Barriers to the recognition and evaluation of abnormal uterine bleeding among individuals at increased risk for endometrial Cancer

Objective To evaluate knowledge of abnormal uterine bleeding (AUB) and postmenopausal bleeding (PMB) as symptoms of endometrial cancer (EC), assess understanding of diagnostic evaluation, and identify barriers and facilitators to care. Methods We conducted a web-based survey of participants ( N = 603) with a history of AUB/PMB and increased risk for EC. The survey, informed by semi-structured interviews, assessed symptom recognition, knowledge of EC, familiarity with diagnostic evaluation, and healthcare-seeking behaviors. Descriptive statistics, chi-square tests, and multivariable logistic regression evaluated associations between demographic, clinical factors and study outcomes. Results Although 78% recognized abnormal bleeding within six months, 21% reported delayed recognition and 25% had not sought evaluation. Only 12% identified AUB/PMB as a potential symptom of cancer, with participants aged ≥45 years less likely to make this association. While 75% sought medical care, 28% reported that their healthcare provider was not concerned about their bleeding; among these participants, 60% reported experiencing symptom dismissal. Familiarity with endometrial biopsy was lower among Medicaid-insured participants (OR 0.50, 95% CI 0.33–0.77). More convenient testing options increased self-reported motivation to seek evaluation. Conclusions Knowledge gaps, delayed symptom recognition, and experiences of symptom dismissal identify potential barriers along the pathway to evaluation of abnormal bleeding.