Adherence to current clinical guidelines for the evaluation of postmenopausal bleeding may result in systematic underdiagnosis of endometrial can- cer (EC) in Black women, according to a recent study published in JAMA Oncology. Investigators compared the performance of recommended transvaginal ultrasonography (TVUS) endometri- al thickness (ET) thresholds as a screening meth- od to prompt endometrial biopsy according to race. The analysis included a simulated retrospec- tive cohort (367,073 Black and White women with postmenopausal bleeding) based on data from the Surveillance, Epidemiology, and End Results (SEER) national cancer registry (2012 to 2016), the US Census, and published estimates of ET distribution and fibroid prevalence. Among Black women, the current recommendation of greater than or equal to 4-mm ET threshold prompted biopsy for fewer than half of EC cases (sensitivity, 47.5%), with 13.1% of women referred for biopsy diagnosed with EC (positive predictive value [PPV], 13.1%). For the greater than or equal to 4-mm threshold, the area un- der the curve was 0.57 in Black women versus 0.73 in White women. Among White women, the greater than or equal to 4-mm threshold had a sensitivity of 87.9%, with 14.6% of those referred for biopsy diagnosed with EC (PPV, 14.6%). “These findings suggest that use of ET as measured by TVUS to determine the need for EC diagnostic testing in symptomatic women may exacerbate racial disparities in EC stage at diagnosis,” the study authors wrote.
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