ENDOMETRIAL cancer, cancer of the lining of the uterus, is the most common cancer affecting the uterus and one of the most important cancers affecting women’s health worldwide. For many women, the uterus represents fertility, reproduction and motherhood, making a diagnosis of endometrial cancer particularly distressing.

It is important to distinguish endometrial cancer from cervical cancer. While both affect the uterus, they arise from different tissues, have different risk factors, are detected differently, and require different treatment approaches. Endometrial cancer develops in the lining of the uterus, whereas cervical cancer develops in the cervix, the lower portion or neck of the uterus.

Endometrial cancer is a diverse group of cancers ranging from low-grade, less aggressive tumours to highly aggressive subtypes. In Jamaica, as in many populations of predominantly African ancestry, the more aggressive forms are encountered more frequently and contribute to poorer outcomes. Globally, endometrial cancer is the most common gynaecological cancer, affecting more than 420,000 women each year. Its incidence has more than doubled over the past three decades and continues to rise across all age groups, particularly among younger women. In Jamaica, approximately 496 women were diagnosed with cancer of the uterus in 2022, exceeding the number diagnosed with cervical cancer and reflecting a significant shift in our country’s cancer landscape.

The reasons for this increase are complex, but one of the most important drivers is the growing epidemic of obesity and metabolic disease. Obesity, diabetes, hypertension and high cholesterol levels all contribute to an increased risk of developing endometrial cancer. Collectively, this metabolic syndrome is becoming increasingly common in Jamaica. Black women experience disproportionately higher mortality rates from endometrial cancer. The reasons are likely multifactorial and may include biological differences, a greater prevalence of aggressive tumour subtypes, barriers to healthcare access, delayed diagnosis, and treatment disparities. Understanding and addressing these factors is essential if we are to improve outcomes.

Another risk factor is Polycystic Ovary Syndrome (PCOS), more recently Polyendocrine Metabolic Syndrome (PMOS), a common hormonal and metabolic disorder that increases exposure of the uterine lining to oestrogen. Appropriate medical care can reduce short-and long-term health risks, including the risk of endometrial cancer. Certain inherited conditions, particularly Lynch syndrome, also increase the risk, as do medications like tamoxifen, which is commonly used in the treatment of breast cancer.

Fortunately, approximately 80 per cent of women are diagnosed at an early stage when the cancer remains confined to the uterus. At this stage, survival rates exceed 90 per cent. One reason for these excellent outcomes is that endometrial cancer often presents with an early warning sign: abnormal uterine bleeding. More than 90 per cent of cases occur in post-menopausal women, making post-menopausal bleeding one of the most important symptoms to recognise. The message is simple: post-menopausal bleeding should always be investigated. Unfortunately, some women delay seeking medical attention because they are unaware of its significance or are fearful of what the diagnosis might reveal.

Approximately 10 per cent of cases occur in pre-menopausal women and may be more difficult to diagnose. In Jamaica, uterine fibroids are prevalent and may be a confounder. The diagnosis can be even more challenging in younger women, with approximately four per cent of cases occurring before age 40. Abnormal uterine bleeding at any age warrants medical evaluation, particularly in women with obesity, PCOS, a strong family history of uterine or colorectal cancer, or other significant risk factors.

Many women remain unaware that obesity is the single most important modifiable risk factor for endometrial cancer. Excess body fat increases oestrogen production and promotes chronic inflammation, creating an environment that encourages cancer development. Obesity not only increases the risk of developing endometrial cancer but is also associated with poorer outcomes after diagnosis. Many women diagnosed with endometrial cancer ultimately die not from the cancer itself but from obesity-related conditions such as heart disease and stroke. Yet studies consistently show that discussions about weight management are often overlooked during routine healthcare visits.

The good news is that endometrial cancer is one of the few cancers for which meaningful prevention is possible. Weight loss has been shown to reduce risk and improve outcomes. This may be achieved through healthy dietary changes and regular physical activity, although some women may require medical therapies or bariatric surgery when appropriate.

Hormonal therapies also play an important role in prevention. Progesterone-containing treatments such as the levonorgestrel intrauterine device and depot medroxyprogesterone acetate can protect the uterine lining and reduce cancer risk. This is particularly important in women with PCOS who do not currently desire pregnancy. There are misconceptions surrounding hormone replacement therapy (HRT). When prescribed appropriately, continuous combined HRT does not increase the risk of endometrial cancer and may actually reduce risk.

For women diagnosed with endometrial cancer, treatment extends beyond surgery, radiation, or chemotherapy. Weight management, regular physical activity, emotional support, and participation in support groups can improve quality of life, reduce the risk of recurrence, and decrease the likelihood of developing other obesity-related cancers such as breast cancer. Maintaining a healthy weight, controlling diabetes and hypertension, engaging in regular physical activity, and seeking prompt medical attention for abnormal bleeding can significantly reduce risk. Equally important is increasing awareness among women and healthcare providers alike. By recognising symptoms early and addressing modifiable risk factors, we have an opportunity to reduce the impact of this increasingly common cancer in Jamaica.

Dr Natalie Medley is a consultant obstetrician and gynaecologist and gynaecologic oncologist at the Mona Institute of Medical Sciences, University Hospital of the West Indies. She can be contacted at (876) 977-1512, (876) 618- 6048 or nmedsingh@gmail.com.

DR NATALIE MEDLEY.