A recent study published in JAMA Oncology has revealed a concerning issue. It has revealed that the common use of transvaginal ultrasounds to detect endometrial cancer may not be effective for Black women. This finding further highlights the need for alternative diagnostic approaches. Ensuring early and accurate detection of this potentially deadly cancer is critical when it comes to women’s healthcare.
The Ineffectiveness of Transvaginal Ultrasounds for Black Women
Alarmingly, Black women are more likely to be diagnosed at later stages of endometrial cancer, which can lead to poorer outcomes. Symptoms of endometrial cancer include abnormal vaginal bleeding, pelvic pain, and difficulty urinating.
A transvaginal ultrasound is a technique that uses sound waves to create images of a woman’s pelvic organs. This technique is a standard method for assessing the risk of endometrial cancer. It involves inserting a probe into the vagina to capture detailed images of the uterus, ovaries, and other pelvic structures.
One telltale sign of cancer is the thickness of the endometrium, the lining of the uterus. A thickness of less than 4 millimeters is typically considered normal in postmenopausal women. However, a thicker measurement may prompt further investigation, such as a biopsy.
Diagnostic Challenges
The study reviewed ultrasound data from 1,500 Black women who underwent hysterectomy across 10 health centers. It found that a significant number of Black women with endometrial cancer had endometrial thicknesses below this 4-millimeter threshold. Nearly 10% of these patients would have been incorrectly assessed as low-risk for cancer based on their ultrasound results alone.
Dr. Kemi Doll, a gynecologic oncologist at the University of Washington School of Medicine and the Fred Hutchinson Cancer Center, led the study. According to her, there’s an inadequacy of relying solely on transvaginal ultrasound for Black women.
“What we found in real-world clinical scenarios is that it’s just not accurate enough to be safely employed as a strategy among Black people. Whereas, a tissue biopsy is conclusive,” she noted of the study.
Moving Towards Better Practices
The study highlights several factors contributing to the inaccuracy of transvaginal ultrasound in Black women. This includes decreased visibility of cancers, the presence of fibroids, larger body size, and varying technician skill levels. Fibroids, which are more common in Black women, can distort ultrasound images and obscure the presence of cancerous lesions.
Dr. Doll believes a tissue biopsy should be the first line of investigation rather than an optional follow-up test. This approach is crucial in ensuring that no potential cases of cancer are overlooked.
This study supports earlier research showing racial disparities in the accuracy of ultrasound for endometrial cancer diagnosis. A 2019 study in the Journal of Clinical Oncology found that Black women have a higher risk of false-negative ultrasound results compared to white women. Additionally, Black women are more likely to have aggressive forms of endometrial cancer that do not cause significant thickening of the endometrium.
The implications of these findings are profound. With nearly 70,000 women expected to be diagnosed with uterine cancer this year and over 13,000 anticipated deaths, it is vital to address the limitations of current diagnostic methods to improve outcomes for Black women.
Healthcare providers must recognize the unique risks and challenges faced by Black women and adjust their diagnostic protocols accordingly. Prioritizing tissue biopsies over ultrasounds in symptomatic Black women could be a critical step toward reducing the disparity in endometrial cancer outcomes.