Patients from socioeconomically disadvantaged neighborhoods generally face longer delays between the earliest signs of endometrial cancer (EC) and when they get surgery. A new study published in Gynecologic Oncology Reports found that these delays are mainly due to the time is takes for these patients to have their first visit with a provider about their symptoms.
Researchers at Mayo Clinic found that for patients from the most disadvantaged areas, an average of 50 days passed from their first symptom to their first medical visit. In comparison, only 20.5 days elapsed for patients from the most advantaged areas.
The researchers studied patients who had surgery intended to cure their endometrial cancer, excluding those treated for cancer that had come back. The team reviewed medical records of 1,687 patients who had surgery for endometrial cancer at Mayo Clinic hospitals in Minnesota, Arizona and Florida between January 2018 and March 2024.
To measure socioeconomic status, they used the Area Deprivation Index (ADI), a national tool that ranks neighborhoods by income, education, employment and housing quality. They then compared 185 patients from the most advantaged quarter of neighborhoods with 257 patients from the most disadvantaged quarter.
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Overall, the median time from symptom onset to surgery was 126 days for patients in the most advantaged group, about a month longer than the 96 days for those in the least disadvantaged group. The most common first symptom was postmenopausal bleeding — vaginal bleeding after menopause. Other reported symptoms included abdominal or pelvic pain and a feeling of bloating or fullness in the abdomen.
Once a biopsy confirmed the cancer, patients in both groups went on to surgery within a similar time frame: a median of 29 days in the advantaged group and 33 days in the disadvantaged group. Both groups fell well short of eight weeks, which is the point earlier research found a longer interval between diagnosis and surgery is tied to a higher risk of death.
Where patients first sought care also differed. Those from advantaged areas were about three times more likely to have their first visit at Mayo Clinic’s main campus, where they later had surgery. Those from disadvantaged areas were more often first seen at smaller regional clinics in the Mayo Clinic Health System.
The researchers pointed to several possible reasons for the early delays, including limited awareness that postmenopausal bleeding can signal cancer, insurance and logistical barriers, and worries about not being taken seriously by providers. They suggested better patient education about warning symptoms and easier access to primary gynecologic care as ways to close the gap.
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They added that many records were missing the date symptoms began, and that patients with missing dates may have faced even greater barriers to care.
