How endometrial cancer impacts Black Americans

Different diseases affect different populations in different ways. Health disparity is a term that is sometimes used to describe these differences. Health disparities can refer to differences in prevalence, severity, and treatment outcomes. A closely related term is healthcare disparity, which refers to differences in things like access to care, insurance coverage, and the type of treatment a person receives.

These terms are often used to describe unjust differences that affect specific populations, such as inequity and inequality associated with race, ethnicity, gender, age, and socioeconomic status.

Below is a look at health and healthcare disparities related to endometrial cancer and Black Americans, as well as steps a person can take to address these disparities when seeking care for endometrial cancer.

Endometrial cancer is cancer that begins in the uterus

The uterus is a hollow, fist-sized, pear-shaped organ that is part of the female reproductive system. It is where a fetus will develop during pregnancy. Endometrial cancer is cancer that begins in the endometrium, the layer of tissue that forms the inner lining of the uterus. The endometrium is where a fertilized egg attaches when a person becomes pregnant. It’s also the tissue that is shed during menstruation.

Endometrial cancer begins when cells in the endometrium undergo genetic mutations that change how those cells reproduce and function. These mutations result in cancerous cells.

Cancerous cells have abnormal features that make them dangerous to a person’s health. Unlike healthy cells, which grow and expire on a regulated schedule, cancerous cells grow and divide at a much faster rate and have abnormally long lifespans. This results in the uncontrolled growth of cells, the formation of tumors, and potentially, the spread of cancer to other parts of the body.

Endometrial cancer among Black Americans

Black people in the United States are disproportionately affected by endometrial cancer, and they face significant health disparities and healthcare disparities. Compared to non-Hispanic white Americans, Black Americans are:

• More likely to be diagnosed at an advanced stage of endometrial cancer.
• More likely to be diagnosed with a less common, more aggressive subtype of endometrial cancer (such as clear cell, serous, or carcinosarcomas).
• Have significantly higher mortality rates and shorter survival.
• Are less likely to be treated with hysterectomy or non-invasive surgical procedures after a diagnosis of endometrial cancer.
• Are less likely to receive genetic counseling that can guide treatment with targeted therapies or immunotherapy.
• Are less likely to be recommended treatment that meets current guidelines.
• Are underrepresented in clinical trials related to endometrial cancer therapies.

The reasons for these health and healthcare disparities are not fully understood, but socioeconomic and environmental factors are considered to be the most significant contributors.

The need for cultural awareness in healthcare

Endometrial cancer affects everyone differently, and it requires individualized treatment—treatment that takes into account details about the diagnosis, what the cancer is doing at the cellular level, a person’s overall health, and many other factors. In other words, treatment is different for every person, and some of the ways that the experience can be different are related to a person’s race and ethnicity.

For example, postmenopausal bleeding (PMB) is a common early symptom of endometrial cancer, but research has shown that it is commonly overlooked in Black populations. One reason is the higher prevalence of uterine fibroids and irregular menstrual cycles among Black populations. PMB can be mistaken for a symptom of these common conditions, leading to normalization of symptoms, delays in endometrial cancer diagnosis, and diagnosis at more advanced stages.

Recognizing cultural awareness in healthcare

Your healthcare providers will be your best source of information—and it’s important to work with healthcare providers you can communicate with effectively.

Cultural awareness is something to consider. Cultural awareness is a healthcare provider’s ability to recognize how race, ethnicity, and cultural background can affect a person’s healthcare needs.

Signs of cultural awareness in a healthcare setting:

• You feel respected by your healthcare provider and other staff members.
• You feel comfortable asking questions and bringing up concerns during an appointment.
• You feel that your questions and concerns are taken seriously and addressed by your healthcare provider.
• You feel that you can be honest with your healthcare provider.
• You leave an appointment with a good understanding of what you and your healthcare provider discussed and the next steps you will take.
• You are confident you are receiving the best treatment possible for your diagnosis.

If you have doubts about any of the above, bring up your concerns—you and your healthcare provider need to be honest with one another.

You may also consider working with a different healthcare provider. Recommendations from family or friends, researching other providers, reading reviews from other patients, the website for your insurance provider, and recommendations from other healthcare providers you’ve worked with in the past can help you find a different healthcare provider.