Objective: The clinical characteristics and outcomes of endometrial cancer in women 45 years of age or younger evaluated and treated at the community hospital level are presented. Methods: A series of 500 consecutive women with endometrial cancer operated on by the author over a nine-year period of time was used to identify women 45 years of age or younger and compared to older patients from the author’s data base. Results: Although the majority of patients presented with clinical stage I disease, 30% of women 45 years of age or younger had occult metastatic disease and 5.0% had clear cell or papillary serous histology, similar to the older patient population. In addition, survival was similar in both groups of patients. Serum CA-125 was useful in identifying patients with possible occult metastatic disease in the group of women 45 years old or younger. Conclusion: Patients 45 years of age or younger with uterine cancer are not ipso facto a “lower risk” group of patients; efforts to preserve fertility should be balanced against a thorough effort to identify those individuals at higher risk for occult metastases.