Black Women Increasingly Support Biopsy-First Approach for Endometrial Cancer Diagnosis

Key Clinical Summary

• Black women have more than twice the 5-year mortality rate from endometrial cancer compared with White patients.
• A qualitative study found growing acceptability of a biopsy-first diagnostic approach among Black women after targeted education.
• Trust-building, shared decision-making, and cultural competence are key to improving early detection and reducing disparities.

A new community-engaged qualitative study highlights that Black cisgender women in the US may increasingly accept a biopsy-first approach to rule out endometrial cancer when provided with culturally sensitive education and communication. The findings, based on 3 focus groups and guided by the theory of planned behavior, were published by researchers examining barriers and facilitators to diagnostic acceptability among Black women at risk for endometrial cancer.

Study Findings

Researchers conducted 3 focus groups with 25 cisgender Black women recruited through social media and community networks. The sessions explored perceptions of using biopsy as the initial diagnostic step, bypassing transvaginal ultrasound, which has shown lower sensitivity among Black women.

At the outset, participants expressed hesitation and apprehension about a biopsy-first approach, largely due to prior negative experiences with the health care system, pain during procedures, and awareness of medical racism. Many voiced concerns about physical discomfort and mistrust of medical providers.

However, after educational discussions on racial disparities in endometrial cancer, biopsy procedures, and the consequences of delayed diagnosis, participants expressed increasing acceptance of biopsy as the priority diagnostic test. By the end of the focus groups, overall acceptability of the biopsy-first strategy was observed.

Key barriers identified included prior painful or traumatic medical experiences and perceived racial bias in care. Facilitators included transparent communication about medical racism, personalized recommendations, acknowledgment of patient fears, and racial concordance between patients and providers. Education on the benefits and emotional reassurance of timely biopsy also improved comfort with the approach.

Clinical Implications

These findings underscore the critical role of patient-centered communication in addressing diagnostic inequities in endometrial cancer care. Implementing a biopsy-first approach for symptomatic Black patients could mitigate diagnostic delays associated with underperforming ultrasound triage.

For clinicians and pathway developers, incorporating strategies that promote trust, transparency, and culturally responsive education is essential. Clinical pathways that emphasize early biopsy and shared decision-making may reduce advanced-stage presentations and improve survival outcomes. Additionally, training providers to recognize and address historical mistrust can enhance adherence to diagnostic recommendations and strengthen engagement among Black women at risk for endometrial cancer.

“We find that a patient-centered communication approach that incorporates trust-building, shared decision-making, and education may be most successful when recommending biopsy,” said the authors.

Conclusion

This qualitative study demonstrates that culturally informed communication, acknowledgment of systemic bias, and education about diagnostic benefits can foster acceptance of biopsy-first evaluation among Black women. These insights can guide oncology clinicians and health systems in developing equitable diagnostic pathways to reduce mortality disparities in endometrial cancer.

Reference

Alson JG, Orellana M, Robinson WR, et al. Facilitators and barriers to acceptability of a biopsy-first approach in the diagnostic evaluation for endometrial cancer among Black women. Am J Obstet Gynecol. 2025;233(4):294.e1-294.e11. doi:10.1016/j.ajog.2025.03.012.