A common way of screening for endometrial cancer can miss cases in Black women, according to a recent study

Study Shows This Cancer Screening Test Might Be Unreliable For Black Women Researchers recommend that in addition to a transvaginal ultrasound, Black women also get a tissue biopsy, which is more accurate and can better detect endometrial cancer

A common way of screening for endometrial cancer can miss cases in Black women, according to a recent study

• Transvaginal ultrasounds, the most common way to screen for endometrial cancer in women, were found to have missed cases in almost 10% of Black women in a recent study.
• Endometrial cancer is the most common gynecologic cancer in the U.S. and is responsible for roughly 13,000 deaths annually.
• Researchers advise Black women to ask their healthcare providers for a tissue biopsy because it’s more accurate and can better detect endometrial cancer.
  

A common imaging technique used to detect endometrial cancer, the most common gynecologic cancer in the United States, may be unreliable for Black women, according to a recent study.

The research, published in JAMA Oncology, found that almost 10% of the Black women with endometrial cancer included in the study received transvaginal ultrasound results that incorrectly said they were cancer-free. 

Because of this, the authors said Black women with symptoms should jump straight to a tissue biopsy to determine if they have endometrial cancer.

“I hope readers take away that the current triage system that we use to determine who does and doesn’t need a biopsy for endometrial cancer is not as accurate as we once assumed…specifically for Black women,” Kemi Doll, MD, lead study author and a gynecologic oncologist at the University of Washington School of Medicine in Seattle, told Health. 

Finding False Negatives

Endometrial cancer is a type of uterine cancer most common in postmenopausal women that begins in the inner lining of the uterus, known as the endometrium. It’s one of the few cancers on the rise, accounting for about 68,000 new cancer cases and 13,000 deaths annually.

Compared to white women, Black women are more often diagnosed with endometrial cancer at later stages. In addition, “mortality rates are twice as high for Black women even when adjusting for stage and type of endometrial cancer,” Jeffrey A. How, MD, MPH, an assistant professor at the University of Texas MD Anderson Cancer Center, told Health.

One suggested reason for the disparity, the study noted, was the inaccuracy of transvaginal ultrasounds, an imaging test used to predict the likelihood of endometrial cancer by using sound waves to generate images of the pelvic organs and structures.

To test this hypothesis, the team pulled ultrasound data from roughly 1,500 Black women who had a hysterectomy in a 10-hospital academic-affiliated healthcare system. The median age was 46, and the most common reported symptoms within 30 days of the ultrasound were vaginal bleeding, pelvic pain, and fibroids, which are non-cancerous tumors that grow in the muscular wall of the uterus. In total, 210 of the women had endometrial cancer.

The researchers specifically examined the thickness of the participants’ endometria. In postmenopausal women, an endometrial lining thickness of less than 4 millimeters is supposed to rule out most cancer cases. In contrast, a thicker lining could suggest the presence of cancerous cells or a tumor. (Measuring the lining of the endometrium before menopause is less valuable because the thickness increases and decreases based on responses to changing levels of estrogen and progesterone.)

But after analysis, researchers discovered that endometrial lining thickness, as measured by the ultrasound, didn’t always accurately predict cancer risk. In fact, about a tenth of patients with endometrial cancer fell below the 4-millimeter threshold.

“I was disappointed but not surprised,” Doll said. “Our prior research and that of colleagues had suggested that ultrasound was not as accurate as we assumed it to be.”

Doll believes the inaccuracy is due to the presence of fibroids, which can distort the images, and potentially other factors, like the structure of the cancer. “These are factors more common in Black women,” she said.

The authors concluded that tissue sampling rather than transvaginal ultrasound is “strongly recommended” in the presence of postmenopausal bleeding.

How agreed. “With persistent bleeding, investigations with an endometrial biopsy should be highly considered since even reassuring ultrasound results do not eliminate the possibility of cancer,” he said.

Experts noted that further research into what happens after an inaccurate ultrasound is necessary to understand how gaps may continue in the care process.

What To Do If You Have Symptoms

Endometrial cancer is most common in older adults, with the median age being 64, and obesity contributes to over half of cases in the U.S.

Most patients with endometrial cancer have symptoms such as vaginal bleeding or pelvic pain or discomfort, even in the early stages. As such, early detection screening isn’t recommended for the general public. Instead, doctors suggest mentioning symptoms to a healthcare provider as soon as you notice them. 

For Black women with symptoms specifically, Doll recommends asking for a tissue biopsy “in addition to an ultrasound to look for other causes of bleeding.”

When advocating for a tissue biopsy, S. Diane Yamada, MD, a professor of obstetrics and gynecology at the University of Chicago, told Health that Black patients now have “important data” to back up their case.

In turn, she said, “Healthcare practitioners should be aware of this data and more readily willing to offer patients a tissue biopsy.”

This story originally appeared on: Health News - Author:Lauryn Higgins