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False Negatives More Prevalent in Endometrial Cancer Screening for Black Women
A study published in JAMA Oncology revealed that Black women are more likely to receive false negative results for endometrial cancer (EC) from transvaginal ultrasounds compared to their White counterparts. This discrepancy raises concerns about the effectiveness of current screening methods and the potential for delayed or missed diagnoses.
This study aimed to evaluate the false-negative probability of using ultrasonography-measured endometrial thickness (ET) thresholds as a triage tool for diagnosing EC among Black individuals. It analyzed data from over 1500 women who underwent hysterectomy between January 2014 and December 2020 in a network of hospitals. The study focused on those who had pelvic ultrasonography within 24 months prior to surgery.
Key findings revealed that 1494 participants were included, with 210 diagnosed with EC. Common symptoms prior to ultrasonography included fibroids, vaginal bleeding, and pelvic pain. The analysis showed that the false-negative probability for diagnosing EC was 11.4% at an ET threshold of less than 5 mm, decreasing to 9.5% at 4 mm, and 3.8% at 3 mm. Notably, this probability remained consistent across various EC risk factors but was higher when there was partial visibility of the endometrium and in cases of pelvic pain.
The study concluded that transvaginal ultrasonography is not a reliable triage method for Black adults at risk for EC, particularly when postmenopausal bleeding is present, indicating the need for tissue sampling in such cases. While the overall detection rates for endometrial cancer were similar across racial groups, the false negative rate was significantly higher in Black women. This leads to unnecessary procedures, anxiety, and additional medical costs.
The researchers advocate for the development of more accurate diagnostic tools and better training for health care providers to ensure all women receive appropriate care, with special attention to the nuances of screening practices in order to improve health outcomes for Black women and reduce the risk of misdiagnosis. The findings highlight the importance of addressing health care inequalities and ensuring that diagnostic methods are equitable and effective for all demographics.
Reference
- Doll KM, Pike M, Alson J. Endometrial thickness as diagnostic triage for endometrial cancer among black individuals. JAMA Oncol. 2024;10(8):1068-1076. doi:10.1001/jamaoncol.2024.1891
- Higgins L. Common endometrial cancer screening test may miss cases in black women, research shows. health. Published October 11, 2024. Accessed October 17, 2024. https://www.health.com/endometrial-cancer-ultrasound-false-positives-black-women-8674915
