Most uterine cancer is caught because of one symptom: bleeding that should not be there. About 90% of endometrial cancers announce themselves through abnormal bleeding, and there is no routine screening test for the disease. That makes how you respond to the symptom the whole game. For Black women, the stakes are higher than for any other group. Black women are diagnosed later, far more often with aggressive non-endometrioid tumors, and they die at roughly twice the rate of white women.
A cancer that is getting more common, and more deadly
Uterine cancer breaks the usual cancer trend. While death rates for most cancers fall, uterine cancer incidence rose about 0.7% per year from 2013 to 2022 and death rates rose about 1.6% per year from 2014 to 2023. The American Cancer Society estimates about 68,270 new cases and 14,450 deaths in the United States in 2026. Black women carry the heaviest share of that mortality. In CDC data covering 1999 to 2016, uterine cancer death rates were nine per 100,000 for Black women versus five per 100,000 for white women.
The forecast is worse, not better. A 2025 modeling study led by Dr. Jason Wright of Columbia University projected that incidence-based uterine cancer mortality among Black women would climb from 14.1 per 100,000 in 2018 to 27.9 per 100,000 by 2050, leaving Black women dying at nearly three times the rate of white women. This is one of the few cancers where both new cases and deaths are still rising.
The one warning sign you cannot ignore
The cardinal sign is bleeding after menopause. Any of it. Spotting, pink discharge, a single episode, blood that shows up months or years after your last period: all of it is abnormal and all of it needs evaluation. Before menopause, the signals are heavy or prolonged periods, bleeding between periods, and bleeding after sex. These symptoms are common and usually not cancer, but they are how uterine cancer is found, so they earn a workup rather than a wait-and-see.
Because there is no Pap-style screening test for uterine cancer, the symptom is the early-detection system. A Pap smear screens for cervical cancer, not uterine cancer, and a normal Pap does not rule out a problem in the uterus. Catching uterine cancer early depends almost entirely on bleeding being reported and worked up quickly.
Why the gap is so wide for Black women
Three forces stack on top of each other. First, biology. Black women are far more likely to develop aggressive non-endometrioid tumors: serous carcinoma, clear cell carcinoma, and carcinosarcoma. In the CDC analysis, endometrioid carcinoma (the most treatable type) accounted for 71% of uterine cancers in white women but only 47% in Black women, who had higher rates of carcinosarcoma and sarcoma. These subtypes spread faster and respond less well to treatment.
Second, later diagnosis. The same CDC data showed 69% of white women but only 55% of Black women were diagnosed while the cancer was still localized, and Black women were twice as likely to be diagnosed at distant stage. Part of that delay traces to how bleeding gets interpreted. Fibroids are extremely common in Black women, and abnormal bleeding often gets attributed to fibroids, which can stall the cancer workup. A study by Sarah Romano and Dr. Kemi Doll found that the standard ultrasound-based approach (measuring endometrial thickness) missed more than half of endometrial cancers in Black women presenting with postmenopausal bleeding, with sensitivity of just 47.5%, because fibroids blur the ultrasound and aggressive tumors present with a thinner endometrium. If your bleeding is being chalked up to fibroids, that is exactly the moment to push for a biopsy. Our guide to fibroids in Black women covers why they are so common and how to get them properly worked up.
Third, unequal care. Black women are less likely to receive guideline-concordant treatment, undergo fewer of the minimally invasive surgeries that are standard, and are less often treated by gynecologic oncologists. In a national analysis of more than 89,000 women, 75.3% of white patients received guideline-concordant care versus 70.1% of Black patients. And the biology and access gaps do not fully explain the disparity: a JAMA Oncology study found Black women had the highest hysterectomy-corrected mortality even after accounting for subtype and stage, with nonendometrioid mortality rising 3.5% per year among Black women.
Who is at higher risk
Most uterine cancer is driven by estrogen that is not balanced by progesterone, which is why the risk factors cluster around hormones and metabolism:
- Obesity. Fat tissue converts other hormones into estrogen, especially after menopause. This is the single largest modifiable risk factor.
- Diabetes. Women with diabetes are roughly twice as likely to develop uterine cancer.
- PCOS and other conditions that cause irregular ovulation and long-term unopposed estrogen.
- Never having been pregnant.
- Tamoxifen, used to treat or prevent breast cancer, which raises uterine cancer risk.
- Lynch syndrome, an inherited condition that can raise lifetime endometrial cancer risk to as high as 60%.
One caution: do not read this list as the explanation for the racial gap. Black women carry more aggressive tumor biology and worse outcomes that persist even after risk factors, fibroid-related delays, subtype, and stage are accounted for. You can do everything right on the risk-factor side and still need fast action on bleeding.
How the workup should go
For postmenopausal bleeding, the evaluation is a transvaginal ultrasound and an endometrial biopsy. In 2026, the American College of Obstetricians and Gynecologists updated its guidance to recommend both ultrasound and biopsy for most patients with postmenopausal bleeding, rather than relying on endometrial thickness alone, because ultrasound can miss 5% to 12% of cancers and misses far more in women with fibroids. The biopsy is a brief in-office procedure. If it cannot be done or the result is unclear, the next step is usually a hysteroscopy with dilation and curettage.
How to get care
Start by getting the bleeding evaluated by an OB-GYN, and do not accept a fibroid explanation without a biopsy. If a non-endometrioid or high-grade cancer is found, ask for a referral to a gynecologic oncologist, the specialist whose involvement is tied to better survival. You can find a Black OB-GYN or gynecologic oncologist in our directory, and if you are still looking for a regular gynecologist, our guide to finding a Black OB-GYN near you walks through how to vet one. Walk in with one sentence ready: "I have abnormal bleeding and I want an endometrial biopsy."
Frequently asked questions
Is there a screening test for uterine cancer? ▼
No. There is no routine screening test for uterine or endometrial cancer the way the Pap test screens for cervical cancer. A Pap test screens the cervix, not the uterus, and a normal Pap does not rule out uterine cancer. Because there is no screening, the disease is usually caught when abnormal bleeding is reported and worked up, which is why prompt evaluation of any postmenopausal bleeding matters so much.
Is any bleeding after menopause a sign of cancer? ▼
Most postmenopausal bleeding is not cancer, but about 90% of endometrial cancers cause abnormal bleeding, so every episode after menopause should be evaluated. Treat any bleeding after your periods have stopped as a reason to see a clinician promptly, even if it is light or happens only once.
Can fibroids hide uterine cancer? ▼
Fibroids do not turn into uterine cancer, but they can delay its diagnosis. Fibroids are very common in Black women and can blur a transvaginal ultrasound, and abnormal bleeding is sometimes attributed to fibroids without a biopsy. One study found the standard ultrasound-thickness approach missed more than half of endometrial cancers in Black women. If your bleeding is being blamed on fibroids, ask for an endometrial biopsy.
Why are Black women more likely to die from uterine cancer? ▼
The gap is driven by several stacked factors: Black women are more often diagnosed with aggressive non-endometrioid tumors (serous, clear cell, carcinosarcoma), are diagnosed at later stages, and are less likely to receive guideline-concordant care or treatment by a gynecologic oncologist. Research shows the disparity persists even after accounting for subtype and stage, so the gap is not fully explained by tumor biology or risk factors alone.
What is the difference between endometrial cancer and uterine cancer? ▼
Endometrial cancer starts in the lining of the uterus (the endometrium) and is by far the most common type of uterine cancer. Uterine cancer is the broader term that also includes rarer cancers of the uterine muscle, such as uterine sarcomas and carcinosarcomas, which are more common in Black women and tend to be more aggressive.
