Risk-based approach could reduce racial disparities in endometrial cancer care
Key takeaways:
- Barriers to biopsy acceptance among Black women included lack of pain-related information and use of jargon-laden terminology.
- Tailored educational information and race-concordant care could improve acceptance.
Clinicians should adopt a risk-based, rather than biopsy-first, approach to encourage biopsy acceptance and improve early diagnosis of endometrial cancer among Black women, according to researchers.
Study results presented at Society of Gynecologic Oncology Annual Meeting on Women’s Cancer showed this could include tailored educational information, race-concordant care and culturally competent communication.
Endometrial cancer is the fastest-growing cancer in the United States, with a significant mortality disparity between Black and white women, according to the study background.
Ultrasound-based endometrial thickness triage, which is performed to determine whether biopsy is needed, has lower accuracy among Black women. As guidance shifts toward a biopsy-first approach, data are needed to better understand barriers and facilitators to this approach for this demographic.
Julianna G. Alson, MPH, senior program manager in gynecologic oncology at University of Washington, and colleagues conducted three focus groups — two in person and one virtual — in April and June 2023. They included 26 Black women (mean age, 52 years; range, 33-76) recruited from Southeast and Midwest regions of the U.S. through community organizations and social media networks.
Eligible participants self-identified as Black or African American and had no history of hysterectomy. Women aged 35 to 49 years had an additional eligibility criterion of experiencing “bleeding of concern,” including heavy periods lasting more than 7 days, spotting between periods and irregular cycles.
Results showed that obstacles to a biopsy-first approach included insufficient information related to pain, lack of understanding of the rationale for biopsy, jargon-laden terminology and mistrust based on previous gynecologic encounters.
Conversely, facilitators included the use of “risk-based” rather than “biopsy-first” language, respectful and detailed communication about the procedure, racial and gender understanding, acknowledgement of medical racism and opportunities to ask questions.
Public communication efforts that incorporate these findings — along with use of biopsy-focused diagnostic guidelines — could help promote patient trust in gynecologic oncology and reduce racial inequity in endometrial cancer care, Alson and colleagues concluded.
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Alson JG, et al. Black women's perspectives on a biopsy-first approach to improve early diagnosis of endometrial cancer: Using community focus groups for an equity-centered approach to clinical guideline changes. Presented at: SGO Annual Meeting on Women’s Cancer; March 14-17, 2025; Seattle.