How to Reduce the Increasing Mortality from Endometrial/Uterine cancer

The revised ACOG guidance on the use of transvaginal ultrasound in women with postmenopausal bleeding has much of its rationale in the fact that mortality for endometrial cancer is rising 1 to 2% per year. If we, as healthcare practitioners, want to reduce the mortality from uterine cancer, there are several factors that can and should be strongly implemented.

Dr Steven R. Goldstein a menopause specialist in NYC, warns that there should be no bleeding in menopause. He says the first factor that should be implemented to reduce the mortality from uterine cancer is that of a robust education and public awareness campaign. A survey study, published by Wise et al. is extremely distressing and eye opening. A survey of 145 postmenopausal women revealed that only 37% knew that bleeding in menopause could even represent endometrial cancer, 41% claim they would not tell their provider if they only had one episode of bleeding, and 53% said their provider had never counseled them in postmenopausal bleeding. Those authors concluded, “there is a need for increased recognition of postmenopausal bleeding, and provider counseling and educational intervention should focus on public and provider awareness of endometrial cancer and its risks and symptoms.”

Interestingly enough, in that study, 80% of the participants were White, 12% Asian, and only 2.4% were Black. Thus, the findings of that survey study would only be expected to be even more extreme in the Black population. Black women, because of an increased incidence of fibroids, likely have had more irregular bleeding as premenopausal patients, and thus are even less likely to report such bleeding in the postmenopausal state. This is totally separate from all of the other racial disparities, inherent racial bias of providers, and social determinants of health that contribute to the increased mortality of the Black population. Any attempt to reduce the mortality for endometrial cancer should have this information front and center with greater emphasis than any future guidelines.

Furthermore, as evidenced by the risk factors strongly associated with endometrial cancer in the article by Raglan, et al., obesity in the form of increased body mass index and waste-to-hip ratio were two of the only three factors with strong association. The increasing obesity in this country is a major risk factor for endometrial cancer and certainly contributing somewhat to the alarming annual increase in mortality from this disease. Thus, a combination of attempts to combat obesity, as well as public and provider education about the importance of prompt reporting of any bleeding in menopause are important factors to help combat this rise in mortality from endometrial cancer.

If you are in menopause or post-menopausal, there should be no bleeding. If you are experiencing this, then perhaps a consultation with Dr Steven R. Goldstein, a gynecologist in Manhattan, may be in order.