Social Determinants of Health Negatively Affected Endometrial Cancer Diagnosis

Factors such as language spoken, social vulnerability index characteristics, and insurance type were found to alter endometrial cancer diagnoses and led to worse outcomes.

Social determinants of health (SDOH) were found to hinder the timely diagnosis of endometrial cancer, thus leading to worse outcomes, according to the results of a retrospective study presented at the 2025 Society of Gynecologic Oncology Annual Meeting on Women’s Cancer.

The median time from symptom onset to treatment was 7.4 months. The median intervals were 4 months from symptom onset to presentation (initial medical visit), 2 days from initial medical visit to biopsy diagnosis, and 5.5 weeks from biopsy diagnosis to initiation of treatment. Delays were defined as the third quartile of each interval.

Per the social vulnerability index (SVI), 66.7% of patients with high household characteristics had a timely presentation and 33.3% had delayed presentation whereas 85.5% of patients with low household characteristics had a timely presentation and 14.5% had delayed presentation (OR, 2.94; 95% CI, 1.27-6.85; P = .012); regarding housing type and transportation, 66.1% of those with high characteristics had a timely presentation and 33.9% had delayed presentation whereas 81.5% of those with low characteristics had a timely presentation and 18.5% had delayed presentation (OR, 2.53; 95% CI, 1.17-5.49; P = .019).

Overall, those with high SVI domains had 69.4% timely presentation and 30.6% had delayed presentation whereas those with low SVI domains had 86.7% timely presentation and 13.3% had delayed presentation (OR, 2.87; 95% CI, 1.10-7.50; P = .032).

Of those with high household characteristics, 66.7% had timely treatment from symptom onset and 33.3% had delayed treatment, whereas of those with low household characteristics, 83.9% had timely treatment and 16.1% had delayed treatment (OR, 2.61; 95% CI, 1.11-6.16; P = .029). Of those with high housing type and transportation, 65.5% had timely treatment and 34.5% had delayed treatment, whereas of those with low housing type and transportation, 80.8% had timely treatment and 19.2% had delayed treatment (OR, 2.22; 95% CI, 1.01-4.91; P = .047).

Delays in presentation and treatment intervals were associated with higher vulnerabilities across the SVI domains (P < .05).

English speakers experienced 77.5% timely diagnosis and 22.5% delayed diagnosis, whereas non-English speakers experienced 57.5% timely diagnosis and 42.3% experienced delayed diagnosis (OR, 2.52; 95% CI, 1.05-6.10; P = .039).

Additionally, 78.2% of patients with an established health care relationship were diagnosed with stage I or II disease and 21.8% were diagnosed with stage III or IV disease, whereas 26.9% of patients without an established health care relationship were diagnosed with stage I or II disease and 73.1% were diagnosed with stage III or IV (OR, 9.75; 95% CI, 3.71-25.62; P < .001).

Those with private insurance were diagnosed in early stages 71.6% of the time vs 28.4% in late stages; with Medicare, the rates were 73.9% and 26.1% (P = .01); with Medicaid, the rates were 50.0% and 50.0%; and in those who self-paid, the rates were 0% (n = 0) and 100% (n = 4).

“Social determinants of health may pose critical barriers to the timely diagnosis of endometrial cancer, leading to worse outcomes,” lead study author Jorge Cervantes, an MD candidate at McGovern Medical School at The University of Texas Health Science Center at Houston, wrote in the presentation. “Public health campaigns aimed at raising awareness of endometrial cancer symptoms and promoting timely medical consultation are essential, especially in underserved communities.”

The study included a total of 155 patients with endometrial cancer who were evaluated between 2022 and 2024 at a single academic institution.

The majority of patients were aged 55 to 69 years (49.0%); patients were Hispanic (36.8%), non-Hispanic Black (29.0%), non-Hispanic White (26.5%), Asian (5.8%), and other race (1.9%); they used Medicare (45.8%), private insurance (45.2%), Medicaid (6.5%), and self-pay option (2.6%); they spoke English (83.2%) and spoke other languages (16.6%); and they had high socioeconomic status (64.5%), high household characteristics (55.5%), high racial and ethnic minority status (77.4%), and low housing type and transportation (56.8%). Most patients were diagnosed with early-stage disease (67.1%), and endometrioid was the most prevalent histology (70.3%).

The primary objectives were to identify and characterize delays in care for patients with endometrial cancer and explore how social determinants of health act as barriers to early diagnosis and treatment.

SVI was calculated using each patient’s home address.

Additionally, Medicaid and uninsured patients had higher rates of advanced-stage diagnosis (P = .01). There was no association between SDOH variables and delays in treatment after diagnosis.

“The association between SDOH and delayed care emphasizes the need for comprehensive interventions to address these barriers,” the study authors wrote.

Reference

Cervantes J, Sammouri J, Haydamous J, et al. Barriers to timely diagnosis and treatment of endometrial cancer: the impact of social determinants of health. Poster presented at: Society of Gynecologic Oncology 2025 Annual Meeting on Women’s Cancer; March 14-17, 2025; Seattle, WA. Poster 836184.