Endometrial Cancer Rates Climb Fastest in San Antonio Region, Texas Study Finds

An Upper-South region of Texas that includes San Antonio and Bexar County carries the state’s highest hysterectomy-corrected incidence of endometrial cancer and has experienced the largest increase over time, according to a study led by scientists at The University of Texas at San Antonio Health Science Center and the National Cancer Institute.

Endometrial cancer is the most common gynecologic cancer in the United States. While several other cancer types are declining across the country, endometrial cancer is moving in the opposite direction, and the rise is especially pronounced in South Texas. The disease is often diagnosed early and is highly survivable, yet both its incidence and its mortality rates have increased sharply over the past twenty years. That combination, a cancer that is typically caught in time but is nonetheless killing more women, is one of the central puzzles the research team set out to address.

The study drew on population-based data from 42,571 Texas women ages 20 to 79 who were diagnosed with endometrial cancer between 2000 and 2019, using the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program. The researchers compared eight Texas Health Service Regions, allowing them to map where the disease concentrates and where it is growing fastest. The Upper-South region, which includes San Antonio and Bexar County, showed the highest hysterectomy-corrected incidence in the state and the largest increase over the study period, climbing from 42.6 cases per 100,000 women in 2000-2009 to 53.8 per 100,000 in 2010-2019.

Principal investigator Edward R. Kost, MD, professor of gynecologic oncology in the Department of Obstetrics and Gynecology at the Long School of Medicine and a gynecologic oncologist at the Mays Cancer Center at UT Health San Antonio, said the goal is to figure out why endometrial cancer rates are rising and which populations are most affected. “The mission of the Mays Cancer Center is to reduce the burden of cancer in San Antonio, South Texas and beyond,” Kost said. “To do that, we need to understand the cancers that affect our local population.”

One of the study’s most striking findings concerns age. Among women under 50, Hispanic women had the highest incidence of endometrial cancer compared with the other groups included in the analysis. Statewide, the hysterectomy-corrected incidence rate among women under 50 was 12.4 per 100,000 among Hispanic women, compared with 8.9 among non-Hispanic white women and 5.6 among non-Hispanic Black women. In the Upper-South region, the early-onset incidence among Hispanic women reached 17.2 per 100,000, a figure that underscores how sharply the burden is concentrated in this part of the state. The study also found that non-Hispanic Black women had higher rates of non-endometrioid tumors, the more aggressive form of the disease, and poorer five-year relative survival.

“Part of our responsibility is to understand the cancer burden of the population we serve, and we found cancer disparities that are affecting our community,” Kost said. The age pattern amplifies that concern. Institutional tumor registry data from Bexar County suggest that approximately 25 percent of endometrial cancer patients there were younger than 50 at diagnosis, compared with approximately 15 percent nationally, according to Kost.

The most common treatment for endometrial cancer is hysterectomy, the surgical removal of the uterus. For carefully selected women with early endometrial cancer who want to preserve fertility, more conservative options exist. These can include progestin therapy, often delivered with an intrauterine device, close endometrial surveillance with repeat biopsies, and efforts to address obesity and other metabolic risk factors through diet modification, exercise, and, when appropriate, consideration of weight reduction with GLP-1 medications or bariatric surgery. Even when the cancer is successfully controlled and fertility is preserved, achieving a pregnancy can present challenges. Many women may need to see a reproductive endocrinologist, and the process can be grueling, expensive and not always successful. “Wanting to have a child is one of the strongest desires a human can have,” Kost said. “We do everything we can to preserve a woman’s ability to have children, but there are so many hurdles, and the primary goal is to get the cancer into remission.”

Why rates are climbing remains an open question, and the study is explicit about the limits of what it can answer. One of the greatest risk factors for endometrial cancer is increased body mass index (BMI), and while scientists are still working to understand why endometrial cancer rates are increasing, rates of early-onset endometrioid cancer have risen in parallel with increasing rates of obesity. Crucially, however, BMI and individual-level metabolic factors such as obesity, diabetes, hypertension and fatty liver disease were not available variables in the SEER data used for this study, so the observed regional and ethnic disparities cannot yet be tied to specific metabolic causes. Kost said the research team hopes to study population-level differences at a more granular level to better understand the factors that may contribute to the observed disparities. This initial study identifies the problem; the next step is a closer look at metabolic factors, social determinants of health, geographic differences and other known risk factors in the Upper-South region to see where they overlap with endometrial cancer rates.

That next phase will lean on geospatial analysis. Kost said the team plans to use geospatial methods to examine how cancer rates overlap with various risk factors across populations. “We want to understand how cancer incidence and potential risk factors overlap at a much more local level, including census-tract-level geography,” he said.

One of the strengths of the study, the authors note, is the collaborative team behind it, which brought together expertise in cancer epidemiology, population health, cancer biology and gynecologic oncology. The paper, “Regional and Statewide Hysterectomy-Corrected Endometrial Cancer Incidence and Five-Year Relative Survival in Texas,” was published July 20, 2026, in Cancer Epidemiology by Akemi T. Wijayabahu, Nicolas Wentzensen, Nameer B. Kirma, Lillian Lin-Smith, Wayne R. Lawrence, Chen-Pin Wang and Edward R. Kost. “Ultimately, the purpose is to move from identifying disparities to understanding their causes and developing better prevention, early detection, outreach and care,” Kost said. For now, the study establishes a clear and measurable fact: in the region anchored by San Antonio, endometrial cancer is more common, rising faster and striking younger women, particularly Hispanic women under 50, at rates that demand explanation. The Mays Cancer Center at UT Health San Antonio, one of only four National Cancer Institute-designated Cancer Centers in Texas, is positioned to pursue that explanation with the clinical and research infrastructure the question requires.

Subject of Research: Regional disparities in endometrial cancer incidence and survival across Texas

Article Title: UT San Antonio Health Science Center study finds state’s highest endometrial cancer rates in San Antonio region

Article References: UT San Antonio Health Science Center study finds state’s highest endometrial cancer rates in San Antonio region. Original publication (Bibliographic details unavailable.)

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Keywords: endometrial cancer, gynecologic oncology, Texas, San Antonio, Bexar County, SEER data, health disparities, Hispanic women, early-onset cancer, obesity, Cancer Epidemiology, hysterectomy-corrected incidence