- A recent study revealed that a widely used screening method for endometrial cancer may not be as effective for Black individuals.
- Pelvic transvaginal ultrasonography (TVUS) often fails to detect a significant number of endometrial cancer cases in Black women.
- The most reliable method for diagnosing endometrial cancer in Black women is through a tissue biopsy.
Published in JAMA Oncology in June, the study showed that TVUS missed endometrial cancer in some Black women who had the disease.
TVUS, which creates an image of the pelvic area using sound waves, is commonly recommended for women with postmenopausal bleeding, a symptom of endometrial cancer.
If TVUS indicates a thicker endometrial lining, a tissue biopsy is typically advised for further screening. However, some Black women with endometrial cancer have a thinner endometrial lining and may not undergo a biopsy, resulting in missed diagnoses.
Early detection of endometrial cancer is vital. Since ultrasound may not always provide accurate results for Black women, it is important to use additional screening methods, including increased awareness of symptoms and proactive health advocacy.
Study Finds Many Cancers Missed in Black Women During Ultrasounds
Research analyzed health records of 1,494 Black individuals who had pelvic ultrasounds before hysterectomies.
Among them, 210 were diagnosed with endometrial cancer (EC). Most patients also had fibroids (78%), vaginal bleeding (71%), and pelvic pain (57%).
About 11% of those with EC had endometrial thickness (ET) below the 4 mm detection threshold.
The study revealed that 9.5% of cancers in Black women were detected with an ET below 4 mm, and 3.8% with an ET below 3 mm.
Approximately 11.5% of cancers could have been missed due to thin ET. The research underscores the importance of biopsy for accurate EC diagnosis in Black women.
Dr. Diana Pearre, a gynecologic oncologist at Providence Saint Joseph Medical Center, highlighted Dr. Kemi Doll’s work, emphasizing the need for deeper research into health disparities in endometrial cancer diagnosis and treatment.
Pearre stressed that relying solely on ultrasound images may overlook crucial cases requiring biopsy, especially in postmenopausal bleeding patients.
Why TVUS May Be Less Effective for Detecting Cancer in Black Women
A transvaginal ultrasound uses sound waves to create images of the pelvic area, involving the insertion of a probe into the vagina. It’s used to measure endometrial thickness, which can indicate endometrial cancer.
Transvaginal ultrasound (TVUS) is generally effective for measuring endometrial thickness (ET) and assessing the risk of endometrial cancer (EC) in many patient groups.
“It is often used to determine whether patients should get a biopsy of the internal lining of the uterus and make sure there are no cancerous or precancerous changes in the lining,” says Amer Karam, MD, a gynecologic surgeon at Stanford Medicine.
However, TVUS seems to be less reliable in Black women this is because, research indicates that the 4-millimeter threshold might miss cancers in Black women due to factors like;
- decreased visibility of the cancer
- increased presence of fibroids within the endometrium
- A larger body size, and
- The skill of the technician doing the scans
Research has shown that Black women with postmenopausal bleeding are less likely to receive an endometrial biopsy.
A 2019 study found that Black women are more likely to have false negative results from transvaginal ultrasounds compared to white women.
“In publications, ultrasound findings of being below a certain endometrial thickness threshold rule out the possibility of endometrial cancer. In Black women, that does not appear to be the case,” says Ratner.
According to Karam, most studies on the accuracy of TVUS have predominantly involved white patients.
Researchers of the new report believe that the lower visibility of cancers in Black women and the higher prevalence of fibroids may make cancer detection via TVUS more difficult.
“One other factor not examined in the current study is the higher prevalence of aggressive types of endometrial cancer that present with thinner linings among Black patients,” Karam said.
Biopsies Can Enhance Cancer Detection Rates
Pearre believes that the new findings will come as a surprise to many doctors.
“I hope this study encourages physicians to refer patients to gynecologists for further evaluation when they report bleeding, regardless of the thickness of their uterine lining,” Pearre stated.
The researchers recommend that tissue biopsies be routinely performed to ensure an accurate diagnosis of endometrial cancer.
Pearre emphasized that endometrial sampling is essential for diagnosing this type of cancer.
“If a patient experiences postmenopausal bleeding or heavy premenopausal bleeding, endometrial sampling is likely the most effective next step in their diagnostic process,” Pearre explained.
Conclusion
A recent report has revealed that a commonly employed screening technique for evaluating endometrial cancer risk may not be as effective for Black individuals as it is for other populations.
Specifically, pelvic transvaginal ultrasonography, a standard procedure for detecting potential endometrial cancer, has been found to miss a significant proportion of cancer risk cases in Black women.
This suggests that the reliability of this method varies across different demographic groups, potentially leading to underdiagnosis and delayed treatment in Black women.
To address this disparity, the report underscores that the most accurate and dependable way to detect endometrial cancer in Black women is through a tissue biopsy.
This method provides a more precise diagnosis, ensuring that patients receive timely and appropriate medical intervention.
References
“Black patients may be missed on common cancer screening, study suggests”
“Ultrasounds may not find this cancer in Black women”newsroom.uw.edu/news
“Estimated Performance of Transvaginal Ultrasonography for Evaluation of Postmenopausal Bleeding in a Simulated Cohort of Black and White Women in the US”
https://jamanetwork.com/journals/jamaoncology/article-abstract/2781891
