ATLANTA - Uterine cancer is the fourth most common cancer in women and the most common gynecological cancer, with a prediction of 42,000 new cases and almost 8,000 deaths this year, according to the American Cancer Society.

While this uterine disease - also called endometrial cancer - is more frequent in whites, the death rate is more than 80% higher in blacks, according to the latest data from the Surveillance Epidemiology and End Results Program of the National Cancer Institute.

Cyril Spann Jr., M.D., professor of gynecology and obstetrics at the Emory Clinic in Atlanta, said while some of the racial disparity tends to look biological, endometrial cancer unfortunately is mainly a disease of the obese, diabetic and hypertensive population. "Some of it is biological but I think most cases of endometrial/uterine cancer are due to lifestyle choices," he said. "Obesity is a major factor in the etiology of endometrial/uterine cancer.

If we control weight then the majority of endometrial cancer would probably be eliminated."

Spann added he also thinks it is mainly an issue of education. "Those who are economically disadvantaged often are educationally deprived also. If one does not know what the early symptoms of cancer are then one is likely to present for diagnosis later when treatment is more difficult and less efficacious," said Spann. "Also, if a patient has limited resources, she may be discouraged to seek out care even though she has knowledge of the warning signs. This is an argument for universal healthcare." However, women who take hormone replacement therapy of estrogen without progesterone do have a higher incidence.

"The risk decreases when estrogen and progesterone are used together," said Spann. "This is true. The likelihood that a patient will be prescribed estrogen in this way during this era is very low however."

Spann said there are plenty of warning signs, including abnormal vaginal or uterine bleeding. "Most cases are those patients who are menopausal and over 51(have gone through the change)," he said. "However younger patients--especially obese ones, with bleeding in between periods or unpredictable periods are also at risk."

He said that cervical cancer could also be a cause of post menopausal bleeding.

A dilation and curettage procedure can let women know for sure. Spann said the procedure is often described as "scraping of the womb." "This procedure gathers tissue from inside the uterus or womb so that it can be carefully examined in the lab under the microscope," he said. "A diagnosis can then be made. A newer technique is to obtain tissue in the office with a very small plastic suction device. It is very well tolerated with minimal pain experienced by most patients. An aspirin can be taken 30 minutes prior to the procedure for those patients who may have low pain tolerance."

He said while there is no screening test for the disease, if the patient has abnormal bleeding, an ultrasound and endometrial biopsy can aid the healthcare provider in making a diagnosis. "Remember that the abnormal bleeding should be the trigger for the evaluation. If the patient is under 50 then pregnancy has to be considered also," he said.

So what about a cure?

"The best cure is prevention....avoid obesity," he said. Spann added that the next lesson is for women to report to or contact a healthcare professional if she has abnormal bleeding over the age of 35(especially if obese). "If she is over 50 then this contact must be made as soon as possible. If the disease is found early in its course then a simple hysterectomy is curative. Patients with more advanced disease may need radiation and / or chemotherapy in addition to hysterectomy" Spann added, to avoid the disease, patients must understand the importance of education when it comes to dietary intake and regular exercise. Fruits vegetables and diets low in starch are important to avoid endometrial/ uterine cancer and in addition to diabetes and heart disease.