Beyond Bleeding: An Analysis of Presenting Symptoms Among Black Patients with Endometrial Cancer

Black patients have the highest mortality rate from endometrial cancer (EC), and yet remain underrepresented in EC research. Thus, currently published symptom patterns may not be comprehensive for this population. The purpose of this study is to analyze symptomatology among Black patients with EC in the Guidelines for Ultrasound in the Detection of Early Endometrial Cancer study and to compare with those undergoing benign hysterectomy.

This is a retrospective consecutive patient sample of Black individuals undergoing hysterectomy in an academic-affiliated 10-hospital health care system from 2014 to 2020. We collected clinical, sociodemographic, and diagnostic information for 24 months before hysterectomy, using merged structured and abstracted data from electronic health records. We used descriptive statistics to describe the sample and pertinent subgroups-patients with fibroids/enlarged uteri, without postmenopausal bleeding (PMB), and patients <50 years old. Symptom distribution between subgroups was analyzed using chi-square tests and Fisher exact tests.

The sample included 3,455 hysterectomy patients, 12% with EC (n = 404). Among EC patients, 77% had PMB and 7% had no bleeding history. EC patients were symptomatic beyond bleeding, with fibroids/enlarged uteri (70%), pelvic/abdominal pain (38%), anemia (30%), and more. Young patients (8% of all EC cases) had more pelvic/abdominal pain (61% vs. 36%, p = 0.017) and anemia requiring transfusion (33% vs. 6%, p < 0.001) compared with older patients. Subgroup symptom presentations overlapped between those with and without cancer, with few symptoms differing by >20%.

PMB alone is rarely the only presenting symptom among Black patients with EC; symptoms overlap heavily with patients presenting with benign disease. Young patients, those with fibroids/enlarged uteri, and those without PMB represent subgroups with nuanced presentations, for whom EC should be considered.