Black Patients Face More Screening Delays for Uterine Cancer Diagnosis
Black women are not getting the tests they need to diagnose uterine cancer early, according to a new study.
Previous research had found that Black patients are less likely to receive early diagnoses than people from other racial and ethnic groups. The new study showed that it's because Black women were more likely to face testing delays or to not get recommended tests at all.
That matters because early diagnosis can improve survival rates. When uterine cancer is confined to the uterus, nearly 95% of patients survive the next five years. Survival drops to less than 70% if the cancer has spread to nearby lymph nodes and to 18% if the cancer spreads to other parts of the body.
“Early diagnosis is important,” said lead author Xiao Xu, an associate professor of obstetrics, gynecology and reproductive sciences at Yale School of Medicine.
“We don't know why there's a racial disparity in early diagnosis and until we do, it's hard to address it," she said in a school news release.
To study this, Xu's team used a nationwide database of more than 44 million Medicaid patients.
Their analysis included women who had reported abnormal uterine bleeding to their health care providers. The patients also had later received a diagnosis of uterine cancer.
Abnormal uterine bleeding is the most common symptom of uterine cancer. It can look like light spotting or heavier bleeding at unexpected times, Xu said.
Doctors have several ways to evaluate abnormal uterine bleeding: an endometrial biopsy; transvaginal/pelvic ultrasound; and hysteroscopy, in which a doctor uses a small telescope-like device to examine the inside of the cervix and uterus.
More than twice as many Black patients (10%) than white patients (5%) had none of these procedures, researchers found.
Among those who did, Black patients were more likely than white patients to encounter a delay of more than two months in receiving their first diagnostic procedure after reporting abnormal bleeding.
Black patients were also more likely than white patients to receive a cancer diagnosis after a delay.
About 11.3% of Black patients who reported abnormal bleeding waited more than a year to receive a uterine cancer diagnosis. That compared with 8.3% of white patients.
“Overall, we found a pretty consistent difference in the quality of care received by Black and white patients,” Xu said.
Xu and her colleagues are now evaluating more data to see whether Black patients experience barriers to specialist care. They also want to learn if more education about uterine cancer symptoms may be beneficial and whether delays result in diagnosis at later stages of cancer. They're studying whether these findings among Medicaid patients are seen in other patient populations.
“The goal,” said Xu, “is for every patient to receive high-quality care.”
The findings were published Feb. 15 in the Journal of the National Cancer Institute.
The U.S. National Cancer Institute has more on uterine cancer.
SOURCE: Yale Cancer Center/Smilow Cancer Hospital, news release, Feb. 15, 2023