Barriers to Timely Endometrial Cancer Care Persist for Underserved Women

Endometrial cancer (EC), the most common gynecologic malignancy in the US, continues to exhibit widening disparities in incidence, mortality, and care quality, particularly among minority and rural populations. Black women face the highest mortality rates and the most aggressive histologic subtypes yet remain less likely to receive timely or guideline-concordant care.

Delays in diagnosis stem from low awareness of symptoms such as abnormal bleeding, limited trust in health care systems, and inadequate access to gynecologic oncology. “Women who are unaware of abnormal bleeding as a sign of EC may inadvertently delay initiation of care,” the authors noted. Even when symptoms are recognized, barriers including lack of insurance, absence of gynecologic oncologists in local networks, and long distances to care facilities can compound delays.

A study published in the American Surgeon highlights the importance of the “Three Delays” framework: delays in deciding to seek care, accessing care, and receiving appropriate care. Women reliant on Medicaid or those in states without Medicaid expansion are at greater risk, with many experiencing delayed surgeries due to prior authorization requirements or a lack of in-network specialists. Additionally, rural hospital closures and limited surgical services further restrict care for these patients.

Treatment advances, such as minimally invasive surgery and sentinel lymph node biopsies, have not been equitably distributed. Minority women are less likely to receive these procedures, which contributes to higher complication rates and worse outcomes. The authors emphasized, “Minority women are persistently less likely to undergo hysterectomy at all and are less likely to have minimally invasive surgery or lymph node evaluation.”

The authors call for broader policy reform, increased Medicaid expansion, and inclusion of gynecologic oncologists in all insurance networks. It also identifies key roles for nongynecologic surgical specialists in recognizing risk factors and referring patients promptly. Genetic counseling, multidisciplinary coordination, and structured risk assessment tools are proposed as ways to close gaps.

The authors highlighted that efforts to improve EC outcomes must address structural inequities through education, policy, and collaborative clinical strategies.

Reference
Leonis R, Chavez T, Caldwell A, Del Priore G, Matthews R, Franklin C. Inequities in surgical access for women with endometrial cancer in the United States: opportunities for surgical justice. The American Surgeon. 2025;91(5). doi:10.1177/00031348251318376.