INTRODUCTION: We sought to compare cancers currently screened for and uterine cancers (UC) due to its relative ascendancy in incidence, using a vanguard of contemporary cancer risk with high non-communicable disease rates (American Samoa [AS]), as a demonstration project in a population with disparities. METHODS: Public access de-identified databases covering the entire national population of AS over several time periods. RESULTS: The annualized incidence of UC increased from 21/100,000 women/year (2004) to 50 (2011) to 60 (2015) and eclipsed breast, colon, and skin since 2011. Gynecologic cancers were the leading cause of cancer death among women after lung since approximately 2014. UC was the leading cause of gynecologic deaths (1.6x greater than ovarian or cervical) and was 33% more likely to be diagnosed than breast cancer, 3.8x greater than colon, 4.6x cervical, 7.7x ovarian, and 23x lung. Compared to mainland incidence, uterine was 2.3x and cervical 1.5x greater on AS. In a recent 24-month period, there were 33 UCs among 291 biopsies for abnormal bleeding (PPV 33/291 11.3%). The median age was 55 with 25% <50 years old; BMI-38.2 with 95% > 30; and 33.3% grade 3. CONCLUSION: This may be the first report of UC being the leading cause of cancer death in any population. UC has similar characteristics to currently screened cancers with an incidence in this high-risk population just under breast and prostate, but ahead of lung and colon. An enriched population, eg, BMI combined with age, especially with disparities, could benefit most from changes in screening strategy and management.