Uterine cancer is on the rise, especially among black women

Angelin Jackson, a school teacher on the outskirts of Atlanta, initially confused the symptoms of uterine cancer for menopause. (Linsey Weatherspoon / The New York Times)

Linda Collins was menopausal for almost a decade and began to bleed again. The bleeding was easy – occasional spots, really – and he barely thought.

When he finally went for a checkup, he refused to see his doctor until he had a biopsy. Within a few days, Collins learned that she had uterine cancer and its particularly aggressive form.

Collins, a 64-year-old retiree from New York, said: “I had no illness, no other symptoms, and I didn’t think seriously about it. “It was a mistake.”

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Uterine cancer, also known as endometrial cancer, is growing so fast that it will replace colorectal cancer as the third most common cancer among women by 2040 and the fourth leading cause of death from female cancer.

According to a recent study by JAMA Oncology, the death rate has risen by almost 2% per year, even more sharply among Asian, Hispanic and black women. Despite the increase, the public seems to be ignoring the disease.

With early detection of uterine cancer, the overall survival rate is high, but few women know that changes in menstrual blood before or after menopause are one of the main warning signs, along with pelvic pain and urinary and sexual pain.

Uterine cancer was thought to be less common among black women. However, new research has shown that this can be fatal not only for black women.

According to a March report by an expert commission convened by the American College of Obstetricians and Gynecologists, black women are twice as likely to die of cervical cancer as white women.

This gap is one of the largest racial disproportions observed for any cancer, the statement said. Black women are more likely to develop non-endometriotic uterine cancer, which is more aggressive.

Among all populations, uterine cancer is more common in young women of childbearing age, as well as in women who do not have risk factors such as obesity and infertility and have never been pregnant, he said. Dr. Shannon Westin is a gynecologist oncologist at the Anderson Cancer Center at the University of Texas at Houston.

He said that when he first began caring for women with uterine cancer, about 39,000 new cases were reported each year. Now their number exceeds 65,000, and it has been in practice for only 15 years.

“It’s a clear indication that we’re ringing the bell,” Westin said.

Dr. Carol Brown, a gynecologist at the Memorial Sloan Kettering Cancer Center in New York, called the increase an epidemic.

“Currently, the number of women diagnosed with endometrial cancer in the United States in 2022 is almost the same as the number of women who die from ovarian cancer, which is amazing for us. Experience for the last 30 years, ”said Brown, the center’s senior vice president and chief health officer.

The JAMA Oncology Study analyzed racial trends in uterine cancer and corrected hysterectomy results. This is important because black women have more hysterectomies, says lead author Megan Clark. (Women who have had a hysterectomy do not have a uterus, so they cannot get endometrial cancer; adding stones to them artificially lowers the risk of the disease.)

“By adjusting the hysterectomy, we are more confident – this growth is real,” said Clark of the National Cancer Institute.

Clark’s study found that between 2000 and 2017, black women accounted for less than 10 percent of the 208,587 cases of cervical cancer diagnosed in the United States, but they accounted for nearly 18 percent of 16,797 cases of cervical cancer at the time.

Mortality rates for cervical cancer in black women are 31.4 per 100,000 women aged 40 and older, and 15.2 for white women of the same age, Clark said. (The relative mortality rate for Asian-American women was 9 per 100,000, and for Hispanic Americans it was 12.3 per 100,000.)

This is an anti-cancer indicator because over the past two decades, the racial gap in mortality rates has been reduced from most cancers. Another report by the National Cancer Institute, published in the journal JAMA Oncology in May, found that overall cancer mortality rates among black Americans fell steadily between 1999 and 2019, but they remained higher than other racial and ethnic groups.

The reasons for the increase in uterine cancer are not well understood. The most common form, endometrioid cancer, is associated with the effects of estrogen, which is higher when there is obesity, and obesity rates are rising in the United States.

However, the prevalence of non-endometrioid cancer has also increased and is not related to overweight. Clark’s study found that black women were more likely to develop this aggressive form of uterine cancer. They are less likely to be diagnosed in the early stages of the disease and have a lower standard of living, regardless of when they were diagnosed and what type of cancer they had.

“There are different outcomes at each stage of the diagnosis,” the doctor said. Karen Knudsen, CEO of the American Cancer Society. “Are they having the same quality of cancer treatment?” He called for more research into the factors driving the trends.

An expert commission convened by the American College of Obstetricians and Gynecologists found racial and ethnic differences in the care provided to black and Hispanic women with cervical cancer. They were less likely to have a hysterectomy than white women, the lymph nodes could not be properly biopsied to see if the cancer had spread, and they were less likely to receive chemotherapy for malignant cancer.

Adrienne Moore, a respiratory therapist who lives in Black and Atlanta, was 45 when she was diagnosed with cervical cancer, but she said it took her almost a year to get a diagnosis. She consulted a doctor a few months later complaining of severe, very painful monthly bleeding that started completely without menstruation.

Moore, now 51, was not insured at the time and the doctors he consulted dismissed his complaints as symptoms of perimenopause or fibroids.

After Moore purchased health insurance under the Affordable Care Act, he saw another gynecologist who performed the scan. This may indicate thickening of the uterine wall, which may indicate cancer, and the doctor immediately ordered a biopsy.

Three days later, the doctor called him to the office. “I knew what had happened. “I knew it was cancer,” Moore said.

According to Mur, he was alive today because he was stable. “If your body is saying something to you, you have to listen to it, and then others have to listen to you,” he said.

Dr. Kemi Doll, a gynecologist-oncologist at the University of Washington School of Medicine in Seattle, has spent years researching why black women die from endometrial cancer.

He found that ultrasound scans that measured the thickness of the uterine wall were inaccurate when patients with non-endometrioid forms of uterine cancer, which are more common in black women.

Even in women with uterine fibroids, the scan is ineffective, which obscures the appearance of the scanner. This explains why black women with uterine fibroids are diagnosed later.

If there is no thickening, doctors will not perform a biopsy to check for cancer.

Women with menopausal menstrual cycles may not understand the need to be screened for uterine cancer because they believe abnormalities are normal, Doll said. And women in perimenopause who are expecting abnormal bleeding may not realize that something is wrong, she said.

“We need to reconsider our guidelines,” Dol. Women with abnormal menstrual cycles and abnormal bleeding are at the highest risk: “Cycle abnormalities increase the risk of endometrial cancer because hormones are not regulated.”

But the biggest problem, he said, is a lack of public awareness. Women know that they need to have mammography and pap smears for screening for breast and cervical cancer.

“If someone finds a tumor in his chest, will he postpone something? “Everyone says, ‘No, no, no, go now,'” the puppet said. Cervical cancer is four times more common than cervical cancer, he added, “and we haven’t had any national dialogue about it.”

When he diagnosed women with uterine cancer, many said they had never heard of it, Puppet added.

Treatment usually requires complete hysterectomy with surgical removal of the uterus, ovaries, fallopian tubes, and cervix. Depending on the stage of the disease, radiation and medication may be required.

Hysterectomy can change the lives of young women, lead them to surgical menopause, and require hormonal treatment to counteract the side effects, and can disrupt the plans of those seeking to conceive.

If caught early, uterine cancer can be cured. Angelin Jackson, a 55-year-old elementary school teacher in Atlanta, decided last summer to sum up the results of an annual inspection that was interrupted by a pandemic. When she reported light bleeding, the gynecologist immediately checked for uterine cancer.

Jackson was diagnosed on July 8 and underwent a hysterectomy 20 days later to catch the disease in its early stages, he said. It is still being carefully observed.

Three years have passed since Collins underwent hysterectomy and radiation therapy. She now tries to tell her friends and acquaintances to talk to her doctor right away about any other symptoms, such as abnormal bleeding or pain, swelling, or sudden weight loss.

“I tell them, ‘Don’t wait; don’t wait If it doesn’t feel right, check it out if you don’t think it should, “Collins said.” I should have looked into it sooner. “

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