Women in a swath of South Texas that includes San Antonio have higher rates of endometrial cancer than women anywhere else in the state, including among women under 50, according to a new study led by scientists at the University of Texas at San Antonio and the National Cancer Institute.
Young Latinas in the region face even higher rates.
Among women ages 20 to 49 in Texas Public Health Region 8, the study found 13.9 cases of endometrial cancer per 100,000 women, compared with 9.9 statewide. Among young Hispanic women in the region, the rate was 17.2.
“What surprised us was the degree of increased risk,” said Dr. Edward Kost, one of the study’s authors and a board-certified gynecologic oncologist at Mays Cancer Center at UT Health San Antonio. “It was almost double the risk in our young Hispanic patients compared to our non-Hispanic Black and our non-Hispanic White patients.”
Endometrial cancer begins in the lining of the uterus. Kost, a professor in the Department of Obstetrics and Gynecology at the Long School of Medicine at The University of Texas at San Antonio, says it is the most common gynecologic cancer in the United States. The study didn’t determine why rates are higher in this part of South Texas or why young Latinas are more vulnerable, but some risk factors cut across populations, including obesity, diabetes and polycystic ovary syndrome (PCOS), which is now also known clinically as polyendocrine metabolic ovarian syndrome (PMOS).
PCOS/PMOS is associated with insulin resistance, a tendency to gain weight easily, and irregular periods. Women who go months or even years without menstruating lose one of the body’s protections against endometrial cancer, Kost said. “They don’t ovulate, so they never make progesterone,” he explained. “And progesterone protects the uterus from cancer.”
Endometrial cancer is highly survivable when caught early, and can sometimes be caught even before it develops. “We can diagnose patients with what’s called endometrial hyperplasia, which is a precursor of endometrial cancer,” Kost said. “And that can be treated with medications.”
Kost suggested that young women with risk factors talk with their gynecologist about whether they might need an endometrial biopsy, which he said is only slightly more invasive than a Pap smear and can be done in a doctor’s office.
Treatment typically has good outcomes, too. For older women, or those who don’t want to become pregnant, the first line of treatment is hysterectomy. “Eighty percent of the time the hysterectomy is curative in a post-menopausal patient,” Kost said. Younger women who hope to someday become pregnant have alternatives, usually hormone treatment. “We give them progesterone to try to get balance,” Kost said, “And we can get the cancer in many cases to go away. Then the goal becomes, how can we get these young women to start ovulating?”
This study is just a first step in understanding endometrial cancer in young Texans, particularly Latinas. “Ultimately what we want to do is identify what’s causing this increased incidence in this population and try to intervene at the community level to decrease the incidence,” Kost said.
Science & Medicine is a collaboration between TPR and UT Health San Antonio that explores how scientific discovery in San Antonio advances the way medicine is practiced everywhere.
