Advancing equity in endometrial cancer: A narrative synthesis using a cluster-informed framework for...

Area of Science:

• Gynecologic Oncology
• Health Systems Research
• Implementation Science

Background:

• Endometrial cancer incidence and mortality are increasing globally, straining healthcare systems.
• Rapid advancements in staging, molecular diagnostics, and treatment present challenges for equitable implementation.
• Health system readiness significantly impacts access to care and innovation adoption.

Purpose of the Study:

• To synthesize current evidence on endometrial cancer management and implementation strategies.
• To develop a resource-stratified framework for guideline adaptation and equitable care delivery.
• To identify persistent gaps in diagnostics, treatment, and survivorship across different health system capacities.

Main Methods:

• Narrative review of trials, guidelines, and implementation studies (2010-2025).
• Application of a previously validated health system readiness clustering model for 68 countries.
• Synthesis of evidence across staging, molecular pathology, surgery, radiotherapy, systemic therapy, survivorship, and AI.

Main Results:

• Significant gaps exist in universal mismatch repair (MMR) and p53 immunohistochemistry availability.
• Variable adoption of sentinel lymph node (SLN) mapping and uneven radiotherapy access persist.
• Limited immunotherapy use for dMMR/MSI-H tumors and fragmented survivorship care are notable challenges.

Conclusions:

• A minimum-core-optimal implementation ladder is proposed to guide priorities across resource levels.
• Context-sensitive guideline adaptation is crucial for addressing implementation gaps.
• AI-supported quality assurance requires local validation, bias mitigation, and robust governance for equitable deployment.