{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T13:56:41Z","timestamp":1790344601710,"version":"4.1.0"},"reference-count":42,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100018138","name":"Kuni Foundation","doi-asserted-by":"publisher","award":["Discovery Grants for Cancer Research: Advancing In"],"award-info":[{"award-number":["Discovery Grants for Cancer Research: Advancing In"]}],"id":[{"id":"10.13039\/100018138","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NIH","award":["R01 MD011680"],"award-info":[{"award-number":["R01 MD011680"]}]},{"name":"NIH","award":["Ruth L. Kirschstein National Research Service Awar"],"award-info":[{"award-number":["Ruth L. Kirschstein National Research Service Awar"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Prim Care Community Health"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>Endometrial cancer incidence and mortality disproportionately affect Black patients, and delayed diagnosis is a contributor. Providers in multiple settings share the task of endometrial cancer diagnosis. The purpose of this study is to elicit physician perspectives on national guidelines for the diagnosis of endometrial cancer (EC), understanding of racial disparities in EC, and to explore physician receptivity to a risk-based, endometrial biopsy (EMB)-first approach of peri\/postmenopausal bleeding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We performed semi-structured interviews with 12 U.S. physicians across multiple specialties. Interview structure was developed and refined using an iterative process. We used inductive reasoning to employ exploratory content analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We interviewed OB\/Gyn (n\u2009=\u20094), family medicine (n\u2009=\u20093), internal medicine n\u2009=\u20093), and emergency medicine (n\u2009=\u20092) physicians in all regions of the U.S. Slightly over half (58%) performed EMB. Most (58%) were uncertain about guidelines for diagnosis. Nearly half (42%) reported lack of knowledge regarding racial disparities in EC diagnosis and cancer outcomes. OB\/Gyn physicians were skeptical of guideline efficacy in high-risk patients, including patients identifying as Black. Most (75%) physicians supported a risk-based, biopsy-first approach to diagnosis of EC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Physicians caring for patients at risk for EC lack knowledge of current guidelines and of racial disparities in endometrial cancer diagnosis and outcomes. A multi-pronged approach, incorporating changes to national guidelines and targeted provider education, is necessary to eliminate inequities in diagnosis of EC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21501319251346096","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T04:53:47Z","timestamp":1750136027000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Physician Uncertainty, Beliefs, and Practices on Peri- and Postmenopausal Bleeding Evaluation and the Impact on Risks for Black Patients at Risk for Endometrial Cancer"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6451-755X","authenticated-orcid":false,"given":"Maya","family":"Gross","sequence":"first","affiliation":[{"name":"Obstetrics and Gynecology, University of Washington, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrice","family":"Williams","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, University of Washington, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Whitney","family":"Robinson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Marsh","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mollie","family":"Wood","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of North Carolina Wilmington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Til","family":"St\u00fcrmer","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of North Carolina Wilmington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minerva","family":"Orellana","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, University of Washington, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kemi","family":"Doll","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, University of Washington, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,6,17]]},"reference":[{"key":"e_1_3_2_2_2","unstructured":"Common Cancer Sites \u2014 Cancer Stat Facts. n.d. Accessed September 30 2024. https:\/\/seer.cancer.gov\/statfacts\/html\/common.html"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.3322\/CAAC.21708"},{"key":"e_1_3_2_4_2","unstructured":"NCI Cancer Stat Facts; n.d."},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/JNCICS\/PKAD001"},{"key":"e_1_3_2_6_2","unstructured":"National Cancer Institute. Corpus and Uterus NOS Recent Trends in U.S. Age-Adjusted Mortality Rates 2000-2020. n.d. Accessed July 31 2023. https:\/\/seer.cancer.gov\/statistics-network\/explorer\/application.html?site=58&data_type=2&graph_type=2&compareBy=race&chk_race_1=1&chk_race_6=6&chk_race_5=5&chk_race_4=4&chk_race_9=9&chk_race_8=8&hdn_sex=3&age_range=1&advopt_precision=1&advopt_show_ci=on&hdn_view=0&advopt_show_apc=on&advopt_display=2"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.00151"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21555"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-15-0316"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2022.0009"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2023.11.029"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2018.09.040"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004333"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2023-181912"},{"issue":"9","key":"e_1_3_2_15_2","first-page":"551","article-title":"Endometrial biopsy: tips and pitfalls","volume":"101","author":"Williams PM","year":"2020","unstructured":"Williams PM, Gaddey HL. Endometrial biopsy: tips and pitfalls. Am Fam Physician. 2020;101(9):551-556.","journal-title":"Am Fam Physician"},{"key":"e_1_3_2_16_2","unstructured":"Committee on Practice Bulletins - Gynecology and the Society of Gynecologic Oncology. ACOG Practice Bulletin: Endometrial Cancer. ACOG; 2017."},{"key":"e_1_3_2_17_2","unstructured":"The American College of Obstetricians and Gynecologists. ACOG Committee Opinion #734: The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding. ACOG; 2018."},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.4954"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2018.11.002"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.18865\/ed.30.4.543"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2021.1700"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2024.1891"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/J.YGYNO.2005.09.042"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.12.023"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1080\/01443610410001722671"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.2022.0534"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2018.12.004"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1177\/1049732315588501\/FORMAT\/EPUB"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/1525822X05279903"},{"key":"e_1_3_2_30_2","unstructured":"Dedoose. n.d. Accessed July 31 2024. https:\/\/www.dedoose.com\/?gad_source=1&gclid=CjwKCAjw5Ky1BhAgEiwA5jGujn_OHpBL1q4R9XvgXaX9TBOV1yzWgcJi9th7lxIEk1-k7GKr6JArWxoCn_wQAvD_BwE"},{"key":"e_1_3_2_31_2","unstructured":"Geographic Division or Region - Health United States. n.d. Accessed July 31 2024. https:\/\/www.cdc.gov\/nchs\/hus\/sources-definitions\/geographic-region.htm"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2022.11.015"},{"key":"e_1_3_2_33_2","unstructured":"Cancer Disparities - NCI. n.d. September 6 2023. https:\/\/www.cancer.gov\/about-cancer\/understanding\/disparities"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2020.01.032"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318262e320"},{"key":"e_1_3_2_36_2","unstructured":"Uterine cancer is on the rise especially among Black women. The New York Times. n.d. Accessed August 4 2024. https:\/\/www.nytimes.com\/2022\/06\/17\/health\/uterine-cancer-black-women.html"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000825508.75128.F5"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2018.12.012"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1136\/EMERMED-2021-211878"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2021.11.010"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1097\/GME.0000000000002411"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1371\/JOURNAL.PONE.0289692"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2024.01.010"}],"container-title":["Journal of Primary Care &amp; Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21501319251346096","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/21501319251346096","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21501319251346096","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:23:15Z","timestamp":1777508595000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/21501319251346096"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,17]]},"references-count":42,"alternative-id":["10.1177\/21501319251346096"],"URL":"https:\/\/doi.org\/10.1177\/21501319251346096","relation":{},"ISSN":["2150-1319","2150-1327"],"issn-type":[{"value":"2150-1319","type":"print"},{"value":"2150-1327","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,17]]},"article-number":"21501319251346096"}}