We had the opportunity to chat with OB/GYN physician Dr. Latonjia Robinson-Brown and Endometrial Cancer Action Network for African Americans (ECANA) ambassadors Dianne Harris and Miche’al Goodwin to discuss what Black women need to know about endometrial cancers.
Dr. Brown currently serves as a medical officer at Carswell Federal Medical Center with the Bureau of Prisons which is the only federal medical facility devoted to women’s medical care. Ms. Harris and Ms. Goodwin are both endometrial cancer survivors and advocates.
Black Health Matters: For those who may not know, which types of cancer would be considered gynecologic cancers?
Dr. Robinson-Brown: Gynecologic cancers include ovarian cancer, uterine/endometrial cancer, cervical cancer, vulvar cancer, and vaginal cancer.
Black Health Matters: How common is endometrial cancer and who is at a higher risk of being diagnosed?
Dr. Robinson-Brown: Endometrial cancer is the most common gynecological cancer in developed countries. It is the 6th most common in women worldwide and the 4th most common in the United States. The average age of diagnosis is 62, and 90% of cases occur after age 50. This type of cancer occurs less frequently in women who have not yet gone through menopause.
Those living with obesity, diabetes, or Lynch Syndrome are at an increased risk. Lynch syndrome is a genetic syndrome that comes with a high risk of developing endometrial, colorectal, ovarian, and urinary tract cancers. The lifetime risk of endometrial cancer is 40-60%.
If you had your first menstrual cycle before age 10, have not given birth to any children, or experience menopause after the age of 55, you are also at an increased risk. Tamoxifen use is another risk factor.
Black Health Matters: Are there any ways to prevent endometrial cancer from occurring?
Dr. Robinson-Brown: There are some factors that have been shown to be protective against endometrial cancer. They include hysterectomy, use of combined oral contraceptive pills, progestin-based contraceptives or intrauterine devices, pregnancy, smoking (however, you should not start smoking as a means of prevention), exercise, and breastfeeding.
There is no effective screening protocol for endometrial cancer and no noninvasive test with good sensitivity. Controlling weight, blood pressure, and diabetes helps reduce risk. Restrict the use of estrogen after menopause if the uterus is still intact and report any abnormal bleeding to your gynecologist.
Black Health Matters: How is the cancer diagnosed?
Dr. Robinson-Brown: The most common presentation is abnormal uterine bleeding which occurs in about 90% of cases. Advanced disease may present with abdominal pain and distension. Less than 5% of cases do not have any symptoms.
A Pap smear and transvaginal ultrasound will likely show some abnormalities. However, an endometrial biopsy with hysteroscopy is the gold standard for diagnosis. Other exams, such as a pelvic exam, are usually normal unless there is advanced disease.
Black Health Matters: How is the cancer staged and what are the survival rates?
Dr. Robinson-Brown: Uterine cancers are staged clinically by a CT or MRI. In Stage 1, cancer cells are only found in the uterus. In Stage 2, the cancer has spread to the opening of the uterus, known as the cervix. In Stage 3, the cancer has spread outside of the uterus to the nearby lymph nodes, ovaries, fallopian tubes, or vagina. In Stage 4, the cancer has spread to the bladder, rectum, or outside of the pelvis such as the lungs or abdomen.
The overall 5-year survival rate for endometrial cancer is 80%. Rates are higher at earlier stages: Stage 1: 87%, Stage 2: 76%, Stage 3: 59%, and Stage 4: 18%. The outlook is good if the cancer is detected and treated early.
Black Health Matters: What kind of treatment options are available or recommended?
Dr. Robinson-Brown: The mainstay of treatment is surgery which usually includes a hysterectomy. Other treatment options include radiotherapy (in those with later-stage disease or who may not be a good surgical candidate), chemotherapy, hormonal therapy, and targeted therapy
Black Health Matters: Thank you for the overview and excellent information Dr. Robinson-Brown.
Let’s switch gears and learn more about our patient ambassadors. Do you mind sharing with us a little about your journey with endometrial cancer?
Ms. Harris: My journey began in 2016 with periodic vaginal bleeding after menopause which I did not know was a sign of endometrial cancer (EC). In May of 2022, I received an abnormal pap smear report and a biopsy of the lining of my uterus was performed. I was diagnosed with uterine cancer and referred to a gynecological oncologist who informed me that immediate surgery for the removal of the uterus was needed.
The total hysterectomy surgery was performed in June of 2022, which included the removal of the uterus, cervix, both ovaries, and both fallopian tubes. The physicians noted the cancer as Stage 1A. In July of 2022, I received six rounds of radiation therapy via vaginal brachytherapy to complete therapy. In January of 2024, I became a survivor of EC for a second time.
Ms. Goodwin: I am a four-year Endometrial Stage 4 cancer survivor. I was first diagnosed in July 2019 with Endometrial cancer stage 3. In October 2019, after a complete hysterectomy, I was diagnosed with Stage 4b. My treatment path was a robotic hysterectomy, 6 rounds of chemotherapy, and 26 rounds of radiation. I became a peer supporter to reach back and support other women like me, to walk this journey victoriously.
Black Health Matters: Thank you for sharing. Any final thoughts or insights to share?
Ms. Harris: I have learned so much since being diagnosed with endometrial cancer of the uterus. My most important piece of advice is to pay attention to your body’s warning signals and seek regular gynecologic care. Also, be a strong advocate for your health when speaking with healthcare providers. There is not nearly enough information about EC as there is about breast, cervical, ovarian, or other reproductive cancers.
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