Gross Maya E, Pike Mindy, Alson Julianna, Williams Patrice, Wood Mollie E, Marsh Erica, Carey Erin, Stürmer Til, Katz Ronit, Robinson Whitney R, Doll Kemi M
Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
Health Equity. 2025 Aug 14;9(1):375-385. doi: 10.1177/24731242251365480. eCollection 2025.
Black patients have the highest mortality rate from endometrial cancer (EC), and yet remain underrepresented in EC research. Thus, currently published symptom patterns may not be comprehensive for this population. The purpose of this study is to analyze symptomatology among Black patients with EC in the Guidelines for Ultrasound in the Detection of Early Endometrial Cancer study and to compare with those undergoing benign hysterectomy.
This is a retrospective consecutive patient sample of Black individuals undergoing hysterectomy in an academic-affiliated 10-hospital health care system from 2014 to 2020. We collected clinical, sociodemographic, and diagnostic information for 24 months before hysterectomy, using merged structured and abstracted data from electronic health records. We used descriptive statistics to describe the sample and pertinent subgroups-patients with fibroids/enlarged uteri, without postmenopausal bleeding (PMB), and patients <50 years old. Symptom distribution between subgroups was analyzed using chi-square tests and Fisher exact tests.
The sample included 3,455 hysterectomy patients, 12% with EC ( = 404). Among EC patients, 77% had PMB and 7% had no bleeding history. EC patients were symptomatic beyond bleeding, with fibroids/enlarged uteri (70%), pelvic/abdominal pain (38%), anemia (30%), and more. Young patients (8% of all EC cases) had more pelvic/abdominal pain (61% vs. 36%, = 0.017) and anemia requiring transfusion (33% vs. 6%, < 0.001) compared with older patients. Subgroup symptom presentations overlapped between those with and without cancer, with few symptoms differing by >20%.
PMB alone is rarely the only presenting symptom among Black patients with EC; symptoms overlap heavily with patients presenting with benign disease. Young patients, those with fibroids/enlarged uteri, and those without PMB represent subgroups with nuanced presentations, for whom EC should be considered.
黑人患者子宫内膜癌（EC）的死亡率最高，但在EC研究中的代表性仍然不足。因此，目前已发表的症状模式可能并不适用于该人群。本研究的目的是分析《早期子宫内膜癌检测中的超声指南》研究中黑人EC患者的症状学，并与接受良性子宫切除术的患者进行比较。
这是一项回顾性连续患者样本研究，研究对象为2014年至2020年在一个学术附属的10家医院医疗系统中接受子宫切除术的黑人个体。我们使用电子健康记录中的合并结构化和摘要数据，收集了子宫切除术前24个月的临床、社会人口统计学和诊断信息。我们使用描述性统计来描述样本和相关亚组——患有子宫肌瘤/子宫增大、无绝经后出血（PMB）的患者，以及年龄<50岁的患者。使用卡方检验和Fisher精确检验分析亚组之间的症状分布。
样本包括3455例子宫切除术患者，其中12%患有EC（n = 404）。在EC患者中，77%有PMB，7%无出血史。EC患者除出血外还有其他症状，包括子宫肌瘤/子宫增大（70%）、盆腔/腹部疼痛（38%）、贫血（30%）等。与老年患者相比，年轻患者（占所有EC病例的8%）有更多的盆腔/腹部疼痛（61%对36%，P = 0.017）和需要输血的贫血（33%对6%，P < 0.001）。有癌和无癌患者的亚组症状表现有重叠，很少有症状差异超过20%。
单独的PMB很少是黑人EC患者唯一的症状表现；症状与患有良性疾病的患者有很大重叠。年轻患者、患有子宫肌瘤/子宫增大的患者以及无PMB的患者代表了表现细微的亚组，应考虑这些患者患有EC的可能性。
