Racial and Ethnic Differences in Hysterectomy-Corrected Uterine Corpus Cancer Mortality by Stage and Histologic Subtype

Abstract

IMPORTANCE Uterine cancer incidence has been increasing, particularly rates of aggressive, nonendometrioid subtypes, which are disproportionately higher among non-Hispanic Black women. The association of subtype-specific trends with uterine cancer mortality and with the role of tumor subtype and stage at diagnosis with racial disparities in uterine cancer deaths at the population-based level are not known.OBJECTIVE To estimate histologic subtype-and stage-specific uterine cancer mortality rates by race and ethnicity, corrected for hysterectomy. DESIGN, SETTING, AND PARTICIPANTSThis cohort study used the US Surveillance, Epidemiology, and End Results-18 Incidence-Based Mortality database, representing approximately 26% of the US population and including deaths that occurred from 2000 to 2017. Hysterectomy correction was based on hysterectomy prevalence data from the Behavioral Risk Factor Surveillance System. Uncorrected and corrected rates associated with uterine corpus cancer cases diagnosed between 2000 and 2017 and uterine corpus cancer deaths occurring between 2010 and 2017 were age-adjusted to the 2000 US standard population and are expressed per 100 000 person-years, and annual percent changes in rates were calculated using log-linear regression. Data analysis was performed from March 10 to May 20, 2021.EXPOSURES Tumor histologic subtype, cancer stage at diagnosis, and race and ethnicity.

SMAD2/3 signaling in the uterine epithelium controls endometrial cell homeostasis and regeneration

“…Uncovering the pathways that underlie normal endometrial homeostasis and regeneration is critical for designing improved therapies that target endometrial pathologies. This is especially true for endometrial cancer, which displays a rapidly rising incidence in the United States and world-wide 65,66 . Approximately 65,000 women will be diagnosed with endometrial adenocarcinoma in 2022, leading to ~12,550 deaths 67 .…”

Alarming trends and disparities in high-risk endometrial cancer

“…Overall, this reflects the largest black-white survival disparity of all cancers with black women experiencing a 63% 5-year relative survival with uterine cancer compared with 84% in white women. While later stage at diagnosis, more aggressive tumor histology, and lower likelihood of timely treatment contribute to this survival disparity, none of these factors completely account for the vast disparities experienced by black women [6,11]. In this review, we highlight recent publications that have focused on the trends and disparities among women diagnosed with high-risk uterine cancer.…”

“…Serous carcinoma, the most frequent of the nonendometrioid histologic subtypes, increased 4.88% annually [5]. Thus, while uterine cancer overall is increasing approximately 1% per year, this trend is largely driven by nonendometrioid histologic subtypes, with the sharpest increase observed among Asian, Hispanic, and non-Hispanic black women [6].…”

Surveillance Strategies in Endometrial Cancer Care: Why Less Represents Progress

“…Moreover, the rising incidence of endometrial cancer in 26 of 43 countries studied recently highlights this as a global public health problem. 2…”

“…Moreover, the rising incidence of endometrial cancer in 26 of 43 countries studied recently highlights this as a global public health problem. 2 There are more than 600,000 endometrial cancer survivors in the United States and millions globally. 3 Given this rapidly growing population, cancer surveillance-aimed at the early detection of recurrent disease-has become an increasingly important part of survivorship.…”