Racial disparities in survival among women with endometrial cancer in an equal access system

Park, Amie B.; Darcy, Kathleen M.; Tian, Chunqiao; Casablanca, Yovanni; Schinkel, Jill; Enewold, Lindsey; McGlynn, Katherine A.; Shriver, Craig D.; Zhu, Kangmin

doi:10.1016/j.ygyno.2021.07.022

Cited by 25 publications

(22 citation statements)

References 24 publications

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“…Although insurance status was the largest modifiable factor associated with ERR for younger women, we know that even among populations with equal access to care, there continue to be health disparities in survival for Black vs White patients with uterine cancer. 15 Another significant finding of our study was the percentage associated with ERR in survival for histologic subtype. Other studies have shown the differences between histologic subtype, disease stage, and grade for White vs Black patients.…”

Section: Discussionmentioning

confidence: 55%

Factors Associated With Survival Disparities Between Non-Hispanic Black and White Patients With Uterine Cancer

et al. 2023

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ImportanceDisparities in survival exist between non-Hispanic Black (hereafter, Black) and non-Hispanic White (hereafter, White) patients with uterine cancer.ObjectiveTo investigate factors associated with racial disparities in survival between Black and White patients with uterine cancer.Design, Setting, and PatientsThis cohort study used data from the National Cancer Database on 274 838 Black and White patients who received a diagnosis of uterine cancer from January 1, 2004, to December 31, 2017, with follow-up through December 2020. Statistical analysis was performed in July 2022.Main Outcomes and MeasuresOverall survival by self-reported race and evaluation of explanatory study factors associated with hazard ratio (HR) reduction for Black vs White patients. A propensity scoring approach was applied sequentially to balance racial differences in demographic characteristics, comorbidity score, neighborhood income, insurance status, histologic subtype, disease stage, and treatment.ResultsThe study included 32 230 Black female patients (mean [SD] age at diagnosis, 63.8 [10.0] years) and 242 608 White female patients (mean [SD] age at diagnosis, 63.5 [10.5] years) and had a median follow-up of 74.0 months (range, 43.5-113.8 months). Black patients were more likely than White patients to have low income (44.1% vs 14.0%), be uninsured (5.7% vs 2.6%), present with nonendometrioid histologic characteristics (46.1% vs 21.6%), have an advanced disease stage (34.1% vs 19.8%), receive first-line chemotherapy (33.8% vs 18.2%), and have worse 5-year survival (58.6% vs 78.5%). Among patients who received a diagnosis at younger than 65 years of age, the HR for death for Black vs White patients was 2.43 (95% CI, 2.34-2.52) in a baseline demographic-adjusted model and 1.29 (95% CI, 1.23-1.35) after balancing other factors. Comorbidity score, neighborhood income, insurance status, histologic subtype, disease stage, treatment, and unexplained factors accounted for 0.8%, 7.2%, 11.5%, 53.1%, 5.8%, 1.2%, and 20.4%, respectively, of the excess relative risk (ERR) among the younger Black vs White patients. Among patients 65 years or older, the HR for death for Black vs White patients was 1.87 (95% CI, 1.81-1.93) in the baseline model and 1.14 (95% CI, 1.09-1.19) after balancing other factors. Comorbidity score, neighborhood income, insurance status, histologic subtype, disease stage, treatment, and unexplained factors accounted for 3.0%, 7.5%, 0.0%, 56.2%, 10.6%, 6.9%, and 15.8%, respectively, of the ERR among Black vs White patients aged 65 years or older.Conclusions and RelevanceThis study suggests that histologic subtype was the dominant factor associated with racial survival disparity among patients with uterine cancer, while insurance status represented the main modifiable factor for women younger than 65 years. Additional studies of interactions between biology and social determinants of health are merited.

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Section: Discussionmentioning

confidence: 55%

Factors Associated With Survival Disparities Between Non-Hispanic Black and White Patients With Uterine Cancer

et al. 2023

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“…Unfortunately, even in the context of a controlled clinical setting, black women with endometrial cancer seem to fare worse than white women, with lower treatment response rates, shorter periods of remission, and lower rates of survival 68 69. Examination of a military population by Park et al found that even within that equal access setting, black women with endometrial cancer had higher mortality rates, despite adjusting for histologic subtype 70. Huang et al examined whether adherence to endometrial cancer treatment guidelines resolved the gap in outcomes between black and white women and found that even perfect adherence to treatment recommendations did not yield equivalent survival rates for black women 71.…”

Section: Discussionmentioning

confidence: 99%

Disparities in gynecologic cancer incidence, treatment, and survival: a narrative review of outcomes among black and white women in the United States

Towner

Kim

Simon

et al. 2022

Int J Gynecol Cancer

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For patients diagnosed with ovarian, uterine, or cervical cancer, race impacts expected outcome, with black women suffering worse survival than white women for all three malignancies. Moreover, outcomes for black women have largely worsened since the 1970s. In this narrative review, we first provide an updated summary of the incidence and survival of ovarian, uterine, and cervical cancer, with attention paid to differences between white and black patients. We then offer a theoretical framework detailing how racial disparities in outcomes for each of the gynecologic malignancies can be explained as the sum result of smaller white–black differences in experience of preventive strategies, implementation of screening efforts, early detection of symptomatic disease, and appropriate treatment. Much research has been published regarding racial disparities in each of these domains, and with this review, we seek to curate the relevant literature and present an updated understanding of disparities between black and white women with gynecologic malignancies.

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“…There is good evidence to suggest that ethnicity affects outcomes from endometrial cancer (154,155). In the USA, Black women are more likely to be diagnosed with late stage disease and biologically aggressive endometrial cancer phenotypes (high grade, non-endometrioid cancers) than women of White ethnicity (154,(156)(157)(158)(159).…”

Section: Sociodemographic Associations With Prognosismentioning

confidence: 99%

“…In the USA, Black women are more likely to be diagnosed with late stage disease and biologically aggressive endometrial cancer phenotypes (high grade, non-endometrioid cancers) than women of White ethnicity (154,(156)(157)(158)(159). Park and colleagues found that non-Hispanic Black women had significantly shorter overall survival than non-Hispanic White women in an equal access healthcare system, despite correcting for traditional clinico-pathological characteristics, suggesting that other factors including molecular phenotypic differences might be contributing (155). It has been postulated that differential expression of specific tumour markers such as p53, PTEN, HER2/neu and PIK3R1 mutations may explain some of the racial disparities (160,161).…”

Section: Sociodemographic Associations With Prognosismentioning

confidence: 99%

Current and Emerging Prognostic Biomarkers in Endometrial Cancer

2022

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Endometrial cancer is the most common gynaecological malignancy in high income countries and its incidence is rising. Whilst most women with endometrial cancer are diagnosed with highly curable disease and have good outcomes, a significant minority present with adverse clinico-pathological characteristics that herald a poor prognosis. Prognostic biomarkers that reliably select those at greatest risk of disease recurrence and death can guide management strategies to ensure that patients receive appropriate evidence-based and personalised care. The Cancer Genome Atlas substantially advanced our understanding of the molecular diversity of endometrial cancer and informed the development of simplified, pragmatic and cost-effective classifiers with prognostic implications and potential for clinical translation. Several blood-based biomarkers including proteins, metabolites, circulating tumour cells, circulating tumour DNA and inflammatory parameters have also shown promise for endometrial cancer risk assessment. This review provides an update on the established and emerging prognostic biomarkers in endometrial cancer.

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Racial disparities in survival among women with endometrial cancer in an equal access system

Cited by 25 publications

References 24 publications

Factors Associated With Survival Disparities Between Non-Hispanic Black and White Patients With Uterine Cancer

Factors Associated With Survival Disparities Between Non-Hispanic Black and White Patients With Uterine Cancer

Disparities in gynecologic cancer incidence, treatment, and survival: a narrative review of outcomes among black and white women in the United States

Current and Emerging Prognostic Biomarkers in Endometrial Cancer

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