Endometrial cancer continues to expose one of the most persistent racial survival gaps in women’s health, with African American women facing far higher risks of aggressive disease and death than European American women. New research in npj Precision Oncology shows that these disparities are driven not only by access to care, but also by fundamental differences in tumor biology and immune response that shape outcomes long after diagnosis.
Five-year mortality for African American women with endometrial cancer stands at 39%, compared with 20% for European American women. The study found African American women are more likely to develop high-grade, non-endometrioid tumors such as serous carcinoma, which carry a poorer prognosis even when treatment access is equal. Investigators noted that survival remains lower “even after stratifying by age, stage, and grade,” underscoring that social factors alone cannot explain the disparity.
Using artificial intelligence to analyze tumor images and molecular data, researchers uncovered striking population-specific immune patterns. In African American women, survival was more strongly linked to immune cells in the tumor’s surrounding stroma, while in European American women, immune activity within tumor epithelium carried greater prognostic weight. The most aggressive molecular subtype, characterized by high copy-number alterations, was more common in African American women and showed sparse immune infiltration, a feature associated with worse outcomes.
The study also identified distinct gene signatures tied to survival in each group. Several genes predicted outcomes only in African American women, while others were prognostic solely in European American patients, highlighting how one-size-fits-all risk models can miss vulnerable populations.
Researchers concluded that population-specific prediction tools are essential. Without them, advances in precision oncology risk reinforcing, rather than reducing, racial health disparities in endometrial cancer care.
See: “Computational image and molecular analysis reveal unique prognostic features of immune architecture in African versus European American women with endometrial cancer” (May 27, 2025)
