MedStar Health Blog

Gout is a common type of inflammatory arthritis, with sudden flares of joint swelling, pain, warmth, and redness, often in the big toe. Some patients may go months or even years between flares. Many gout sufferers assume that the gout is gone between flares and they don’t need medication to treat it.

These prolonged gaps between flares, when the patient feels fine, fuel the misconception that gout is no big deal—but that couldn’t be further from the truth. 

Left untreated, gout can cause permanent joint damage, even between flares. As a rheumatologist, I see some of the worst outcomes from untreated gout: destroyed joints that cause significant, irreversible pain and disability. 

Over 9 million people in the U.S. have gout. Yet only one-third to half of them receive treatment—and less than half of those who seek treatment stick to their care plan.

Patients consistently tell me, “I wish I had taken my gout more seriously.” It’s incredibly disheartening because most of the negative outcomes are preventable with early recognition and consistent treatment.

You can avoid permanent damage from chronic gout by learning its risk factors and symptoms—and seeking treatment at the first sign of the condition.

Know your risk factors.

Gout flares, also known as “attacks,” are triggered by a buildup of uric acid. This chemical develops in the bloodstream when your body breaks down purines, natural substances in certain foods. Normal amounts of uric acid simply dissolve and move through your kidneys and into your urine. But when there’s too much of it, uric acid crystals can form and accumulate in joints.

The exact cause of excess uric acid that leads to gout is an active area of research. It’s believed to be a perfect storm of genetics, environmental exposures, and other health conditions, such as:

• Chronic disease, including heart failure, high blood pressure, kidney disease, metabolic syndrome, and diabetes
• Certain high blood pressure medications, such as diuretics (“water pills”)
• Obesity
• A diet heavy in high-purine foods and beverages, such as alcohol, red meat, certain types of seafood and shellfish, and food and drinks sweetened with fructose
  

Estrogen appears to have a protective effect, so we rarely see gout flares in premenopausal women and most often see gout in middle-age and elderly men. 

Gout isn’t fully preventable, but you can reduce flares by modifying risk factors you can control, such as your diet and weight. Your doctor can help you make healthier lifestyle or medication changes to reduce your risk of gout.

How to recognize symptoms of gout.

Symptoms of a gout flare can include:

• Redness
• Swelling
• Warmth
• Extreme tenderness
• Reduced range of motion in the affected joint
• Severe pain that lasts up to a few days and decreases to moderate discomfort for days or weeks
• Fevers
  

A key differentiator between gout and other types of arthritis is that gout attacks occur abruptly, often within a day, without warning. For example, you might feel fine when you go to bed and wake up unable to walk because of a gout flare in your foot. 

While 50% of all first gout attacks occur in the big toe, gout can occur in many other joints, including the hands, wrists, elbows, shoulders, knees, and ankles. You may not have another flare for months, so you might forget about it or decide that treatment is unnecessary.

If you experience a gout attack, see a doctor right away. Gout usually can be diagnosed based on physical symptoms alone. The gold standard for diagnosing gout is needle aspiration of joint fluid and visualization of uric acid crystals under polarized microscopy. Gout can be visualized by ultrasound and advanced imaging like CT or MRI.

Seek short- and long-term treatment for gout.

Gout should be treated aggressively and consistently to improve a patient's long-term quality of life. With treatment, we can put gout into complete remission. 

Treating gout is a two-pronged approach: minimizing the short-term pain and swelling that occur during a flare, and decreasing uric acid levels over time to prevent future attacks.

During a flare, our goal is to decrease painful inflammation as quickly as possible with oral medications such as:

• Colchicine 
• Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
• Prednisone
  

If only one joint is inflamed, a rheumatologist can provide a steroid injection instead to quickly reduce the swelling.

While the flare is resolving, we recommend starting a long-term oral medication to help control uric acid levels, such as:

• Allopurinol
• Febuxostat
• Pegloticase
  

Gout treatment requires a lot of self-management. You’ll need to consistently take your medication and make sustainable lifestyle changes.

Related reading: Manage Metabolic Syndrome for Better All-Around Health

It's important to treat gout as soon as possible.

Over time, patients with untreated gout can develop a condition called tophi — hard and bulky uric acid deposits in the affected joint. Tophi are usually painless, but they can erode the bone and even pop open the overlying skin and start draining. 

Untreated gout also can cause erosions, which are basically bites taken out of the bone. Erosions may or may not be painful but can reduce joint stability and function. At that point, medication won’t help—you might develop permanent functional loss and/or need surgical correction.

Thankfully, patients can avoid these detrimental complications with early intervention.

One gout attack is reason enough to talk about gout prevention with your doctor. While rheumatologists like myself specialize in advanced gout treatment, primary care providers can help you prevent or manage gout.
 

Never in the history of medicine have we experienced such a high degree of clinician burnout and turnover. Physician turnover takes a heavy toll on patients and the lives of physicians and their families. The cost of replacing physicians through the process of recruitment, lost revenue, onboarding, and time to return to optimal efficiency can be upwards of $1million per physician departure. This can be problematic for many hospitals and health care organizations that are experiencing high rates of physician burnout or turnover that has only been exacerbated by the ongoing pandemic and impending threat of another COVID-19 surge.

Previous survey research has established associations of electronic health record (EHR) use with professional burnout and reduction in professional effort, but these findings are subject to response fatigue and bias. In collaboration with Yale University, MedStar Health investigators Raj Ratwani, PhD, Daniel Marchalik, MD, MA, Mihriye Mete, PhD, and Allan Fong, MS evaluated the association with physician productivity and EHR use patterns with physician turnover as detailed in the recent study “Analysis of Electronic Health Record Use and Clinical Productivity and Their Association with Physician Turnover” published in JAMA Network Open.

This retrospective research study included 314 non-trainee physicians who worked exclusively in an ambulatory care delivery network without teaching duties. EHR use and scheduling data were collected using the Epic Signal platform and Epic Clarity database, respectively. EHR user actions were tracked via mouse action or keyboard action using a 5-second latency period where the user is idle for 5 seconds and tracking pauses until user actions resume. Physician demographic data, including termination status and departure date were also recorded.

The associations between departure status, physician productivity, and EHR use patterns were examined monthly for each physician. Physician productivity was based on demand, patient volume, completed appointments/month, and intensity. EHR use was determined by analyzing total EHR time, note documentation, work outside of scheduled clinical hours, time on inbox, and teamwork. Physician specialties were grouped into 3 categories: primary care, medical specialties, and surgical specialties.

Overall, the study found:

• Physician productivity and EHR use metrics were associated with their departure, while physician age, gender and specialty were not.
• Counterintuitively, less time spent on the EHR was associated with physician departure and warrants further investigation.
• The specialties with the highest turnover rates were medical subspecialities, surgical specialties, gastroenterology, and internal medicine.
• A teamwork approach may help to prevent physician turnover. This finding is consistent with evidence that team-based care can reduce professional burnout and optimize team performance. This suggests that a prospective model of vendor-derived EHR data could help to identify physicians at high risk of departure who might benefit from targeted team-based care interventions.

The research team suggests that standardizing vendor-derived EHR data definitions in a way that is clinically relevant and qualitative exit interviews to provide further insight into existing data and the association between EHR use, burnout, and physician attrition, could be beneficial. With greater data validity and reliability, future models could prospectively identify physicians at high risk of departure who would benefit from targeted interventions to improve retention. Future studies could also further assess the association of burnout and departure with EHR use by linking survey data with EHR use and productivity metrics with more detailed information on departure. Additional future research could prospectively track physician productivity and EHR use patterns to identify physicians at risk of departure.

As the COVID-19 pandemic continues to keep us diligently searching for solutions while also responding to clinical and administrative duties, MedStar Health is committed to providing resources and tools to help prevent burnout for both physicians and our administrative staff. This research and the broader work from our team of investigators is just one avenue we are exploring to find ways to create more balance among our clinicians. Learn more about MedStar Health wellness initiatives here.

Physical activity during every stage of life can help protect and maintain your overall health. But as your age increases, so does your risk of exercise-related injuries—such as a ruptured Achilles tendon.

The Achilles tendon connects the heel to the calf. You use it to walk, run, and jump, so it’s constantly under pressure. Over time, this pressure can cause the tendon to become irritated or tear.

A tear in the Achilles tendon (also known as a rupture or snap) is one of the most common Achilles injuries, occurring in about 18 of every 100,000 patients. It typically occurs in men over 30 and continues to increase in patients age 40-59 for two main reasons:

• Muscles and tendons stiffen with age, making them more likely to snap when stretched.
• Patients in this age group tend to be “weekend warriors”: people who may not exercise as much during the week and then take part in recreational activities on weekends. This pattern can lead to foot and ankle pain, including Achilles tendon injuries.

Minimally invasive surgery is the best option for patients who are in good health and want to get back in action as soon as possible after an Achilles tendon rupture. 

However, before moving forward with treatment for any type of Achilles tendon injury, it’s important to understand why the injury occurred and how different treatment options and behavioral changes can prevent it from happening again.

Identifying Achilles tendon injuries.

Achilles tendon injuries are categorized as acute or chronic.

Acute injuries include:

• Rupture: the result of overuse and the lack of a proper warmup before exercise. It often occurs during sports such as soccer, basketball, volleyball, and softball. When a patient pushes their foot off the ground, they feel a snap as if someone stepped on or threw a ball at the back of their leg.

• Tendonitis: inflammation that occurs when patients ramp up their exercise too quickly. It can cause ongoing pain and swelling in the heel, ankle, and back of the leg.

Chronic injuries include:

• Haglund’s deformity: a painful bump that forms on the back of the heel and rubs against the Achilles tendon. It can be caused by a tight Achilles tendon, shoes that are too tight in the heel, or constant walking on the outside of the heel.
• Heel spur: a pointy calcium buildup on the back of the heel that can cause the Achilles tendon to become more inflamed and harden. It can also be caused by tight shoes and constant pressure on the heel bone.
• Tendinosis: tendon damage that occurs when tendonitis is not treated. It causes the Achilles tendon to become hard and rubbery.

To diagnose your injury, your doctor will physically examine your foot and ankle and ask you to demonstrate your range of motion. Then, they’ll perform imaging tests to look for damage in your Achilles tendon. 

Full recovery from an Achilles injury usually takes six to 12 months, regardless of the treatment method. However, the speed at which patients can rebuild strength during this time depends on the type of injury and treatment they have, as well as their personal fitness goals.

The benefits of minimally invasive surgery.

Ruptures are often treated surgically in patients who are healthy and want to return to their former level of activity. Some studies have shown that surgical treatment can decrease the risk of a re-rupture more than nonsurgical treatment. 

I often recommend minimally invasive surgery for a faster, less painful recovery.

Minimally invasive repair allows the patient to start putting weight on their injured foot sooner than they would with open surgery or nonsurgical care. And the sooner their foot can handle weight, the faster they can start physical therapy and work on getting stronger; early weight bearing leads to better health and strength after six months.

During traditional open surgery, the surgeon makes a 12-cm incision on the back of the leg to access and repair the Achilles tendon. Minimally invasive techniques allow the surgeon to make a 3-cm incision over the Achilles tendon and two smaller incisions at the back of the heel to reattach the tendon to the heel bone.

• Easier wound care 
• Lower risk of blood loss, scarring, and infection 
• Shorter recovery

Patients leave the hospital with a cast or boot the same day they have surgery. After a week or so, l check on their pain level and discuss how they feel about putting weight on their injured foot. If they’re ready, I guide them through basic physical therapy exercises to prepare them for more strength building. 

Once we both feel confident about moving forward, I connect them with one of our physical therapists, who customize treatment plans to each patient’s overall health and lifestyle.

Alternative treatments, from casting to tendon lengthening.

Nonsurgical treatment for ruptures and all other types of Achilles injuries are recommended for older and less active patients. It typically requires a cast or boot to ensure proper rest for four to 12 weeks; timing depends on how severe the injury is. Ice and over-the-counter pain medications can be used as needed.

Once the patient can put weight on the injured foot, they begin physical therapy to strengthen and stretch the tendon and surrounding muscles. To avoid reinjury, they may need to permanently modify or avoid certain activities.

If a chronic injury is severe, surgery may be an option to:

• Transfer another tendon to the area to assist with foot push-off.
• Remove the damaged portion of the tendon.
• Lengthen the tendon—ongoing stress can cause it to shorten.
  

While you can still walk or even run after an Achilles injury, putting off treatment will only make the injury worse. Seek care immediately to lessen the damage and shorten your road to recovery.

Practical prevention tips.

At the start of the COVID-19 pandemic, I saw an increase in Achilles injuries. Patients were antsy to get outside, and they started hiking, running, and walking long distances without ramping up appropriately. 

Taking certain precautions can decrease the risk of injury:

• Before any form of exercise, warm up for at least five to 10 minutes with a quick walk or jog, in addition to dynamic stretches such as lunges and high-knee skips.
• Wear athletic shoes that fit.
• Slowly increase the intensity of your workouts. For example, if you regularly run three miles at a time, don’t suddenly start running five or more; increase your distance no more than 10% each week. 
• Try different workouts. Repeating the same motion over and over again leads to more pressure on the Achilles tendon. Mix activities that require running with walking, biking, swimming, or yoga.
• Always stretch after exercising and pay extra attention to calf muscles. Tight calves can increase pressure on the tendon.
  

Even the most disciplined athletes can suffer from Achilles tendon injuries. We collaborate with other specialists, from primary care providers to physical therapists, to ensure patients get the personalized care they need to get back to their favorite activities.

In the United States, more than 34 million Americans have diabetes, and more than half have at least one other chronic physical or mental health condition. Depression is very common in diabetics with studies showing that rates of depression are higher in persons with type 2 diabetes compared to those without. Adults living with type 2 diabetes are also more likely to have an anxiety condition when compared to those without. To improve type 2 diabetes outcomes, it is important to diagnose and treat both diabetes and depression/anxiety when patients present with both.

Collaborative research from MedStar Diabetes Institute, MedStar Health Research Institute, and the Georgetown University Department of Psychiatry examines the impact of providing mental health care alongside diabetes care to adults with uncontrolled type 2 diabetes and moderate depression and/or anxiety. This is especially important for our region because diabetes is a leading cause of chronic health issues for African Americans which is only compounded by the effects of these behavioral and socioeconomic factors.

Patients from the MedStar Health Diabetes Boot Camp program were enrolled in the pilot study and offered 6 structured sessions with a mental health interventionist, who was also trained to recognize worsening mental health symptoms, identify and evaluate safety concerns, seek consultation, and make appropriate referrals. The mental health component targeted depression and/or anxiety symptoms based on questionnaires and survey scores. Participants were assessed at baseline and 90 days.

For participants who completed the mental health co-management program, study results showed significant improvements in both mental health outcomes and diabetes management.

• At the conclusion of the study, the percentage of participants with moderate depression was down from 50% at baseline to 31%, and the percentage with moderately severe depression was down from 33% to 15% based on participants’ score on the depression and anxiety screening instruments.

Most importantly, participants in the co-management study experienced significant improvement with their blood glucose levels. Based on these results, researchers at MedStar Health are excited to continue investigating coordinated care models specifically for patients with diabetes and others managing chronic diseases. “Anyone with a chronic condition knows the toll it can take on your mental health,” said Michelle F. Magee, MD, endocrinologist at MedStar Washington Hospital Center and primary investigator for this research. “The results of this study further underscore how we as physicians and investigators can consider the holistic impact of disease management and continue to improve how we care for patients.”

Lead by Dr. Magee, the research team included Carine M. Nassar, RD, MS, CDCES from MedStar Diabetes Institute and MedStar Health Research Institute; Mihriye Mete, PhD from MedStar Health Research Institute and Georgetown University Department of Psychiatry; and Stacey I. Kaltman, PhD from Georgetown University Department of Psychiatry.

The Science of Diabetes Self-Management and Care, DOI: 10.1177/0145721721996305

More than 70% of people who are eligible for the COVID-19 vaccine in Maryland and the District of Columbia have gotten at least one dose—thank you to everyone who is doing their part to keep our neighbors safe!

That said, the pandemic is not over yet—in October 2021, around 1,200 deaths from COVID-19 occurred each day in the U.S. As we balance the weight of this knowledge with the optimism of successful COVID-19 treatments and vaccines, many people are wondering how to approach a second round of major holidays.

From travel plans to tough conversations with family members, we’ve answered five questions patients are asking the most.

1. Are indoor family gatherings safe?

After a tumultuous couple of years, it is important for everyone to feel socially engaged right now. Children and teens, in particular, will benefit from social activities; a national state of emergency in child and adolescent mental health was recently called by the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association. 

Spending time with loved ones and simply taking time to relax can help ease the ongoing stress complicating mental health. But we’re hesitant to recommend indoor parties, especially because vaccination only opened up to children age 5-11 the first week of November.

If you choose to gather with a group indoors:

• Keep it small with 10-20 people who do not need to travel long distances to attend.
• Wear masks when you’re not eating or drinking if any attendees are not vaccinated or received a positive COVID test within the last three days.
• Maintain safe distances of about 6 feet between other people.
• Wash or sanitize your hands every 30 minutes.
• Open windows, if possible, to improve ventilation.
  

Planning and communication before gathering are key. You may be surprised at who within your circle is not yet vaccinated. Having that conversation ahead of time ensures everyone is on the same page. If everyone is not vaccinated, switch to an outdoor gathering, postpone the event until everyone is vaccinated, or develop a hybrid plan that allows some people to attend virtually.

Related reading: How to deal with re-entry anxiety and post-pandemic stress.

2. Is it safe to travel?

Driving and flying are relatively safe if everyone in your party is vaccinated. Driving significantly decreases the number of people you’ll come in contact with. But if you’ll be stopping at public places in areas with low vaccination rates and high COVID cases along the way, the risk of infection is not lower than if you flew. Cruises and long-distance bus or train trips are not recommended by the Centers for Disease Control and Prevention (CDC).

If you plan to travel internationally, you must be fully vaccinated. Review the CDC’s international travel guidelines. 

If you plan to travel within the United States, the CDC recommends being fully vaccinated and following these guidelines:

• Wear a mask on planes and public transportation.
• Follow all local recommendations and requirements in the area you travel to.
• Consider wearing a mask (both indoors and outdoors) in locations with high numbers of COVID-19 cases.
• Self-monitor for COVID symptoms when you return. Isolate and get tested if you have them.

If you are not fully vaccinated, the CDC recommends getting a viral test one to three days before your trip and:

• Wearing a mask and maintaining physical distance at all times.
• Avoiding crowds.
• Washing your hands and sanitizing often.
• Getting a viral test three to five days after traveling and self-quarantining for a full seven days, whether or not you experience COVID symptoms.

We do not recommend traveling to locations with low vaccination rates. If you choose to do so:

• Limit the activities you participate in while visiting the area.
• Wear a higher-grade mask or double surgical masks on the plane if you fly.
• Consider quarantining once you arrive if you’re visiting someone with a high risk of developing COVID complications.

Staying at a hotel or with people who have not been vaccinated increases your chances of contracting the virus more than staying with fully vaccinated people. If that’s your only option, wear a mask when you’re not eating or drinking and frequently wash and sanitize your hands.

It all comes down to being mindful. Before traveling, avoid large groups of people to lower your risk of contracting and spreading the virus. While traveling, practice good hygiene, be respectful of others’ personal space, and avoid large, unmasked crowds.

3. Can we bring back our favorite holiday outings this year?

From holiday markets to mall Santa visits, many traditional outings were paused last year. But we expect most of them to return this year, and many already have. Movie theaters, shopping centers, and concert halls have been open for a while now and will likely keep getting busier.

The safest way to celebrate this year is to be fully vaccinated. Outdoor activities, such as sledding, skating, or light displays, continue to be safer than indoor activities, regardless of your vaccination status.

Review event guidelines before attending to ensure you’ll be able to comply. Masks or proof of vaccination might be required at certain venues. Even if they’re not, we’ll both be wearing masks in indoor public spaces to help prevent the spread of COVID or any other virus—and we encourage you to do the same.

• Are 18 or older and received the Johnson & Johnson vaccine two or more months ago
• Are 65 or older and received the Pfizer or Moderna vaccine six or more months ago
• Are 18 or older, received the Pfizer or Moderna vaccine six or more months ago, and have underlying medical conditions or live or work in high-risk environments (e.g., long-term care facility, health care setting, school, grocery or department store)
  

If you received two doses of the Moderna vaccine, you can get the Pfizer booster—and vice versa—but we advise patients to stick to the same brand of booster if possible. You can get it at the same time as your flu shot to avoid two trips to the clinic.

5. How can I discuss the vaccine with family members who are not vaccinated?

COVID-19 will likely be a popular conversation topic during the holidays. Be sure to set firm ground rules regarding masks and vaccination status in your home and around your family before any events.

Despite the effectiveness and safety of all three COVID vaccines, misinformation continues to persist. We understand the concerns about the vaccine—and the frustration of discussing its benefits with people who aren’t interested in listening or learning.

Each person who has been vaccinated can help be an ambassador to their community. Increasing our vaccination rates has been challenging and requires effort from all of us: physicians, parents, siblings, and friends.

Try to understand the source of someone’s objection to the vaccine and really listen to their concern. From there, you can gently use science-based facts to address their specific concern.

Emphasize that one of the most important things to consider in a pandemic is the health of those around us. Vaccines and masks protect your neighbors, family, and friends and are the only way to stop COVID-19 from spreading. Many pediatric patients have told us they’re excited to get the vaccine because they want to help people.

You can also recommend that they talk to a trusted health professional. We want people to have as many layers of protection against this virus as possible, which is why we strongly recommend the vaccine for all who are eligible. 

Related reading: COVID-19 vaccine: Answers to frequently asked questions: Part one and Part two.

Stay home if you feel sick.

We’re just as excited as you to celebrate the holiday season with loved ones. But don’t let your excitement overpower your sensibility. If you are experiencing symptoms of COVID-19—or even a cold or flu virus—stay home.

After looking forward to holiday celebrations that feel a little more “normal,” we know it can be difficult to potentially miss out again. But the pandemic has shown just how important it is to sacrifice inconvenience for the health and safety of others. Get the rest and care you need so you can get back to enjoying a healthy holiday season.

Watch our Facebook Live broadcast for more about COVID-19 developments around the Delta variant, booster vaccines, holiday gatherings, and more:

By the end of 2021, approximately 60,000 new cases of endometrial cancer will be diagnosed in the U.S. Over 10,000 patients will die from it—and the majority of these people will be Black women.

Endometrial cancer develops in the inner lining of the uterus and is the most common type of uterine cancer. Though more White patients develop the disease, studies show that Black women with endometrial cancer:

• Are twice as likely to have high-risk histology—more aggressive, abnormal cancer cells
• Get surgery less often, regardless of the cancer’s progression
• Are more likely to be diagnosed after their cancer is at an advanced stage 
• Have a 55% higher mortality rate than non-Black women

As a Black woman and a gynecologic oncologist, I’m passionate about discussing endometrial cancer risks with my patients. With endometrial cancer specifically, genetic, societal, and personal factors converge into a perfect storm of risk for Black women. And there is still much to learn about the disease itself from a biological standpoint.

Research on racial disparities in U.S. health care continues to grow alongside much-needed awareness about higher rates of several health conditions across the hardest-hit populations. 

While we don’t have all the answers to solve disparities in diagnosis and treatment today, we know more than enough to reduce them—starting with better informing Black patients and their health care providers about the risks, symptoms, and treatment options for endometrial cancer.

Risk factors Black women need to know.

Several risk factors for endometrial cancer are universal, but Black women face additional genetic and social challenges that increase their chances of an advanced diagnosis.

Epigenetics is a change in gene function caused by environmental factors such as social, economic, and cultural inequities. Some evidence points to epigenetics as a possible reason why Black women develop more aggressive endometrial cancers. Stress compounded through generations—from slavery through segregation and ongoing racial tensions—may cause higher rates of abnormal cell behavior, resulting in more advanced cancers.

Implicit bias in the medical profession can lessen the quality and effectiveness of treatment, which is already complex and time sensitive —especially with aggressive cancers. Medical professionals must acknowledge and confront personal attitudes and beliefs about patients; implicit biases negatively influence health care delivery and patient outcomes, specifically for Black people.

Lower rates of hysterectomy and radiation may also be to blame. Research shows that Black women are less likely to receive surgery and subsequent radiation than White women. 

Inadequate screening methods, such as some tools to measure endometrial thickness—a possible sign of endometrial cancer—miss almost five times more cases of endometrial cancer in Black women than white women. This is partly because non-cancerous uterine fibroids can make the lining harder to measure, and fibroids are more common in Black women.

Lynch syndrome is associated with approximately 3% of endometrial cancer diagnoses. This inherited gene mutation is also associated with cancers involving colon, ovary, urothelial tract (bladder and ureters), pancreas, stomach, or brain (glioblastoma). If you have a family history of the above cancers or Lynch syndrome, talk with your doctor about genetic testing to help determine your risk. 

Obesity is a leading risk for developing endometrial cancer, in part because it increases patients’ estrogen levels. As obesity rates increase, younger women are developing endometrial cancer. Other factors that can increase estrogen and a woman’s risk of endometrial cancer include:

• Type 2 diabetes
• Never getting pregnant
• Starting menstruation before age 12
• Taking certain hormone therapies for breast cancer, such as tamoxifen

Symptoms and diagnosis.

One of the few qualitative studies of Black patients’ experiences with endometrial cancer shows that diagnosis and treatment are often delayed because women are unaware of their symptoms and risk. 

Providers may not suspect endometrial cancer right away because of the crossover of gynecologic cancer symptoms, particularly in younger patients. While most cases develop after menopause, we’ve treated patients in their 20s and 30s for endometrial cancer. 

The longer the cancer goes undetected, the further it spreads—and the less responsive it becomes to treatment. This is why early recognition of symptoms and timely diagnosis are critical to achieve good outcomes.

Abnormal bleeding is the most recognizable symptom of endometrial cancer. See a doctor if you experience bleeding between periods, heavy bleeding after age 40, and any vaginal bleeding after menopause. If your bleeding patterns change, or you start having bleeding during or after sex, you should also talk with your doctor. Sometimes patients experience bloating and lower abdominal pain or cramping.

Do not accept these symptoms as normal—if they last longer than two weeks, see a doctor because something may be wrong. The earlier you get checked out, the sooner we can help you feel better. Even if your symptoms are not caused by cancer, there are many ways to treat heavy or bothersome vaginal bleeding. 

If you or your doctor suspect you might have endometrial cancer, you should feel empowered to ask for exams or tests to find out for sure. These include:

• Pelvic or transvaginal ultrasound for a detailed image of the uterus and surrounding area
• Uterine biopsy (tissue sampling) to test cells for cancer 
• Chest X-ray, CT scan, or MRI to see if the cancer has spread
  

Endometrial cancer is categorized by four stages, depending on where it spreads:

1. Stays in the uterus 
2. Spreads to the cervix
3. Travels outside of the uterus but not beyond the pelvis
4. Spreads outside the pelvis to organs such as the bowel, bladder, or abdomen (metastatic cancer)

If you have endometrial cancer, your doctor will order imaging and laboratory tests to determine the disease stage. From there, they will work with you to create a treatment plan that fits with your overall health goals and lifestyle. 

Related reading: Why you shouldn’t delay cancer screenings.

Treatment options to ask about.

Endometrial cancer treatment typically involves a combination of surgery, chemotherapy, and radiation. 

Early-stage endometrial cancer often can be cured with surgery, since there is a low risk of the cancer coming back. A total hysterectomy —removal of the uterus and cervix—is the most common surgical treatment. We will usually remove the fallopian tubes and ovaries, as well as some pelvic lymph nodes to help us see if the cancer has spread, and also to decrease the hormonal stimulation from the ovaries that may contribute to cancer recurrence. 

Locally advanced cancer (that has spread to the cervix or lymph nodes) has a higher risk of recurrence and might also require radiation, chemotherapy, or both, depending on how far the cancer has spread and how many cancer cells remain after surgery. Sometimes, if the cancer is already very advanced, we may jump straight to chemotherapy to help treat cancer cells all over the body, and keep surgery as a possibility for the future. 

There are also some types of aggressive cancers (uterine serous, clear cell, carcinosarcomas) that need radiation and chemotherapy treatment even if the cancer is just in the uterus. It is important to ask your doctor to go through your pathology report with you in detail so that you understand exactly what type of cancer you have. I often suggest that patients have a trusted family or friend at their visit or available on the phone so that they can ask other questions that my patients may not think of during these important conversations. 

With work, childcare, and everything in between, treatment can be difficult to navigate. But your health is worth the time it takes. Talk with your doctor about resources that can help you manage other priorities while receiving treatment.

Actions patients can take now.

Trust yourself. You know your body better than anyone, and if something feels different, advocate for your health. Be persistent about getting an answer for why you’re experiencing certain symptoms.

I understand how hard it can be for women to prioritize their health, and you are worth it. If your provider doesn’t share your level of concern, request a cancer screening test or seek a second opinion. 

Related reading: How and why to get a second opinion for cancer diagnosis using video visits.

I entered the medical profession to take care of women because they play a central role in the health of our communities. One of the most rewarding and enjoyable aspects of my career has been joining the steering committee of the Endometrial Cancer Action Network for African-Americans (ECANA).

We promote awareness of endometrial cancer and its effects on Black women, and provide a support network for Black patients to share the burden of pain and challenges that accompany a cancer diagnosis and treatment. If you or someone you know is affected by endometrial cancer, I encourage you to join our community to better advocate for yourself and other women.