Endometrial cancer (EC) is one of the few cancers with an overall increasing incidence in the US.1 Postmenopausal bleeding, which is experienced by approximately 90% of women diagnosed with EC, is a sensitive symptomatic marker for diagnostic testing.2 Current guidelines for diagnostic testing include transvaginal ultrasonography (TVUS) to measure endometrial thickness (ET), with greater than 4 mm used as a trigger for endometrial sampling.2 Endometrial cancer inequities in delayed diagnosis and excess mortality persist for Black women. Black women with EC have a 90% higher 5-year mortality compared with White women.1 Independent of insurance and access to health care, Black women are more likely to be diagnosed with advanced-stage disease and with high-risk, poor prognostic, nonendometrioid EC. In this issue of JAMA Oncology, Doll et al3 summarize the evidence that nonendometrioid EC is less likely to be identified by TVUS ET measurements and that uterine fibroids can distort the endometrium lining and limit accurate ET measurements. Given the high prevalence of nonendometrioid EC and fibroids among Black women, the role of TVUS as a primary diagnostic test may not be adequate. The authors hypothesize that current TVUS guidelines for postmenopausal bleeding may have worse performance when applied to Black women and, as a result, contribute to ongoing racial inequity in EC outcomes.
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Chapman-Davis E, Khabele D. A Race-Conscious Analysis of the Use of Transvaginal Ultrasonography in the Evaluation of Postmenopausal Bleeding. JAMA Oncol. 2021;7(8):1165–1166. doi:10.1001/jamaoncol.2021.1681
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