Comprehensive review by two gynecologic oncologists charts rising incidence, advent of personalized treatments

  • Driven by obesity, incidence and impacts outpace treatment/detection advances
  • Newer molecular profiling helps a subset of patients avoid overtreatment
  • Black women face significantly higher mortality — an urgent care gap

BUFFALO, N.Y. — A new clinical review published in JAMA by physicians at Roswell Park Comprehensive Cancer Center provides an updated, evidence-based overview of endometrial cancer, highlighting rising incidence and mortality rates in the United States alongside advances in diagnosis, risk stratification and personalized treatment.

“Endometrial cancer is often highly curable when it’s found early, but we’re seeing more patients overall and more aggressive disease in some populations,” says senior author Karen McLean, MD, PhD, FACOG, senior author of the review and a gynecologic oncologist at Roswell Park Comprehensive Cancer Center. “That makes awareness, timely diagnosis, and access to specialized care more important than ever.”

Endometrial cancer, which accounts for 95% of uterine cancers, is now the fourth most common cancer among women nationwide. Dr. McLean and co-author Katherine Mager, MD, FACOG, also of Roswell Park, note that while many cases are diagnosed early and remain highly treatable, overall mortality has continued to increase in recent years, underscoring the need for improved prevention, early detection, and equitable access to care.

Roswell Park physicians highlight trends that are shaping endometrial cancer risk, outcomes and opportunities for early intervention

The article, “Endometrial Cancer: A Review,” highlights intersecting trends that are shaping endometrial cancer risk, outcomes and opportunities for early intervention:

  • Obesity is a major driver of rising incidence, as estrogen produced by adipose tissue promotes cancer development. While most cases occur after menopause, rates are increasing among younger women, reflecting broader metabolic and hormonal trends.
  • Persistent disparities in outcomes remain, with Black women experiencing significantly higher mortality despite similar incidence rates, influenced by differences in tumor biology, stage at diagnosis, and access to specialized care.
  • Early diagnosis offers a critical advantage, as abnormal uterine or postmenopausal bleeding is a common presenting symptom, and early-stage detection is associated with five-year survival exceeding 85%.
  • Molecular and histologic classification now play a central role in guiding treatment planning — the steps that follow initial treatment, which typically begins with hysterectomy, or surgical removal of the uterus, along with removal of the ovaries and assessment of lymph nodes.

The authors conclude that continued progress will depend on early recognition of symptoms, wider adoption of molecular testing, and efforts to reduce disparities in access to comprehensive cancer care.

“We’re no longer relying on stage alone to make treatment decisions,” Dr. McLean notes. “Our goal with this review is to help clinicians and patients apply the growing body of evidence — to better identify who may need additional therapy, who can safely avoid it, and which therapies are most likely to prove beneficial.”
Visit the companion podcast “JAMA Clinical Reviews: Diagnosis and Management of Endometrial Cancer” for additional insights from Dr. McLean about trends and new developments in the detection, treatment and management of endometrial (uterine) cancer.