• Posted July 2, 2024

Ultrasound May Be Unreliable in Spotting Endometrial Cancer in Black Women

Ultrasound cannot reliably rule out endometrial cancer in Black women given how readings are now assessed, a new study argues.

Transvaginal ultrasound is commonly used to screen for cancer by measuring the thickness of the endometrium, the inner wall of the uterus.

This screening method is supposed to be 99% to 100% accurate for ruling out endometrial cancer, researchers said. An endometrium thinner than 4 millimeters is considered normal; thicker readings typically trigger a biopsy to check for cancer.

But that protocol can be deadly for Black women, study results show.

Nearly 10% of Black women with endometrial cancer had thickness below 4 millimeters, researchers found by analyzing 1,500 Black patients who underwent hysterectomies at 10 hospitals.

“We found that 9.5% of the cancers in Black women were detected below the threshold of 4 millimeters, and 11.5% of the cancers would have been missed at 5 millimeters,” lead researcher Dr. Kemi Doll, a gynecologic oncologist at the University of Washington, said in a news release.

“This is just not acceptable,” Doll said of the current standards for ultrasound screening. “What we found in real-world clinical scenarios, is that it’s just not accurate enough to be safely employed as a strategy among Black people. Whereas, a tissue biopsy is conclusive.”

In an ultrasound screening, a probe is inserted into the vagina that produces sound waves. By moving it around, technicians can capture images of reproductive structures like the uterus, ovaries and fallopian tubes.

The diagnostic protocols set for ultrasound cancer screening are established for the general population, Doll said.

But in Black women, four complicating factors make it more difficult to screen for endometrial cancer using ultrasound, she said:

• Decreased visibility of the cancers.

• Increased presence of non-cancerous fibroids, which can distort the quality of the images.

• Larger body size.

• The skill of the technician performing the scan.

“You might have a cancerous lesion in one area, but not another, but if you don’t look in that specific area, you might assume (the patient) is cancer free,” Doll said.

These results show that technicians and doctors “need to do more” to screen for endometrial cancer in Black women, she said.

For Black women, a tissue sample should be the first test for cancer, rather than an optional follow-up to ultrasound, Doll said.

The findings were published June 27 in JAMA Oncology.

More information

The American Cancer Society has more about endometrial cancer.

SOURCE: University of Washington, news release, June 27, 2024