Black and Hispanic women with postmenopausal bleeding may face serious delays in diagnosis when they develop endometrial cancer, according to a multi-institutional study led by gynecologic oncology fellow Angela Nolin, MD, at Duke University Health System. The research examined whether a widely used diagnostic strategy—transvaginal ultrasound followed by biopsy only when the uterine lining appears thick or cannot be seen clearly—works equally well across racial and ethnic groups.
Investigators reviewed the records of 6,466 patients treated between 2013 and 2022 at Duke, Mount Sinai, and Columbia, all of whom underwent transvaginal ultrasound for postmenopausal bleeding. Patients were racially diverse: 40.7% were non-Hispanic White, 25.7% non-Hispanic Black, 15.4% Hispanic, 3% non-Hispanic Asian, and 16% other or unknown. Nearly one in four non-Hispanic Black patients in the study did not receive a timely biopsy, risking a delayed or missed diagnosis of endometrial cancer, a disparity Nolin described as a “likely contributor” to worse outcomes compared with non-Hispanic White patients.
Overall, two-thirds of patients with abnormal or inadequate ultrasound findings received timely endometrial sampling, but that proportion dropped to about one-half when the ultrasound was inadequate. Guideline-nonconcordant care—failing to perform biopsy when indicated—was significantly more common in non-Hispanic Black patients than in non-Hispanic White patients, 23.1% vs 14.7%. Nolin concluded that a universal biopsy-based approach for all patients with postmenopausal bleeding could reduce the risk of missed endometrial cancer and “eliminate a source of disparity in care” between non-Hispanic Black and non-Hispanic White patients.
See: “Study Shows Disparities in Diagnosing Endometrial Cancer in Women With Postmenopausal Bleeding” (May 10, 2025)
