HJAR Jan/Feb 2024

42 JAN / FEB 2024 I  HEALTHCARE JOURNAL OF ARKANSAS DIALOGUE COLUMN ONCOLOGY IN TODAY’S WORLD of breakthroughs in cancer prevention, detection, treatments, and outcomes, uterine cancer remains an out- lier. It is the fourth most common cancer for women and the most commonly diagnosed gynecologic cancer in the U.S. While the more benign, slow-growing types have historically had positive outcomes, we are seeing a sig- nificant rise in difficult-to-treat endometrial cancers, particularly among Black women. The much-needed good news?After more than a decade of very little change in how these cancers are treated, new approaches and advancements are expected to pay off in saved lives. Obstacles to early detection First, a quick look at why patient aware- ness is especially important to successfully detecting and treating uterine cancers. The average age of detection is 60 years old. Many women, particularly in the most affected age groups, are uncomfortable with — or, at least, unfamiliar with — openly discussing issues involving female reproductive health. They might not initiate conversation with their provider, and the subject could even be ta- boo among close friends and familymembers. Couple that hesitation with the fact that many patients do not realize the importance of annual pelvic exams beyond childbearing years or after menopause, thus missing op- portunities for early detection. I’ve had pa- tients who have not had a pelvic exam since the birth of their last child thirty years earlier, which, unfortunately, is not an uncommon scenario. Once symptoms are present, such as un- explained bleeding not associated with men- struation or pain during urination or inter- course, those symptoms can be mistakenly — and, perhaps, wishfully — attributed tomore benign causes such as a UTI, further delay- ing detection. To make it all more challenging, women’s health issues historically have been mis- understood and minimized. Even everyday language reveals the outdated thinking that connected the female body with chaos and mental illness. “Hysteria”and “hysterectomy” both come from the Greek word “hystera,” meaning womb or uterus. Thank you, Hip- pocrates. Today, we are still trying to shake harmful ideas about women’s health that were centuries in the making. Rising rates & racial disparity Okay, let’s look at what’s happening with uterine cancer now. The vast majority of uter- ine cancers, more than 90%, begin in the en- dometrium, and the two main subtypes of endometrial cancer are showing different trends. In a recent study led by the National Understanding—andAddressing— the Rise in Uterine Cancers