Endometrial Cancer Black Women — Why Outcomes Are Worse (And What Can Be Done)

Let's talk about something real for a second. You know how we're always told to "take care of ourselves," especially after 40? Eat well. Stay active. Get regular checkups. Maybe even wear that sunscreen every day (okay, I'm still working on that one).

But here's the thing I didn't knowuntil recentlyno matter how much spinach I eat or how many Peloton rides I log, Black women are nearly twice as likely to die from endometrial cancer as white women. And that's not because we're doing anything wrong. In fact, many of us are doing everything right and still falling through the cracks.

This isn't a scare tactic. It's a wake-up callone that's long overdue. And the good news? Awareness is power. So let's dig in, friend, because your body, your voice, and your life matter. Period.

Why It's Real

When I first heard that Black women have the highest uterine cancer mortality rate in the U.S., I literally paused in the middle of folding laundry and said out loud, "Waitwhat?" I thought, "Surely this is about access. Maybe income, or insurance?"

But the data tells a deeper story. According to the American Cancer Society's 2023 report, Black women face a staggering 64% five-year survival rate compared to 84% for white womeneven when diagnosed at the same stage and even when treated.

Let that sink in.

Same diagnosis. Same treatment plan. And still, the odds are stacked against us.

It's not just about late diagnosisthough that's part of it. Black women often wait up to 30% longer from first symptoms to diagnosis, thanks to fragmented care, dismissal by providers, and outdated diagnostic tools. But even after diagnosis, the disparities continue.

Dr. Kristin Taylor from Cedars-Sinai put it simply: "Even in low-risk, early-stage cancer, Black women were less likely to get a hysterectomyand less likely to survive." A preventable surgery. A curative option. And it's not reaching us at the same rate.

Biology Isn't Just Biology

Now, before you think, "Well, maybe it's genetics," let's go deeper. Are there differences in tumor biology? Yesbut not in the way you'd expect.

It's not that being Black causes aggressive cancer. It's that the medical system has historically ignored the nuance.

Researchers are now using AI and genetic research to compare endometrial tumors across racial lines, and what they're finding is eye-opening. Tumors classified as the same subtypesay, endometrioidcan behave differently based on genetic ancestry. Aggressive subtypes like serous carcinoma are found at much higher rates in Black womenand they don't play by the same rules.

Dr. Onyinye Balogun, a leading oncologist at NewYork-Presbyterian, has spent years studying mutations more common in women of African ancestry. She says: "Most genomic studies focus on European ancestry We need to cast a wider net."

And she's right. If we only study one group of people, how can we possibly serve all of us?

Here's a quick look at what we're up against:

Subtype	Frequency in Black Women	Survival Outlook
Endometrioid (low-grade)	~60-70%	Better prognosis
Serous carcinoma	10-15% (vs. 3-5% in white women)	Aggressive, high recurrence
Clear cell	Higher incidence	Poorer outcomes
Carcinosarcoma	More common	Very aggressive, low survival

These non-endometrioid subtypes grow fast, spread early, and often don't respond well to traditional treatments. And because they're under-researched, they're also undertreated.

The System Has Blind Spots

Here's something that blew my mind: the standard ultrasound testthe very first step in diagnosing endometrial cancerwas developed mostly using data from white women.

Yes. You heard that right.

So when a Black woman comes in with abnormal bleeding, the doctor orders a transvaginal ultrasound to measure endometrial thickness. If it's not thick enough, they might skip the biopsy. But here's the catch: aggressive cancerslike serous carcinomadon't always cause thickening. And many Black women have fibroids, which can distort the ultrasound image.

The tool isn't brokenit's just not built for us.

Enter Dr. Kemi Doll, a gynecologic oncologist and fierce advocate who's leading the GUIDE-EC study. She's gathering data from Black women who've had both ultrasounds and biopsies to redefine what "normal" looks like. Her goal? To rewrite the guidelines so more Black women get the biopsy they neednot just the ultrasound they're given.

Dr. Doll puts it perfectly: "The algorithm was built on data from white women. It doesn't work the same for us."

Treatment Isn't Equal

Even when we get diagnosed, that doesn't always mean we get treated the same way.

Studies show Black women are less likely to:

• Be referred to a gynecologic oncologist
• Receive curative surgery (like a hysterectomy)
• Get chemotherapy or radiation when needed

And here's the gut punch: only 13% of gynecologic oncologists in the U.S. are Black. That lack of representation can make it harder to trust, to feel seen, to ask questions without fear of judgment.

But it's not just about who's in the doctor's office. It's about how we're treated once we're there.

In interviews, Black women have shared painful truths: providers didn't believe their pain. They were told, "It's just stress" or "You're overreacting." Some felt so isolated during treatment that ending it early felt like a reliefeven if it meant risking their lives.

One woman, in Dr. Doll's research, said: "Ending treatment early felt like emotional relief."

Let that sink in. Relief. From stopping cancer treatment.

That's not just a medical failure. That's a human one.

Hope Is Rising

Okay, deep breath. This is heavy. I know. But here's the truth I want you to walk away with: this isn't the end of the story.

There's hope. Real, tangible, growing hope.

Researchers are using AI genetic research to map tumor behavior across ancestries. At Fred Hutch, teams are building models that can detect molecular patterns we'd otherwise miss. As one scientist put it: "AI helps us see patterns humans misslike how tumors behave differently across ancestries."

That means one day, screening tools could be tailorednot based on race, but on genetic risk. Imagine getting a treatment plan designed for your body, not a one-size-fits-all approach that was never meant for you.

And the movement isn't just happening in labs.

The SISTER triala study you can join until 2024 at nine U.S. sitesis testing whether peer support, virtual groups, and better information can help Black women stick with treatment. No need to change doctors. Just the chance to connect with others who get it.

And let's not forget ECANAthe Endometrial Cancer Action Network for African Americans, founded by Dr. Doll. It's more than a support group. It's a community where Black women share stories, influence research, and advocate for change. One member said: "We didn't just want a seat at the table. We want to build a new table."

Now that's power.

Your Body, Your Voice

I know it can feel overwhelming. But you're not powerless. In fact, you're the most important player in your care.

Let's start with the signs. You've probably heard "postmenopausal bleeding" a million times. But do you know it shows up in 90% of endometrial cancer cases? If you've gone through menopause and see even a spot of bloodno, it's not "just a fluke." It's a red flag.

Dr. Balogun is clear: "Any kind of bleeding after menopause is not OK. Go get it checkedimmediately."

Other early signs?

• Heavier or irregular periods before menopause
• Spotting between cycles
• Watery, bloody, or foul-smelling discharge
• Pelvic pain or discomfort during sex
• Unexplained weight loss

And here's the thingnone of these automatically mean cancer. But they do mean "pay attention."

Speak Up

So how do you handle the doctor's office when you're scared, tired, or just trying to get through the day?

First: bring someone with you. A sister, cousin, friendsomeone who can listen, take notes, and speak up if you freeze. You don't have to do this alone.

Second: ask for a biopsy. Don't let "the ultrasound looks fine" be the final word. You can say, gently but firmly: "I need a biopsy. Ultrasound isn't enough."

Third: know your family history. If someone in your family had colon, ovarian, or endometrial cancerespecially before age 50you could have Lynch syndrome, an inherited condition that raises your risk. Birth control pills (the combined kind) may actually help reduce that risk, so talk to your doctor.

And finally: honor your instincts. If something feels off, it probably is. You know your body better than anyone.

Dr. Balogun says it best: "Stop the secrecy. Talking can save a life."

Small Steps, Big Impact

You can't change your DNA. But you can shift your habits in ways that make a real difference.

Action	Benefit
Maintain healthy weight	Obesity doubles endometrial cancer risk
Manage diabetes & hypertension	Both linked to higher risk
Eat a balanced, anti-inflammatory diet	Mediterranean-style helps
Exercise regularly	At least 150 min/week
Avoid estrogen-only HRT	Can increase risk

Think of it like this: every healthy choice is a vote for your future. Not perfection. Just progress.

You Are Seen

Friend, I want you to know this: endometrial cancer in Black women is not just a medical issue. It's a justice issue. It's about who gets heard, who gets believed, and who gets the care they deserve.

But it's also about who's fighting back. And today, that includes you.

Thanks to AI genetic research, brave doctors like Dr. Doll and Dr. Balogun, and patient-led groups like ECANA, we're finally starting to break the cycle.

You deserve to be heard. To be seen. To get a biopsy, not just an ultrasound. To have support when treatment feels lonely. To know your risk, your signs, and your rights.

If something feels offdon't wait. Speak up. Your voice matters.

And if you're walking through diagnosis or treatment right now, know this: you're not alone. There's a community behind you, beside you, cheering you on.

We're rewriting the rules. Together.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.