Denise J. Roe

Background: In 2025, Endometrial cancer (EC) is the 6th most common cancer in women globally, with rising cases in younger patients and communities of color. EC risk factors include postmenopausal status, family history, diabetes, and hyperestrogenic state conditions. Methods: We retrospectively reviewed charts of patients who received hysterectomies or hysteroscopies for either cancerous and/or benign diagnoses between 2016 and 2021 at a university hospital in Phoenix (AZ). Sociodemographic and clinical data were collected. The Arizona Social Vulnerability Index was utilized to understand contributors to EC diagnosis outcomes. Kruskal‐Wallis, Fisher's exact, and multinomial logistic regression tests were used to compare EC to benign conditions. Results: Two hundred sixty‐one patients were diagnosed with benign conditions ( n = 31), hyperplasia ( n = 53), or EC ( n = 168). EC patients were older ( p = 0.016), mostly post‐menopausal ( p = 0.008), and more frequently had diabetes ( p = 0.001) compared to patients with benign conditions. Native Americans had a higher percentage of EC cases relative to other races ( p = 0.07) and presented with EC at significantly younger ages (49.79 years, p = 0.001) and with more comorbid diagnoses of diabetes (38.5%, p = 0.051) compared to Whites (61.99 years, 27.1%). Hispanic patients also presented with EC at younger ages (53.74, p = 0.006) compared to non‐Hispanics (61.56 years). Higher vulnerability in Housing Type and Transportation scores ( p = 0.045) among patients diagnosed with EC was observed. Conclusion: Public health initiatives should target modifiable risk factors contributing to increased EC rates at younger ages, especially in Native American and Hispanic communities. Differences in housing and transportation highlight social structures and health accessibility as areas for improving EC outcomes.

Supplementary Table S1: 16S rRNA sequencing data.

Supplementary Figure S2: BV-associated bacteria positively correlate with each other and negatively correlate with Lactobacillus species, including L. crispatus and L. jensenii.

Supplementary Table S4: Differences in global health and perceived stress measurements between hrHPV-positive and hrHPV-negative participants.

Supplementary Table S3: Differences in global health and perceived stress measurements between participants with Lactobacillus-dominant microbiota and non-Lactobacillus-dominant microbiota.

Supplementary Figure S1: Vaginal microbiota profiles cluster based on Lactobacillus dominance and not clinical or sociodemographic factors.

Supplementary Table S5: Differences in global health and perceived stress measurements between Native and non-Native participants.

Supplementary Figure S3: Associations of Lactobacillus abundance with race, vaginal pH, and HPV status.

Supplementary Table S2: Differences in demographic, socioeconomic and behavioral/life style factors between participants with Lactobacillus-dominant microbiota and non-Lactobacillus-dominant microbiota.