Uterine cancer disparities: the silence Dr. Doll fights

In an interview about her book A Terrible Strength, Dr. Kemi Doll links the under-recognition of uterine cancer in Black women to decades of silence, medical racism, and a culture that teaches people to hide reproductive pain. She also lays out early warning s

The first sign, Dr. Kemi Doll says, is often something so easy to dismiss that it becomes a trap.

Postmenopausal bleeding—12 months since your last cycle. if you’re of menopausal age. followed by bleeding again—is the “number one most common sign of uterine cancer. ” she says. It can look like a full period. or it can be “a few little spots.” She emphasizes that it doesn’t automatically mean cancer. just as “a lump in your breast does not mean you have breast cancer. ” but it does mean it’s time to get checked.

For Black women in the United States. Doll argues. too many people are left to wait—sometimes for years—because the pain is treated as something to endure. not something that should be urgent. The statistics she points to are stark: by age 50. 90 percent of Black people with uteruses in the United States report having fibroids and often have severe symptoms like anemia and intense pain. Black women. she says. are not only more likely to have uterine cancer but twice as likely to die from it than non-Black women. She also points to a separate but related life-and-death disparity: Black women are three to four times more likely to die in childbirth.

Doll’s interview lands in the gap between what people know and what they don’t. Breast cancer, ovarian cancer, and the ongoing maternal mortality crisis are discussed with headlines and public urgency, she says. Uterine cancer. by contrast. “doesn’t receive that same attention from the public. ” even as she says the number of cases is rising every year. “It’s an example of what I’m talking about: the power of silencing,” she adds.

She traces that silence to upbringing and to medical history. Doll describes growing up in a household where reproductive health was handled in hushed tones—period talk reserved for behind closed doors. She connects that culture to a broader pattern: “when a girl has her first period. you teach her how to hide it. That a successful period is one that nobody knows is happening.”.

In Doll’s telling, this lesson doesn’t stop at adolescence. It carries forward into adulthood and can shape what happens in the exam room. She argues that the same expectations that push Black women to endure reproductive pain until it becomes unbearable also collide with the realities of cancer disparity.

The reason, she says, is not just personal reluctance. It’s built into the field.

Doll points to the history of obstetrics and gynecology. saying that physicians once issued insurance policies on enslaved Black women “to say: This woman can reproduce.” After emancipation. she argues. when Black bodies were no longer directly profitable. “there is no interest in the continued health and well-being of that body.”.

That history, she says, helps explain why reproductive disparities persist. She describes how decades of research have not focused on the conditions that most strongly affect Black women. and how treatments. protocols. and clinical guidelines have often failed to consider how they would work for Black patients.

For Doll, the consequences show up in the clinical timeline itself. When suffering is treated as something that can be managed quietly for months or years. she says. Black women can end up arriving at later stages. “What that means is that Black women are showing up with stage three and four cancers. when it’s not curable.”.

This is also where a stereotype—stoicism and excellence—becomes medical risk. Doll says Black women are expected to be stoic and high-achieving, a pressure that shapes whether pain is taken seriously. From the medicine side. she says. there is a particular image of what a woman in pain is supposed to look like. “Black women don’t get to look like that.”.

She argues that the vulnerability can become “not read,” and that it becomes “not legible”—something the system struggles to recognize.

The book at the center of the interview. A Terrible Strength: The Hidden Crisis of the Black Womb and Your Survival Guide to Healing. mixes clinical education with the kind of personal stories Doll says are essential to closing the gap between what gynecology has done and what Black women need to know. Doll calls storytelling a Black tradition and says the “huge gap” is information that needs to be communicated in a way that reaches the people most affected.

Doll is also clear that she didn’t build the book from generic accounts. She says she “knew each of these women that I profiled” and that she is a qualitative researcher who conducts interviews as part of her work. She says the most profound part was how she left each interview with “a completely different level of understanding. ” because she asked each person “so specifically about their womb.”.

The practical side of her message is also direct: uterine cancer has warning signs that are often ignored or dismissed—especially when cycles are irregular, as they can be more common for Black women.

Doll lays out several early signs. The cardinal sign is postmenopausal bleeding as defined by bleeding after 12 months without a cycle at menopausal age. She adds that another potential sign. particularly for Black women who are more likely to have irregular cycles. is “heavier cycles as they get older. instead of lighter.”.

Fatigue is another. Doll says she begins to address whether Black women even know when they’re tired—because, again, endurance can hide what the body is telling you.

She includes pelvic pressure as a sign. and she points to bleeding after sex in people “in your fifties and sixties” as another warning sign. something she says “we also don’t talk about.” Her blunt instruction is aimed at the moment many people would try to minimize: “if you’re bleeding after sex. I need to see you.”.

But education, she argues, doesn’t end at symptoms.

Doll ties the crisis to funding and research timelines. laying out how even if people understand the warning signs today. the next breakthroughs can be delayed. She points to cuts she says have happened before even the start of former President Donald Trump’s second term. writing that “less than 8 percent of funding for the National Institutes of Health going toward women’s health research in 2023” has left women’s health research underfunded. She pairs that with “cuts to reproductive health research on top of the DEI initiatives by our current administration. ” calling the situation “ominous.”.

She also describes the long arc of stalled studies: “A study that was canceled today would have some output in two years, four years, and five years,” she says—then argues the downstream discoveries are delayed “potentially decades.” “It’s really sad,” she adds.

Still, she says she and others in the field are not going away. “I’m still running my research lab,” she says. “We’re still figuring out funding. We’re still getting creative.” Her focus, she says, is on “Black women and the Black womb,” using science “to improve things, period.”

The last point in the interview circles back to the personal moment of walking into a doctor’s office. Doll says distrust doesn’t come out of nowhere; medical racism is “very much alive. ” and it is tied to how Black women have been treated in gynecology. including the idea that Black women were more appropriate to experiment on than white women.

And yet, she tells Black women they don’t need to be historians of gynecology to know what to expect when seeking care for the “intimate parts of ourselves” that are often kept private. “You are on guard for being dismissed, being neglected,” she says.

Then she turns the responsibility into something unmistakably urgent and protective. “Black women, you need to go to the gynecologist,” Doll says. As she puts it—speaking as a gynecologic oncologist and cancer physician—“I want you to live.”

uterine cancer Black women fibroids medical racism obstetrics and gynecology gynecologic oncology NIH funding reproductive health research