What to know about endometrial (uterine) cancer, on the rise in the U.S.

Endometrial cancer occurs when cells of the endometrium, or the inner lining of the uterus, change and start to grow out of control. It’s the most frequently diagnosed cancer in the female reproductive organs, and it has several subtypes that are based on the appearance of the cancer cells when viewed under a microscope.

How common is endometrial cancer?

The American Cancer Society projects there will be nearly 68,000 cases of uterine cancer diagnosed in the United States in 2024 and that more than 13,000 people will die of it.

However, those numbers also include less-common uterine sarcomas, which start in the connective tissue or muscle walls of the uterus and are different than endometrial cancer. This means the actual numbers of endometrial cancer diagnoses and deaths in 2024 will be a bit lower than the above projections.

This disease is one of the few cancers that are on the rise in this country. We’ve been seeing an annual increase in the number of endometrial cancer diagnoses and deaths.

Who’s most likely to have endometrial cancer?

It occurs most often in postmenopausal people. The average age at diagnosis is 60, and it isn’t commonly diagnosed before 45.

The experts’ guide to perimenopause and menopause

Symptoms of endometrial cancer and when to see a doctor

Early endometrial cancer might not cause symptoms, but when they start to appear they may include:

• Vaginal bleeding or discharge unrelated to menstruation (periods)
• Difficult or painful urination
• Pain during sex
• Pain in the pelvic area

Having these symptoms doesn’t always mean you have endometrial cancer, but you should tell your doctor about them, especially if they last more than a few weeks. Doctors can more easily treat this disease when it’s found early, increasing your chances for a full recovery.

Who’s at risk for developing endometrial cancer?

Obesity, or being overweight, is the top risk factor. Others include:

• high-fat diet
• diabetes
• high blood pressure
• never giving birth
• starting menstruation (periods) before age 12
• reaching menopause at an older age
• taking tamoxifen for breast cancer treatment or prevention
• taking estrogen without also taking progesterone to control menopause symptoms

Another risk factor could be irregular menstrual cycles caused by polycystic ovary syndrome — a hormonal imbalance that prevents a normal monthly cycle.

In addition, an estimated 3-5% of endometrial cancers may stem from hereditary or genetic factors such as Lynch syndrome, an inherited genetic disorder that raises your risk for developing endometrial and several other types of cancer.

Can endometrial cancer be prevented?

There’s no known way to prevent this or any cancer entirely, but you can reduce their risk for endometrial cancer by:

• Maintaining a healthy weight through diet and exercise
• Getting treatment for precancerous conditions, such as endometrial hyperplasia, which makes the inner uterine lining unusually thick
• Being tested for Lynch syndrome. People with uteruses who test positive for this syndrome and who have finished having children may consider having a hysterectomy to reduce their cancer risk.

Also, people who take hormones such as estrogen to help control menopause symptoms might consider combining it with progestin, since taking estrogen by itself may raise your risk for endometrial cancer.

The racial disparities of endometrial cancer

Even more alarming than the rise in endometrial cancer diagnoses and deaths are the widening health disparities between Black and white women — more Black women are being diagnosed at later stages and are dying of this disease.

According to the American Cancer Society, over the past decade endometrial cancer has increased by 1% per year among white women, but by 2-3% per year among women in all other racial or ethnic groups.

Since the mid-2000s, the endometrial cancer death rate has risen by 1.7% per year, and Black women are more likely to die of it than other groups. It’s a health care crisis that needs to be at the forefront of our efforts to improve patient care.

There are likely many reasons for these disparities. Some involve delays in diagnosis and not receiving proper treatment at the onset of symptoms, especially among women in underserved areas with lower incomes and limited access to health care services such as cancer screenings.

The disparities could also be linked to molecular differences among the subtypes of endometrial cancer that may affect people differently. Every person’s cancer is biologically unique, and, unfortunately, we’ve seen that some of the more aggressive endometrial cancers arise in Black women.

How is the OSUCCC – James helping to diminish these disparities?

At Ohio State, our medical scientists are leading several research studies designed to better understand these health disparities so that we can help provide more effective, individualized treatment for everyone with endometrial cancer, rather than using a one-size-fits-all approach.

Here are examples of our research:

A study we recently published in the journal Cancer found that discrepancies in test results for endometrial cancer come from slight genetic differences in the cells that make up endometrial tumors. It was the first study to report that these differences in cells lead to a higher risk for the cancer to recur and spread to other organs. This information helps oncologists choose more precise genetic testing and the best treatment plan for each person.

An exciting project funded by a National Cancer Institute (NCI) Moonshot Initiative grant is conducting molecular or genomic characterization of tumors from about 700 women with high-risk endometrial cancers. Half of the participants are self-reported Black women and half are self-reported white women. Through our testing, we’re identifying genetic differences in cancer cells so that we can create personalized therapies based on racial or ethnic differences among patients.

The Ohio Prevention and Treatment of Endometrial Cancer (OPTEC) initiative — supported by a grant from the NCI and funds from Pelotonia, the annual cycling event that raises millions of dollars for cancer research at Ohio State — tests endometrial cancer patients for Lynch syndrome and other inherited genetic syndromes that make people more likely to develop cancer. OPTEC has recruited over 1,000 women with endometrial cancer from partner hospitals in Ohio and screened them for Lynch syndrome so that, if they have it, they can take precautions such as increased monitoring from medical care teams.

One of the most incredible breakthroughs of the past decade for endometrial cancer treatment has been the use immunotherapy, which harnesses the body’s immune system to better recognize and attack cancer cells. Certain biomarkers within endometrial tumors can suggest ways that doctors can use immunotherapy to better target cancer cells — a tremendously valuable and emerging tool for treating our patients.

These are just some of the many ways the OSUCCC – James is working to reduce the endometrial cancer disparities among Black and white women in terms of diagnoses and outcomes so we can provide more effective and equitable therapies for all.