Endometrial cancer is the most common gynecological cancer in the United States, with roughly 67,000 new cases diagnosed each year. About 3 in every 100 women will develop it during their lifetime. While most cases are caught early and have excellent survival rates, incidence has been climbing steadily, particularly among younger women and certain racial groups.
Incidence by the Numbers
Globally, endometrial cancer (sometimes called uterine cancer) accounts for over 420,000 new cases per year, making it one of the most frequently diagnosed cancers in women worldwide. In the U.S., it ranks as the fourth most common cancer among women overall, behind breast, lung, and colorectal cancers. The majority of cases are diagnosed in women over 55, with a median age at diagnosis around 60. Still, roughly 5% of cases occur in women under 40.
The overall trend is upward. Deaths from uterine cancer across all racial and ethnic groups increased 1.8% per year between 2010 and 2017, a pattern driven by both rising obesity rates and a shift toward more aggressive cancer subtypes.
Rising Rates in Younger Women
One of the more striking trends is the increase among women who are nowhere near the typical age of diagnosis. Between 2001 and 2017, the incidence among women aged 20 to 29 doubled, climbing from 0.6 to 1.2 per 100,000. Among women in their 30s, rates rose from 4.6 to 7.5 per 100,000 over the same period. That translates to roughly a 3% annual increase in both age groups.
These numbers are still small in absolute terms. A 30-year-old woman’s individual risk remains low. But the pace of the increase has caught the attention of researchers, largely because it tracks closely with rising obesity rates in younger populations.
How Obesity Affects Risk
Excess body fat is the single strongest modifiable risk factor for endometrial cancer. Fat tissue produces estrogen, and chronic estrogen exposure without adequate progesterone to balance it drives abnormal cell growth in the uterine lining.
A large meta-analysis of 19 studies found that for every 5-point increase in BMI, a woman’s risk of endometrial cancer rose by 59%. The Million Women Study in the UK reported even steeper numbers: for every 10-point increase in BMI, risk nearly tripled. Women with a BMI over 40 face more than six times the risk of dying from uterine cancer compared to women at a healthy weight. This dose-response relationship is one of the most consistent findings in cancer epidemiology.
Racial and Ethnic Disparities
While white women are diagnosed with endometrial cancer at slightly higher rates overall, Black women die from it at more than double the rate of other racial and ethnic groups. This gap reflects several overlapping factors. Black women are more likely to be diagnosed with aggressive, non-endometrioid subtypes of uterine cancer, which grow faster and respond less well to standard treatments. They also tend to be diagnosed at later stages and face well-documented disparities in access to timely, high-quality care.
The mortality gap has been widening, not narrowing, which makes it one of the starkest racial disparities in cancer outcomes in the U.S.
Genetic Risk and Lynch Syndrome
A small but significant percentage of endometrial cancers are driven by inherited genetic mutations rather than lifestyle factors. The most important is Lynch syndrome, a condition that impairs the body’s ability to repair DNA errors. Women with Lynch syndrome have a 40% to 60% lifetime chance of developing endometrial cancer, compared to roughly 3% in the general population.
Lynch syndrome also raises the risk of colorectal, ovarian, and several other cancers. It’s estimated to account for 2% to 5% of all endometrial cancer cases. Women diagnosed with endometrial cancer before age 50, or those with a strong family history of Lynch-associated cancers, are often tested for the mutation. Knowing your Lynch status can guide screening schedules and preventive options, including the possibility of risk-reducing surgery after childbearing is complete.
Survival Rates by Stage
The good news is that endometrial cancer tends to announce itself early. Abnormal vaginal bleeding, especially after menopause, is the hallmark symptom, and it typically shows up before the cancer has spread. As a result, the majority of cases are caught at a localized stage.
The five-year relative survival rates, based on SEER data from 2016 to 2022, break down clearly by how far the cancer has progressed at diagnosis:
- Localized (confined to the uterus): 94.9%
- Regional (spread to nearby lymph nodes): 70.1%
- Distant (spread to other organs): 19.9%
That steep drop from regional to distant disease underscores why early detection matters so much. There is no routine screening test for endometrial cancer the way there is for cervical or breast cancer. Instead, the key is paying attention to symptoms. Any unexpected vaginal bleeding after menopause, or unusually heavy or irregular bleeding before menopause, warrants evaluation. Most of the time, the cause will be something benign. But when it is cancer, catching it while it’s still localized makes a dramatic difference in outcomes.
Other Factors That Raise or Lower Risk
Beyond weight and genetics, several other factors shift the odds. Conditions that increase lifetime estrogen exposure raise risk: early menstruation (before age 12), late menopause (after 55), never having been pregnant, and estrogen-only hormone therapy without progesterone. Polycystic ovary syndrome (PCOS) is another contributor because it causes irregular ovulation and prolonged periods without progesterone.
On the protective side, factors that reduce estrogen exposure or introduce progesterone lower risk. Pregnancy, breastfeeding, and the use of combination hormonal contraceptives all provide some degree of protection. Physical activity independently lowers risk, even after accounting for its effect on body weight. Women who use combination birth control pills for several years can reduce their endometrial cancer risk by roughly 30% to 50%, with the benefit lasting for over a decade after stopping.