Meeting the Moment in Endometrial Cancer Care

ith rates of endometrial cancer rising at an unprecedented speed across the United States, troubling disparities are also being revealed. Recent data highlights both stark racial disparities in endometrial cancer incidence and mortality and an uptick in incident cases among young women. In response to these developments, the Division of Gynecologic Oncology in the Department of Obstetrics and Gynecology at Columbia University Irving Medical Center has increased its commitment to offering a comprehensive approach to endometrial cancer care and, hopefully, prevention, especially for women of color and young women.

Estimates from the American Cancer Society suggest that there will be over 67,000 new cases of endometrial cancer diagnosed in 2024, as compared to 42,000 cases in 2010. Approximately 12% of incident cases are expected to occur in premenopausal patients. Endometrial cancer is also one of the few cancers with increasing mortality rates, which have risen by nearly 1.7% each year for the past decade.

There are stark racial disparities within these troubling trends; Black women are experiencing the fastest increase in endometrial cancer incidence rates and are nearly 2 times as likely to die of endometrial cancer as compared to white women.

Given these trends, there is an evident and pressing need for high-quality, comprehensive endometrial cancer care and prevention efforts. To best meet this need, the Division of Gynecologic Oncology provides a multi-disciplinary approach to prevention, diagnosis, and treatment with a focus on three key areas: social determinants of health, fertility preservation in young endometrial cancer patients, and genetic diagnostic testing.

Extensive research indicates that addressing the social determinants of health is critical for advancing equity and tackling disparities in health outcomes. Accordingly, the Division of Gynecologic Oncology is focused on identifying and addressing social determinants of health that impact the prevention, diagnosis, and treatment of endometrial cancer, and can contribute to harmful racial disparities in outcomes.

Gynecologic Oncologist Dr. Alexandre Buckley de Meritens identifies access to care and health literacy as two important social determinants of health that the Division seeks to address through their care model.

Accessibility of care has a direct impact on the timeliness of endometrial cancer diagnosis and treatment, with downstream effects on health outcomes. In efforts to improve the accessibility of endometrial cancer care services, the Division of Gynecologic Oncology partners with community-based clinics and care providers, such as midwives and primary care physicians, to develop a robust referral network. Per Dr. Buckley de Meritens, “we have created a network with external providers that allows direct communication between providers and clinic support staff. This network streamlines and hastens diagnosis, referral, and treatment for our community.”

Health literacy is another social determinant of health with impacts on cancer care outcomes and health disparities. Accordingly, health education is a focus of the Division of Gynecologic Oncology’s care model, which aims to increase health literacy among patients. All patients receive education regarding endometrial cancer risk factors, in particular, obesity. Due to the relationship between obesity and hormonal changes, obesity is a strong risk factor for endometrial cancer-women with a BMI>30 have more than double the risk for the disease. Integrating initiatives designed to address the social determinants of health into endometrial cancer care stands to transform the standard of care, improve health outcomes, and reduce disparities.

In response to the rising incidence of endometrial cancer among young people, the Division of Gynecologic Oncology is committed to advancing research and care to best meet the unique needs of this population. For patients with early-stage endometrial cancer, the standard of care for treatment is hysterectomy. Yet the permanent loss of fertility associated with a hysterectomy can pose a significant concern among younger women who may have not completed childbearing therapy. Accordingly, there has been a recent increase in patients utilizing fertility-preserving hormonal therapy.

Leveraging cutting-edge research, the Division of Gynecologic Oncology provides younger endometrial cancer patients with comprehensive care reflecting the latest advances in the field. Dr. Jason Wright, Chief of the Division of Gynecologic Oncology, served as Senior Author on a 2024 study examining the long-term outcomes of hormonal therapy for early-stage endometrial cancer treatment in premenopausal women. Results from the study suggest that overall survival rates for patients under 40 years of age are similar for hormonal therapy and hysterectomy, making fertility preservation a viable option for younger women with endometrial cancer.

The Division of Gynecologic Oncology is also at the forefront of diagnostic advances in the field, as the team uses molecular and genetic testing to offer more personalized care. The molecular and genetic testing of endometrial tumors offers gynecologic oncologists a better understanding of optimal treatment and therapy plans for patients. Reflecting on this approach, Dr. Buckley de Meritens shared, “we are excited for the incorporation of molecular testing which allows us to tailor treatments to each patient. Molecular testing enables us to decrease the aggressiveness of the treatment when appropriate and can also confirm the need for chemotherapy.”

By offering comprehensive, patient-centered care, which touches on social determinants of health, fertility preservation, and advanced diagnostic testing, the Division of Gynecologic Oncology seeks to improve endometrial cancer health outcomes.