The healthcare system is designed to provide safe, effective, and beneficial care for all. Unfortunately, the current system represents a wealth of socioeconomic and racial disparities. Past studies have shown that racial and ethnic minorities tend to receive less access to effective healthcare, as well as a lower quality of care. According to Medical XPress, a study by Dr. Kemi Doll highlights how current screening tools for endometrial cancer, to determine whether or not a patient should receive a biopsy, often misses endometrial cancer signs in Black women. The study, published in JAMA Oncology, shows that transvaginal ultrasound (TVUS), a noninvasive option, is both inaccurate and inequitable for Black women, requiring the development or use of a new or more equitable screening measure.
TVUS
According to Healthline, a TVUS:
also called an endovaginal ultrasound, is a type of pelvic ultrasound used by doctors to examine female reproductive organs [including] the uterus, Fallopian tubes, ovaries, cervix, and vagina. Unlike a regular abdominal or pelvic ultrasound…this procedure involves your doctor or technician inserting an ultrasound probe around 2 or 3 inches into your vaginal canal.
So how is TVUS used in regards to endometrial cancer? When technicians perform a TVUS, they are able to determine how thick the endometrium (uterine lining) is. If the lining is 4mm+, it could signify endometrial cancer. Thus, a biopsy can be scheduled to determine whether or not cancer is present. However, Dr. Doll’s study shows that the decision to use endometrial thickness was based on large-population studies which did not include Black women.
More so, Black women also have higher incidences of non-cancerous fibroids, which can make it more difficult to identify endometrial cancer within this group. In fact, using TVUS to screen for endometrial cancer missed 4x more cases in Black women compared to Caucasian women. Ultimately, this prevents early diagnosis and treatment. This often later diagnosis causes Black women to have a 90% higher mortality rate following an endometrial cancer diagnosis than other groups.
The Research
Within this study, Dr. Doll sourced data from the SEER National Cancer Registry to create 2 retrospective cohorts: one over a 4-year period, and one over a 6-month period. Altogether, data from 367,073 women were included. Included women were either Black or Caucasian, and had been experiencing postmenopausal bleeding. According to the study, the use of TVUS:
to prompt biopsy resulted in a sensitivity of 47.5% among Black women compared with 87.9% among White women, with a negative predictive value of 92% among Black women vs 98% among White women.
Ultimately, this shows the depth of the racial inequity associated with using TVUS. In the end, because these were both retrospective and simulated cohorts, additional research is needed in a real-world study. However, the study does urge physicians to recognize that TVUS could be ineffective for Black women, especially those with fibroids.
Endometrial Cancer
Endometrial cancer first forms in the endometrium (uterine lining). This cancer is considered the most common form of uterine cancer. In many diagnoses, endometrial cancer occurs after age 55. Additional risk factors include having never been pregnant, hormonal changes or hormone therapy, early menstruation or late menopause, and obesity. Symptoms include:
- Vaginal bleeding after menopause
- Abnormal vaginal bleeding between periods
- Pelvic pain
- Pain during sexual intercourse
- Fatigue
- Anemia (low red blood cell count)
Learn more about endometrial cancer.
