The usual method of checking for endometrial cancer is not reliable in Black women, researchers reported on Thursday in JAMA Oncology.
In Black patients with symptoms suggestive of endometrial cancer, particularly postmenopausal bleeding, a tissue biopsy is needed to rule out the disease, instead of the typical approach of performing an ultrasound exam via the vagina, they said.
Endometrial cancer, a malignancy in the lining of the uterus, or endometrium, is on the rise, especially among Black women, who are more likely to be diagnosed at later stages of the disease, the researchers noted.
Current guidelines suggest that patients with postmenopausal bleeding should undergo the ultrasound exam plus a biopsy if the exam shows endometrial thickness of 4 millimeters or greater. If the endometrium measures less than 4 mm, then no further testing is required, they said.
When the researchers reviewed data from nearly 1,500 Black women who had undergone transvaginal ultrasound exams followed by hysterectomy, however, they found that 10% of patients with endometrial cancer had endometrial thickness below 4 mm.
Among the reasons ultrasound is less reliable in Black women, they said, are that fibroids, which are much more common in these women, can distort the quality of the images, leading to inaccurate measurement. In addition, Black women often have high-risk cancers that may cause less thickening of the endometrium.
The endometrium measurement test is supposed to be 99% to 100% accurate for ruling out endometrial cancer, but that’s not the experience of Black women, study leader Dr. Kemi Doll of the Fred Hutchinson Cancer Center in Seattle said in a statement.
“This is just not acceptable,” she said.