women as previously thought.
Recommendations for Black women
Given the study’s findings, experts strongly recommend that Black women experiencing postmenopausal bleeding or other symptoms should advocate for a tissue biopsy rather than relying solely on ultrasound results. Dr. Jeffrey A. How, an assistant professor at the University of Texas MD Anderson Cancer Center, emphasized the importance of considering biopsies in cases of persistent bleeding, as even reassuring ultrasound results do not eliminate the possibility of cancer.
Importance of early detection
Endometrial cancer symptoms often include vaginal bleeding and pelvic pain, even in the early stages. However, general early-detection screening is not recommended for the public. Instead, healthcare providers encourage women to report any concerning symptoms as soon as they arise. For Black women, Dr. Doll advises requesting a tissue biopsy in addition to an ultrasound to explore other potential causes of bleeding.
Empowering patients with knowledge
Dr. S. Diane Yamada, a professor of obstetrics and gynecology at the University of Chicago, highlighted that Black patients now have crucial data to support their case for more thorough testing. She urges healthcare practitioners to be aware of these findings and to be more willing to offer tissue biopsies when necessary.
A call for change
The findings of this study serve as a wake-up call for the medical community and underscore the urgent need for changes in the diagnostic approach to endometrial cancer, particularly for Black women. By prioritizing accurate testing methods and advocating for patient rights, we can work towards reducing the disparities in cancer diagnosis and treatment.
In conclusion, awareness and education are vital in addressing the healthcare inequities faced by Black women. It is essential for both patients and healthcare providers to engage in open discussions about symptoms and testing options to ensure timely and accurate diagnoses.
