The timely diagnosis of endometrial cancer is critical to increase the likelihood that treatment is successful and survival is improved. Unfortunately, not all women receive timely or appropriate care. Researchers at the Society of Gynecologic Oncology (SGO) 2025 Annual Meeting on Women’s Cancer presented data from a study evaluating disparities in chemotherapy recommendations for patients with newly diagnosed, advanced endometrial cancer.

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Following this presentation, featured expert Alexander B. Olawaiye, MD, FRCOG, FACOG, FACS, was interviewed by Conference Reporter Medical Director Lauren Weinand, MD. Dr Olawaiye’s clinical perspectives on these findings are presented here.

The most common stage of endometrial cancer at diagnosis is stage I. However, this may vary across regions, and, unfortunately it also varies between ethnic groups, as non-White patients tend to suffer delays in diagnosis and to be diagnosed with more advanced stages of endometrial cancer. This is very critical because the stage at which almost any solid cancer is diagnosed is impactful. For example, with serous endometrial cancer, one of the most aggressive types of endometrial cancers, being diagnosed at stage I vs stage III/IV is prognostically like the differences between sky and sea levels when it comes to patient outcomes.

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It is important to emphasize how unfortunate it is when there is a delay in diagnosis. In most cases of endometrial cancer, its onset is typically associated with abnormal vaginal bleeding, whether it is occurring in premenopausal or postmenopausal women. If disorganized, abnormal bleeding is properly investigated close to when it starts, it may be possible to diagnose almost all cases of endometrial cancer when they are at stage I. We do not know the full story of why early diagnosis does not always happen after the onset of abnormal bleeding, but we do know that there are some problems on the sides of both patients and health care providers.

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For example, I have had patients who went into menopause, began to bleed again several years later, and eventually were diagnosed with endometrial cancer 2 to 4 years after the bleeding restarted. When I would ask them why they did not go to their physician about their abnormal bleeding, they would simply tell me that they did not think it was abnormal and that they thought their period had returned. If a patient minimizes symptoms or has medically irrational reasons to explain symptoms, a delay in diagnosis can easily occur. So, education for women is a major component of addressing these delays in diagnosis. The educational thrust should be simple: let every patient know that bleeding is abnormal after menopause and should be checked out in case it is an indication of endometrial cancer. However, it is important to emphasize to patients that postmenopausal bleeding does not always mean cancer; in fact, only 9% of women with postmenopausal bleeding have endometrial cancer.

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Further, some patients who present with abnormal vaginal bleeding are given medically unjustifiable reassurance and are not appropriately evaluated. There are a number of reasons why this might happen, but one of them is inequity, as delays in endometrial cancer diagnosis are disproportionately more common in Black and Hispanic women than in White women.

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If the diagnosis is delayed, it gives the cancer the opportunity to spread. Most patients with stage I endometrial cancer only need surgery and do not need any adjuvant therapy. A simple hysterectomy can be curative in the majority of these patients. However, with time, low-grade tumors can spread and may travel to distant places, making it incurable and, eventually, possibly taking the life of the patient. You can go from having a patient who could potentially be cured with a simple surgery to having a patient who may now die of cancer.

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At the SGO 2025 Annual Meeting on Women’s Cancer, Xuan Li, MD, and colleagues presented a retrospective cohort study of characteristics associated with not receiving a chemotherapy recommendation for patients with stage III/IV endometrial cancer from the National Cancer Database between 2004 and 2021 (poster 223). Dr Li et al reported that 2828 patients (2.4%) were not recommended for chemotherapy. Using a regression model, researchers found that older age, Black race, a lower educational status, having no insurance or no government insurance, and treatment at a nonacademic or non–National Cancer Institute–designated cancer center were independent factors associated with not being recommended for chemotherapy treatment. There may be additional factors affecting the recommendation for chemotherapy that were not obvious from the National Cancer Database data, but I still think that this is a very important study. All patients should be getting a standard-of-care–compliant therapy, regardless of who they are.