While incidence rates for some cancers have declined among women, endometrial cancer, the most common type of uterine cancer, has increased substantially over the past two decades, with particularly concerning increases among Native American and Hispanic women. New research from the University of Arizona Cancer Center found that Native American and Hispanic women were diagnosed with endometrial cancer at significantly younger ages than other race and ethnic groups.
The study , published in the journal Cancer Medicine, reviewed records of 261 women who had gynecologic surgery from 2016 to 2021 at Banner – University Medical Center Phoenix. Of the 168 women in that group who had endometrial cancer, Native American patients were diagnosed at an average age of 49.8 years, compared with 62 years for White patients. Hispanic patients were diagnosed at 53.7 years, compared with 61.6 years for non-Hispanic patients.
Endometrial cancer begins in the lining of the uterus, which thickens and sheds under hormonal control during the menstrual cycle. According to the American Cancer Society, endometrial cancer rates rose in the United Sates between 1.8% and 2.6% per year from 2013 to 2022 with recent trends showing some stabilization with current estimates of approximately 68,270 new cases of endometrial cancer per year in the U.S.
Diagnosed early, before the cancer has spread beyond the uterus, the five-year survival rate for endometrial cancer is approximately 95%. However, not all cases are detected early, and cancers of the uterus are expected to claim more than 14,000 lives in the United States in 2026. The high incidence rate and late diagnoses contribute annually to more deaths than ovarian cancer.
"We need to rethink who we consider at risk for endometrial cancer," said Melissa Herbst-Kralovetz, the study's lead author and a professor of basic medical sciences at the U of A College of Medicine – Phoenix and a member of the U of A Cancer Center's Cancer Prevention and Control Program . "Native American and Hispanic women in our study were diagnosed significantly younger than their White and non-Hispanic counterparts. These findings challenge the perception that endometrial cancer is primarily a disease of older, postmenopausal women."
Herbst-Kralovetz, a member of the BIO5 Institute , directs the Translational Women's Health Research Program and Women's Health Microbiome Initiative. She focuses her research on gynecologic cancers, particularly cervical and endometrial cancer, and the role of the microbiome and microenvironment in cancer risk and progression. She said that the retrospective study results need to be confirmed in larger groups.
"This study highlights the need to increase awareness of endometrial cancer risk, particularly among younger women and their providers. Native American and Hispanic women in this study were diagnosed significantly younger than their counterparts. The Society of Gynecologic Oncology's 2026 evidence review identified delayed evaluation of abnormal bleeding in premenopausal women as an important concern, citing research in which 36% experienced delays of more than six months before undergoing endometrial sampling. These findings underscore the importance of recognizing risk factors and symptoms earlier, alongside developing simple, low-cost, point-of-care diagnostic tests that can be made accessible through primary care and rural health settings. Earlier detection offers an important opportunity to reduce deaths from a cancer that is highly treatable when diagnosed at an early stage," said Patricia Thompson, deputy director of the U of A Cancer Center and professor of physiology at the U of A College of Medicine – Tucson .
The study also found that 45% of Native American patients and 21% of Hispanic patients in the study had diabetes. Obesity and diabetes are some of the primary drivers of the disease, and estrogen levels can affect the growth of the uterine lining.
"Adipose or fatty tissue is hormonally active and can produce estrogen, and metabolic conditions like obesity and diabetes can create an environment that promotes abnormal growth in the uterine lining," said Herbst-Kralovetz. "Over time, this can drive cancer development. But we need to look beyond metabolic health alone and understand how environmental, biological and social factors intersect to drive these disparities."
The research team used the Arizona Social Vulnerability Index, which draws upon census data to measure the challenges faced by people in underserved areas. The study found that patients with cancer were more likely to live in areas with housing and transportation difficulties, and more likely to lack access to a vehicle and live in crowded housing.
Herbst-Kralovetz's lab is working to develop a simple, less invasive test that could detect endometrial cancer without the need for a tissue biopsy. Her goal is to make testing more accessible through primary care offices, particularly for women in rural and underserved communities. She hopes to see greater investment in validating these tests and in building partnerships with rural health care providers to improve access to early detection when treatment leads to cure.
To reduce endometrial cancer deaths in the coming years, Herbst-Kralovetz points to bringing earlier diagnosis closer to patients, "moving diagnostic innovation closer to primary care and underserved communities could help change the trajectory of endometrial cancer diagnoses."
This study was supported in part by the University Cancer Center Support Grant, P30 CA023074 and the Partnership for Native American Cancer Prevention, U54CA143924, both funded by the National Cancer Institute.
