Are Black Women More at Risk for Endometrial Cancer?

When Matthew Schlumbrecht, M.D., started his career as a gynecologic oncologist, he never imagined that his work would lead him to research public health, housing policy, anthropology, and America’s history of systemic racism tracing back to the TransAtlantic slave trade.

But after spending years treating women from different racial and ethnic backgrounds throughout Sylvester Comprehensive Cancer Center’s health care network in South Florida, he started seeing glaring differences in the frequency and severity of endometrial cancer, which arises from the lining of a woman’s uterus. 

Black women, including those born in the Caribbean, developed tumors more often than their white counterparts, but they survived at variable rates.

That anecdotal observation has now turned into a series of research papers – the latest of which was published in the American Journal of Obstetrics & Gynecology and reports the associations between African ancestry and the risk of aggressive endometrial cancer. And while he’s elevating the scientific community’s understanding of the root causes of endometrial cancer, Dr. Schlumbrecht says it will take experts from all fields to find the solutions to that deadly disease collectively.

“One thing that’s important for me to recognize is I can’t find the answer to every single problem that may be contributing to this by myself. This really requires a group of experts from many different backgrounds,” says Dr. Schlumbrecht, a gynecologic oncologist at Sylvester and Vice Chair of Global and Community Health at the University of Miami Miller School of Medicine.

The first paper Dr. Schlumbrecht published on endometrial cancer came to some startling conclusions. Black women born in Caribbean nations were more likely to have the most severe cases of the cancer and they were less likely to have medical insurance, but their survival rates were higher than U.S.-born black women.

Those findings spawned a wide range of questions for Dr. Schlumbrecht.

Did the movement of Black women across the Atlantic and into the Caribbean islands create pockets where geographic isolation allowed specific genes that cause endometrial cancer to increase in the community?

He was equally curious as to why Caribbean-born Black women were able to survive at higher rates than their U.S.-born counterparts. He wondered whether stress played a factor and if the “Healthy Immigrant Effect,” which suggests that the healthiest people are the ones who decide to emigrate to a new country, was contributing to the findings. 

“Is it something in the food? Is it something in the water? Is it something that’s affiliated with just being an immigrant?” Dr. Schlumbrecht says.

And he questioned why U.S.-born Black women fare so poorly. Black women in the U.S. face multiple socio-cultural challenges throughout their lives. Relative to White women, they tend to have poorer access to health care, live in lower socio-economic households, and endure stressors influenced by systemic racism that their white counterparts don’t experience.

“So how do those things translate into manifestations of your cancer risk?” Dr. Schlumbrecht says.

In his latest study, Dr. Schlumbrecht and his co-authors zoomed into the nativity of people who have endometrial cancer. 

They found that increasing African ancestry is clearly associated with an increase in the odds of developing tumors. 

And it found that a person’s self-reported race may not reflect their actual genetic background.

The study also bolsters findings reached by another Sylvester researcher, Sophia George, Ph.D., a research associate professor and molecular geneticist, and the associate director of diversity, equity, and inclusion at Sylvester, who found that women in the Caribbean see markedly elevated rates of hereditary breast and ovarian cancer. 

Those findings have shed new light on Dr. Schlumbrecht’s questions, which he will continue to explore. But looking back, he marvels at the fact that his research started as a simple question he asked himself while making his rounds.  

As part of the Sylvester team, Dr. Schlumbrecht has treated patients at Jackson Memorial Health, who tend to be minorities, come from lower-income households, and are either uninsured or have medical insurance through the Jackson Public Trust. He also sees about 50 patients a week at Sylvester, where his patients tend to come from higher-income families, and all have health insurance.

That’s where he first noticed the differences – more Black women in his Jackson clinic were suffering endometrial cancer than white women in the Sylvester. 

And now he’s got an ever-growing body of research starting to answer his questions.

Dr. Schlumbrecht believes his research can help the medical community develop tests to identify who would be at risk for endometrial cancer or to identify the first stages of endometrial cancer when there is a higher chance of cure. 

He wants to push policy-makers in Tallahassee to see his research and respond with money for more health care providers for these vulnerable populations. 

And eventually, he hopes to target the specific genes that hinder or help the development of endometrial cancer so Black women can permanently remove at least one major stressor from their lives.

“There’s really a push now recognizing endometrial cancer is a public health problem to identify how we can find women early if they have the disease, or identify women who would be at risk so we can intervene before they get the disease,” Dr. Schlumbrecht says.

“Our goal is to make it so that our departments in OB/GYN and at Sylvester are recognized for having this very high-level perspective and the interconnectivity of everybody because that’s how we’re going to solve these problems.”

Written by Alan Gomez, a contributor for UHealth’s news service.

Tags: cancer care in Miami, Dr. Matthew Schlumbrecht, Dr. Sophia George, endometrial cancer, global oncology, health disparity