When Linda Collins was diagnosed with endometrial cancer in her early 60s, she wanted to find the best treatment possible.
After doing her research, she felt confident she would receive the care she needed at Memorial Sloan Kettering Cancer Center.
She also knew what she needed to give her peace of mind. “When I called the MSK Patient Access Service to ask about an appointment, I told them that as a Black woman, I would feel more comfortable with a female doctor who is a person of color.”
She explains that “years before, I had a white, male gynecologist who dismissed concerns that I had. Respectfully, it seemed like he couldn’t be bothered. And I have great insurance!”
Paging Dr. Brown
Linda searched the MSK website and knew she had found the doctor she hoped for in Carol Brown, a gynecologic oncology surgeon and MSK’s Chief Health Equity Officer.
Dr. Brown has devoted her career to improving cancer disparities that mean some groups of people suffer far worse outcomes, particularly Black people.
In May 2021, she launched an important new initiative as the leader of the Endometrial Cancer Equity Program (ECEP). Endometrial cancer develops in the lining of the uterus (womb) and is also sometimes referred to as uterine cancer.
The program’s goals are to educate Black women about endometrial cancer, help those diagnosed find appropriate care, and ultimately find treatments to improve outcomes for all women facing the disease, like Linda.
A Deadly Disparity
The numbers are truly shocking.
Black women are nearly twice as likely to die of endometrial cancer as white women, even though the disease is actually slightly more common in white women than in Black women.
The number of cases of endometrial cancer is also on the rise, with the greatest increase among Black women.
Why Is Endometrial Cancer Worse for Black Women?
Dr. Brown stresses that many factors play a role in the troubling disparity in endometrial cancer, including poorer access to health care in some communities, a lack of awareness among some providers, and research efforts that often have not included enough people who are Black, Hispanic, and Asian.
Dr. Brown says research also suggests another important factor may be a cruel twist of biology.
Dr. Brown points out that “the disparity in survival between Black and white women diagnosed with endometrial cancer hasn’t changed in four decades. There’s no question that if the difference was only about access to health care, the disparity would have at least narrowed. That’s what we’ve seen happen in cervical cancer and most forms of breast cancer, when you compare Black and white women. But not endometrial cancer.”
A More Aggressive Form of Cancer
One distinction coming into clearer focus is that Black women are more often diagnosed with rare but aggressive forms of endometrial cancer.
“Black women are more likely to have papillary serous carcinoma of the endometrium as well as carcinoma sarcoma,” Dr. Brown says. “Cancers caused by these two types of cancer cells definitely lead to worse outcomes and that in itself is a biologic difference.”
Ying Liu is a medical oncologist whose specialty is the genetic component of gynecological cancers. She works alongside Dr. Brown investigating cancer disparities.
Dr. Liu explains that “one aspect we are looking at is whether these biological differences in the kinds of cancer more commonly found in Black women are not as well targeted by current treatments. That may explain some of the disparity in survival rates between Black and white patients.”
Finding a Target
The ultimate goal of research at MSK is to better understand these biological differences in endometrial tumors, down to the molecular level, and then use this knowledge to identify weaknesses in the tumors that are more common in Black women. Then, it’s about finding therapies to treat them.
Dr. Brown explains “at MSK we probably have one of the largest groups of Black female patients in the country where we can analyze the genetics of their endometrial cancer tumors as well as their personal genetics.”
Linda’s diagnosis was an aggressive papillary serous carcinoma, the type that more commonly affects Black women. Fortunately, the cancer was caught at an early stage.
Linda recalls that “within days of our first appointment, Dr. Brown performed a laparoscopic hysterectomy, which involves a much smaller incision, and also removed my fallopian tubes, ovaries, and nearby sentinel lymph nodes.” To reduce the chance the cancer could come back, Linda underwent a short course of radiation.
Linda says of her treatment, “the staff was just fantastic. And I love Dr. Brown. She was so proactive and always took the time to answer all my questions.”
Pillar of the Community
Today, Linda is doing the things she loves. She is a pillar of her community in the Bronx, serving as president of her building association, leading clothing drives for homeless shelters, and serving as a liaison with police associations, among other efforts.
After a 32-year career, most of it in government, she says “I just love to serve people.”
She also wanted to be sure she was around for her family, retiring from the working world in her mid-50s. She explains “as a Black woman, you have the sense that your life expectancy might not be as long as the next person.”
The Endometrial Cancer Equity Program
Dr. Brown and her colleagues hope their new initiative can help.
Since May 2021, the ECEP has participated in community events that have reached more than 500 women in predominately Black neighborhoods that stretch across Long Island, Brooklyn, and Queens.
In addition, Dr. Brown and colleagues including MSK nurse practitioner Latasha Anderson-Dunkley have screened over 20 women at high risk who have been identified through the ECEP. The goal is to assess whether the women have cancer or precancerous conditions and get them appropriate care.
Dr. Brown says it’s particularly important that women and their providers are aware of endometrial cancer because as cases rise, the symptoms of the disease are not always clear cut.
“Traditionally, providers have focused on symptoms that include bleeding in post-menopausal women, who often have other symptoms such as obesity and diabetes,” she explains. “But this cancer can present as just a heavier-than-usual period bleeding in your 40s. That’s true of all women and particularly Black women.”
For Linda, making women aware of how they can protect their health is just what the doctor ordered. “To me, outreach and education is so important, because you don’t know what you don’t know. Too often, this kind of outreach doesn’t happen in communities of color. But if it does, it can save lives.”
- Black women are nearly twice as likely to die from endometrial cancer as white women, even though the disease is slightly more common among white women.
- Research shows that aggressive forms of endometrial cancer appear to be more common in Black women.
- Cases of endometrial cancer are rising in all women, particularly Black women.
- Memorial Sloan Kettering launched the Endometrial Cancer Equity Program in May 2021 to reduce the disparity in endometrial cancer faced by Black women.