Role of bleeding recognition and evaluation in Black-White disparities in endometrial cancer

Doll, Kemi M.; Khor, Sara; Odem‐Davis, Katherine; He, Hao; Wolff, Erika M.; Flum, David R.; Ramsey, Scott D.; Goff, Barbara A.

doi:10.1016/j.ajog.2018.09.040

Cited by 43 publications

(44 citation statements)

References 18 publications

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“…P. somerae detection could therefore be pursued for development as a potential EC biomarker test for patients at high risk of developing EC, who may not experience or recognize early disease symptoms, which could help address marked health disparities that exist in EC 9 . This becomes of particular interest to pursue given that P. somerae was detected in all Type II EC cases in our study, which is more prevalent in black women 8,42 . Given that the vaginal microbiome of black women is often characterized by a higher diversity index 15 , the colonization by the ECbiome and P. somerae in particular may be facilitated, which could lead to a higher propensity for the development of microbiome derived cancer transformations.…”

Section: Discussionmentioning

confidence: 85%

“…Type II EC develops in a background of endometrial atrophy, but hormonal risk factors are unknown, making early identification and treatment important to improved patient prognosis 5,7 . Importantly, Type II EC is less likely to manifest early through postmenopausal bleeding, and is more common among Black women 8 , contributing to the existing health disparities in the disease outcome 9 .…”

Section: Introductionmentioning

confidence: 99%

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Postmenopause as a key factor in the composition of the Endometrial Cancer Microbiome (ECbiome)

Walsh

Hokenstad

Chen

et al. 2019

Sci Rep

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Incidence rates for endometrial cancer (EC) are rising, particularly in postmenopausal and obese women. Previously, we showed that the uterine and vaginal microbiome distinguishes patients with EC from those without. Here, we sought to examine the impact of patient factors (such as menopause status, body mass index, and vaginal pH) in the microbiome in the absence of EC and how these might contribute to the microbiome signature in EC. We find that each factor independently alters the microbiome and identified postmenopausal status as the main driver of a polymicrobial network associated with EC (ECbiome). We identified Porphyromas somerae presence as the most predictive microbial marker of EC and we confirm this using targeted qPCR, which could be of use in detecting EC in high-risk, asymptomatic women. Given the established pathogenic behavior of P. somerae and accompanying network in tissue infections and ulcers, future investigation into their role in EC is warranted.

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Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Postmenopause as a key factor in the composition of the Endometrial Cancer Microbiome (ECbiome)

Walsh

Hokenstad

Chen

et al. 2019

Sci Rep

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“…Unfortunately, non-Hispanic black women are less likely to receive guideline-concordant clinical care for symptoms associated with endometrial carcinoma. Regrettably, women who do not receive guideline-concordant care are more likely to have high-risk carcinomas [21].…”

Section: Biologic Differences In Low- and High-risk Histologic Endmentioning

confidence: 99%

Unique Molecular Features in High-Risk Histology Endometrial Cancers

Pandita

Wang

Jones

et al. 2019

Cancers

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Endometrial cancer is the most common gynecologic malignancy in the United States and the sixth most common cancer in women worldwide. Fortunately, most women who develop endometrial cancer have low-grade early-stage endometrioid carcinomas, and simple hysterectomy is curative. Unfortunately, 15% of women with endometrial cancer will develop high-risk histologic tumors including uterine carcinosarcoma or high-grade endometrioid, clear cell, or serous carcinomas. These high-risk histologic tumors account for more than 50% of deaths from this disease. In this review, we will highlight the biologic differences between low- and high-risk carcinomas with a focus on the cell of origin, early precursor lesions including atrophic and proliferative endometrium, and the potential role of stem cells. We will discuss treatment, including standard of care therapy, hormonal therapy, and precision medicine-based or targeted molecular therapies. We will also discuss the impact and need for model systems. The molecular underpinnings behind this high death to incidence ratio are important to understand and improve outcomes.

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“…In addition, different levels of health education between populations are a possibility. In particular, there may be differences in the recognition of the importance of postmenopausal vaginal bleeding by racial/ethnic group, a key sign of possible EC which warrants medical investigation and can affect timely treatment [38].…”

Section: Plos Onementioning

confidence: 99%

The role of histology on endometrial cancer survival disparities in diverse Florida

et al. 2020

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Background Endometrial cancer (EC) mortality is particularly high among non-Hispanic Blacks and is twice that of non-Hispanic Whites. However, comparisons of EC survival outcomes by race/ ethnicity are often confounded by histology and grade. Here, we analyze EC survival disparities in multiracial Florida with a focus on EC types (1 and 2) and subtypes, defined according to histology and grade. Methods All 27,809 cases of EC diagnosed during 2005-2016 were obtained from the Florida Cancer Registry. Age-standardized, 5-year cause-specific survival by race/ethnicity and histological type were calculated. Fine and Gray competing risk regression was used to estimate subdistribution hazard ratios (sHRs) for associations between risk of death due to EC and potential predictive factors such as histology/grade, age, stage at diagnosis, and insurance. Results Type 2 EC accounted for only 38.7% of all incident EC-cases but 74.6% of all EC-deaths. Blacks were disproportionately affected by type 2 EC (57.6%) compared to Whites, Hispanics, and Asians (35.6%, 37.7%, and 43.0%, respectively). Age-adjusted 5-year survival for types 1 and 2 were 85.3% and 51.6%, respectively; however, there was wide variation within type 2 subtypes, ranging from 60.2% for mixed cell EC to as low as 30.1% for carcinosarcoma. In the multivariable model, Blacks with type 2 EC had a 23% higher risk of death due to EC (sHR: 1.23, 95%CI: 1.12-1.36) compared to Whites. Conclusions Population-based analyses should consider the histological heterogeneity of EC because the less common type 2 EC drives racial/ethnic survival disparities in EC. Black women have a higher proportion of more aggressive histological types and an overall higher risk of death due to EC than Whites. To the extent that some of these histological types may be

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Role of bleeding recognition and evaluation in Black-White disparities in endometrial cancer

Cited by 43 publications

References 18 publications

Postmenopause as a key factor in the composition of the Endometrial Cancer Microbiome (ECbiome)

Postmenopause as a key factor in the composition of the Endometrial Cancer Microbiome (ECbiome)

Unique Molecular Features in High-Risk Histology Endometrial Cancers

The role of histology on endometrial cancer survival disparities in diverse Florida

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