Ultrasound Screening Often Misses Endometrial Cancer in Black Females

• A new report found that a common screening technique used to assess the risk of endometrial cancer may be less effective in Black people.
• Pelvic transvaginal ultrasonography misses a significant percentage of cancer risk cases in Black females.
• The most accurate way to detect endometrial cancer in Black females is through a tissue biopsy.

A new report found that a common screening technique used to assess the risk of endometrial cancer (EC) may be less effective in Black people.

The study , published in JAMA Oncology in June, discovered that pelvic transvaginal ultrasonography (TVUS) led to false negatives in a portion of Black females who actually had EC.

TVUS, which uses sound waves to produce a picture of the inside of the pelvis, is routinely recommended to females experiencing postmenopausal bleeding , which is a symptom of EC.

If the TVUS reveals that the individual has a thicker endometrial thickness (ET), they should also get a tissue biopsy to screen for EC.

Some Black females with EC have a relatively thin endometrial thickness — as a result, they don’t get a biopsy, and the cancer is missed.

With EC, early detection is crucial.

“Since we know that ultrasound assessment is not always accurate in Black women, other screening modalities are essential for early cancer detection, including symptom awareness and advocacy,” Elena Ratner , MD, MBA, a gynecologic oncologist at Yale Cancer Center and Smilow Cancer Hospital, told Healthline.

Many cancers were missed on ultrasounds in Black females

The report evaluated the health data of 1,494 Black individuals who underwent pelvic ultrasonography with an ET measurement before a hysterectomy.

Of the group, 210 had EC. In addition, 78% had fibroids , 71% had vaginal bleeding, and 57% had pelvic pain.

Of the 210 who had EC, about 11% had an ET that was below the diagnostic threshold for detection (4 mm).

The study found that roughly 9.5% of cancers detected in Black females were detected below the threshold of 4 mm, and 3.8% were in people who had an ET less than 3 mm.

An estimated 11.5% of the cancers would have been missed because the people had a relatively thin ET.

The findings suggest the most accurate way to identify EC in Black females is through a tissue biopsy.

Diana Pearre , MD, a board certified gynecologic oncologist at The Roy and Patricia Disney Family Cancer Center at Providence Saint Joseph Medical Center in Burbank, CA, says that the lead researcher of the study, Dr. Kemi Doll, has significantly added to the scant research that’s been done surrounding health inequities in the diagnosis and treatment of endometrial cancer .

“The main takeaway I believe she wants us to understand is that we cannot rely simply on the image we see on an ultrasound report to determine whether to biopsy a patient with postmenopausal bleeding,” Pearre said.

Why TVUS may be less reliable for detecting cancer in Black people

In many patient populations, TVUS is an effective way to measure ET and provide a risk assessment for EC.

“It is often used to determine whether patients should get a biopsy of the internal lining of the uterus and make sure there are no cancerous or precancerous changes in the lining,” Amer Karam , MD, a gynecologic surgeon with Stanford Medicine, says.

However, the procedure doesn’t appear to be as reliable in Black females.

Prior research has shown that Black females with postmenopausal bleeding are less likely to get an endometrial biopsy.

A study published in 2019 revealed that Black females are more likely to get false negative transvaginal ultrasounds compared to white females.

“In publications, ultrasound findings of being below a certain endometrial thickness threshold rule out the possibility of endometrial cancer. In Black women, that does not appear to be the case,” Ratner said.

According to Karam, the majority of studies examining the accuracy of TVUS have been conducted in mostly white patients.

The researchers of the new report suspect that the decreased visibility of the cancers in Black females and the increased prevalence of fibroids may make the cancer harder to detect via TVUS alone.

“One other factor not examined in the current study is the higher prevalence of aggressive types of endometrial cancer that present with thinner linings among Black patients,” Karam said.

Biopsies can help detect a greater percentage of cancers

Pearre suspects that many physicians will be surprised to see these new findings.

“I hope they take this study into account and refer patients to gynecologists when they report bleeding regardless of how thick the inner lining of their uterus is,” Pearre said.

The researchers suggest that a tissue biopsy should always be done to provide an accurate diagnosis of EC.

According to Pearre, endometrial sampling is the cornerstone of EC diagnosis.

“If a patient reports bleeding after menopause or even heavy bleeding prior to menopause, endometrial sampling is probably the next best strategy in their workup,” Pearre said.

The bottom line:

A new report found that a common screening technique used to detect endometrial cancer risk may be less effective in Black people.

Pelvic transvaginal ultrasonography misses a significant percentage of cancer risk cases in Black females.

The most accurate way to detect endometrial cancer in Black females is through a tissue biopsy.