Adherence to current clinical guidelines for the evaluation of postmenopausal bleeding may result in systematic underdiagnosis of endometrial cancer (EC) in Black women, according to a study published online July 15 in JAMA Oncology.
Kemi M. Doll, M.D., from the University of Washington in Seattle, and colleagues compared the performance of recommended transvaginal ultrasonography (TVUS) endometrial thickness (ET) thresholds as a screening method to prompt endometrial biopsy according to race. The analysis included a simulated retrospective cohort (367,073 Black and White women with postmenopausal bleeding) based on data from the Surveillance, Epidemiology, and End Results national cancer registry (2012 to 2016), the U.S. census, and published estimates of ET distribution and fibroid prevalence.
The researchers found that among Black women, the currently recommended ≥4-mm ET threshold prompted biopsy for fewer than half of EC cases (sensitivity, 47.5 percent), with 13.1 percent of women referred for biopsy diagnosed with EC (positive predictive value, 13.1 percent). For the ≥4-mm threshold, the area under the curve (AUC) was 0.57 in Black women versus 0.73 in White women. Among White women, the ≥4-mm threshold had a sensitivity of 87.9 percent, with 14.6 percent of those referred for biopsy diagnosed with EC (positive predictive value, 14.6 percent). Sensitivity, positive predictive value, and AUC were consistently lower for Black women than White women when examining ≥3-mm and ≥5-mm thresholds.
“The findings of this simulated cohort study suggest that use of ET as measured by TVUS to determine the need for EC diagnostic testing in symptomatic women may exacerbate racial disparities in EC stage at diagnosis,” the authors write.
One author disclosed financial ties to the biopharmaceutical industry.
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