A noninvasive method of screening for endometrial cancer often fails to detect signs of it in Black women, a new study says. The researchers found that the transvaginal ultrasound (TVUS) endometrial thickness screening missed over four times more cases of endometrial cancer among Black women than white women. This is because Black women are more likely to have fibroids and other non-endometrial growths, according to the researchers.
On average, 80 percent of Black women will have fibroids by the age of 50 compared to 70 percent of white women, according to McLeod Health.
Authors say these findings raise questions of rather or not TVUS should be used to determine the need for a biopsy in patients.
“Black women have an over 90 percent higher [death] rate after diagnosis of endometrial cancer when compared with white women in the U.S.,” lead researcher and gynecologic oncologist with the University of Washington School of Medicine Dr. Kemi Doll says. “This is a long-standing disparity that we have yet to make meaningful progress to address.”
She notes that other research has focused on evaluating access to health care, while this study aimed to evaluate screening guidelines.
Endometrial cancer begins in the cells that form the lining of the uterus, known as the endometrium. Endometrial cancer is the fourth most common cancer in the United States, with nearly 62,000 newly diagnosed cases and more than 12,000 deaths in 2019.
Black women have a higher risk of death from endometrial cancer because they’re more likely to be diagnosed at advanced stages and to have high-risk cancer.
“TVUS is a procedure in which an ultrasound probe is inserted into the vagina to thoroughly examine the female reproductive organs. The exam looks at the thickness of the endometrium. Cancer is suspected and a biopsy is usually scheduled if the lining
is 4 millimeters or greater,” Doll says.
“But not all endometrial cancer increases the lining thickness,” she adds in a news release. “In addition, non-cancerous fibroids can make the lining harder to measure.”
Doll and her colleagues used U.S.-wide data to create a simulated group of more than 367,000 women with postmenopausal bleeding, including nearly 37,000 with endometrial cancer.
The group included both Black women and white women.
“This puts Black women at a higher risk of false-negative results,” Doll says. “That is unacceptable in a group that is already the most vulnerable to the worst outcomes of endometrial cancer.”
While a real-world study is needed to confirm these findings, Doll stresses that health care providers need to understand the potential for missed diagnoses by using only TVUS.
She advised Black women with fibroids to discuss a biopsy with their health care provider, instead of relying only on TVUS screening.
Your doctor may suggest you get a biopsy if you’re experiencing the following:
This procedure can help your doctor determine what may be wrong and the best way to proceed. It can also give you an endometrial cancer diagnosis that may have been missed by TVUS.
Although this procedure doesn’t require anesthesia, your doctor may recommend you take an over-the-counter pain reliever 30 minutes before your appointment. During the 10 to 15 minute procedure, you will lay on the exam table with your feet resting in stirrups, just like you would for a Pap smear. Your doctor will enter a speculum into your vagina, which is used to hold it open during the procedure.
Once your doctor cleans your cervix, a very thin, flexible tool will be used to gently suction out a tissue sample from the lining (endometrium) of your uterus. Your results will be sent to the lab, looked at under a microscope and tested for abnormal cells like cancer.
The biopsy is completely safe, although it is common to experience light spotting and cramping after the procedure. Your doctor may prescribe you over-the-counter pain relievers. Keep in mind that some aspirin may cause you to bleed more.
You should be able to return to your normal routine as soon as you feel up to it, but refrain from sex until the bleeding stops.
Your lab results should return in about a week and determine the cause of your abnormal bleeding:
By subscribing, you consent to receive emails from BlackDoctor.com. You may unsubscribe at any time. Privacy Policy & Terms of Service.
