An ultrasound technique commonly used to screen women for endometrial cancer often fails to detect the tumor in Black patients. (Image credit: Carlos Duarte via Getty Imag
July 16, 2024 Story by: Editor
A common screening test for endometrial cancer, typically considered reliable, may not be as effective in Black patients, according to a new study. The test, which uses ultrasound to determine whether more invasive testing via biopsy is needed, has been shown to miss a concerning number of Black patients.
“This is a very important study,” said Dr. Christina Annunziata, a senior vice president of the American Cancer Society, who was not involved in the research, to Live Science.
Published on June 27 in JAMA Oncology, the study identifies a potential reason why Black patients with endometrial cancer tend to be diagnosed later and suffer worse outcomes compared to other populations.
Endometrial cancer, which affects the lining of the uterus, is the most common cancer of the female reproductive organs in the U.S., affecting more than 65,000 people annually. While it primarily impacts women over 60, the incidence has been rising for women of all ages over the past two decades, with rates increasing more rapidly among Black women. Additionally, Black women in the U.S. are at least twice as likely to die from certain subtypes of endometrial cancer compared to white women.
“One of the things that we know drives that disparity is that Black women are more likely to be diagnosed at later stages of the disease and are more likely to experience delays in diagnosis,” said Dr. Kemi Doll, the study’s lead author and a gynecologic oncologist at the University of Washington Medicine, to Live Science.
Postmenopausal bleeding, a key early marker of endometrial cancer, involves vaginal bleeding occurring a year or more after a person’s final period. When patients experience this symptom, doctors use a vaginal ultrasound to examine the pelvic area. If the uterine lining’s thickness exceeds a certain threshold, a follow-up biopsy is conducted. If the thickness is below this threshold, no further testing is typically done.
“Those [thickness] thresholds are supposed to be 99% to 100% accurate,” Doll explained. “They should never miss endometrial cancer.” Current standards dictate that a uterine lining thickness of 0.15 inch (4 millimeters) or greater warrants a biopsy.
Doll became suspicious of the test’s sensitivity after previous research showed Black women were less likely than white women to receive a biopsy following postmenopausal bleeding. Another study found that Black women screened were eight times likelier than white women to receive a false-negative result, where the test indicated no cancer when there was indeed cancer.
In the new study, Doll and her colleagues focused on Black patients, evaluating medical records from nearly 1,500 insured Black patients treated in 10 hospitals in the southeastern U.S., including six gender-expansive individuals. All patients had undergone an ultrasound before a hysterectomy, a surgical procedure to remove the uterus. After the procedure, 210 patients, all cisgender women, were found to have endometrial cancer.
The study revealed that about 10% of the women with endometrial cancer had a uterine lining below the typical threshold for a follow-up biopsy. Using a lower cut-off of 0.1 inch (3 mm) would have reduced this percentage to less than 4%.
“This surprised me,” Doll said. The ultrasound screening has generally been considered a reliable method for endometrial cancer detection.
The rate of false-negatives was similar among patients with fibroids, noncancerous growths in the uterus, that could be seen via ultrasound. However, the rate was slightly higher in patients whose scans showed only part of their uterine lining or who experienced pelvic pain, which may cause sonographers to cut scans short.
Based on these findings, Doll recommended that Black patients with symptoms of endometrial cancer should receive a tissue biopsy to avoid misdiagnosis.
“What we know is that for clinical trials, in general, we have under-representation of diverse population groups,” said Marvella Ford, associate director of community outreach and engagement at the Medical University of South Carolina, who was not involved in the study, to Live Science. “Unfortunately, when that happens, we don’t know how well these techniques and approaches work on different population groups.”
Often, it’s assumed people have delayed diagnoses because they aren’t receiving care at all, Doll noted. “What my research has been showing over the years is that even Black women with insurance, who are going to the doctor, are seemingly continuing to get advanced stage diagnoses.” The insensitivity of screening tests may help explain this.
Black women also tend to have higher rates of irregular bleeding before menopause than other groups, which might be misattributed to fibroids, disproportionately affecting Black women, instead of endometrial cancer, Doll said. This could further delay screening.
“If you have any sort of abnormal uterine bleeding, any sort of postmenopausal bleeding, or bleeding between menstrual periods, that is a reason to get screened for cancer,” Annunziata stressed.
Doll hopes to expand the study to better understand the risk of false diagnosis beyond cisgender women. “That’s going to be increasingly important,” she said. “And we continue to want to investigate ‘why is this happening?'” Source: Live Science
“If you have any sort of abnormal uterine bleeding, any sort of postmenopausal bleeding, or bleeding between menstrual periods, that is a reason to get screened for cancer,” Annunziata stressed.
Doll hopes to expand the study to better understand the risk of false diagnosis beyond cisgender women. “That’s going to be increasingly important,” she said. “And we continue to want to investigate ‘why is this happening?'” Source: Live Science
