February 9, 2023

Filipino Guardian

Sentinels of Filipino Free Press

Black women are more likely to die from endometrial cancer

In 2012, Adrienne Moore noticed that her menstrual cycles were changing. Her periods became irregular and she came with heavy bleeding and significant cramping when it came. Healthcare providers diagnosed cysts, fibroids, and even early menopause, but Moore said no one came up with a treatment plan that worked.

For the next four years, Moore searched for answers. She wondered if her condition was related to the ovarian cancer she survived in 2003, but the providers she saw didn’t investigate her further. Moore was also uninsured for a year, despite working as a respiratory therapist, because one employer offered a plan she couldn’t afford, while another didn’t take out insurance until she completed a trial. She remained uninsured when she lost her job after her illness prevented her from working, and her family helped her pay for the tests directly to find out what was going on.

In March 2016, after securing a job that offered insurance from the start, Moore saw a new provider ordering a biopsy. The results finally gave her an answer: Moore had endometrial cancer, and in stage 3B it had spread to the middle layer of her uterine wall.

“I was stunned at first, then just angry,” she said. “I could have gotten a completely different result if this had been recognized earlier. Why didn’t anyone listen to me when I told them what was going on? They gave me every explanation in the world except [that] I could be at risk for another cancer.”

Endometrial cancer, or cancer of the lining of the uterus, is the most common cancer of the reproductive system in women in the United States. The American Cancer Society estimates that 65,950 new cases of cervical cancer will be diagnosed in 2022 and 12,550 women will die from the disease. Endometrial cancer, a form of uterine cancer, is most common in postmenopausal women, with the median age of diagnosis being 60 years.

While endometrial cancer is uncommon in younger women, Moore was 40 when she began experiencing the symptoms that were likely a sign her cancer was developing. As she later learned, she had several factors that put her at higher risk for endometrial cancer, including her previous ovarian cancer diagnosis and a family history of colon cancer (cancer that starts in the colon or rectum), a disease from which her father died.

As a black woman, Moore was also at a higher risk of dying from endometrial cancer. As with many other diseases, women of color are more likely to die from endometrial cancer despite having fewer diagnoses compared to white women.

“The injustices of endometrial cancer [have many different causes], including delayed diagnosis, sometimes due to inequalities or inconsistencies in treatment by the provider, and sometimes underreporting of symptoms by the patient,” said Daihnia Dunkley, Ph.D., RN, an academic associate professor in the Graduate Entry Prespeciality in Nursing and Master of Science in Nursing Program at the Yale School of Nursing and a member of the HealthyWomen Women’s Health Advisory Council. “Black women may endure symptoms due to medical suspicion or normalize symptoms due to a lack of knowledge.”

There are many reasons for this distrust. From the Tuskegee Syphilis Study to surveys suggesting that healthcare providers believe black patients have a higher pain threshold than white patients, black patients in the United States have historically received substandard medical care . Higher maternal mortality rates, premature births, and hysterectomies as the first option for treating fibroids are examples of the inequalities Black women face when seeking reproductive health care.

A study published in the Journal of the American Medical Association that surveyed 15 black women with endometrial cancer suggested that several factors may contribute to a delay in diagnosis in the black community. Participants described gaps in knowledge about menopause, silence about vaginal bleeding from family and friends, misinterpretation of vaginal bleeding symptoms, and lack of dialogue with healthcare professionals. Black women can also have other conditions at the same time, such as B. Type 2 diabetes, which puts them at higher risk for poor outcomes, Dunkley said. Biological and genetic differences could also be a factor, she said, as black women with endometrial cancer are more likely to be diagnosed with rare and more aggressive forms of the disease.

Moore’s experience prompted her to become an ambassador for the Endometrial Cancer Action Network for African-Americans (ECANA) to reach out to other Black women battling endometrial cancer. She believes her story, and that of other black women survivors she meets, highlights the differences black women can face when receiving appropriate treatment from being able to afford health insurance and specialist treatment , to how to deal with potential biases from healthcare providers who don’t deal with them.

“That’s why we need advocacy groups — so we’re not just being thrown off a cliff and told to just get back to business,” Moore said. “As black women, we need a community of ambassadors to speak out about what prejudice can do in the field of reproductive health. We have to have tough discussions in our community because so many black women fall through the cracks and get late-stage diagnoses. We need to know that menstrual cycles shouldn’t look like we’re soaking through three pads in an hour or writhing in pain and unable to walk.”

It wasn’t until Moore learned about the signs that should have alerted her healthcare providers to cancer, such as the thickening of her uterine lining, that she began working with ECANA. “No vendor has ever told me that,” she said.

Her previous cancer diagnosis should have been an immediate red flag, too, but the only connection anyone made to cancer was a suggestion that Moore’s abnormal cycles were a sign of an early menopause caused by her previous chemotherapy treatments.

Moore, 50, has been cancer-free for more than five years after undergoing a hysterectomy, pelvic radiation and chemotherapy. As an ECANA Ambassador, Moore connects with Black women in her home state of Georgia, takes time to engage in conversations, shares educational materials, and participates in a “Survivors’ Sanctuary,” a twice-monthly gathering for yoga and conversation.

“We’re all at different stages in our journey,” Moore said. “But most of us have the same histories of heavy periods lasting months or years and being misdiagnosed. The most important thing is that we have a community that encourages us to keep surviving and thriving.”

references

https://batten.virginia.edu/about/news/black-americans-are-systematically-under-treatment-pain-why

https://www.cancer.org/cancer/colon-rectal-cancer/about/what-is-colorectal-cancer.html

https://www.cancer.org/cancer/endometrial-cancer/causes-risks-prevention/risk-factors.html

https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5829000/

https://pubmed.ncbi.nlm.nih.gov/32109459/

This resource was created with funding and support from Eisai Inc.

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