The Growing Burden of Endometrial Cancer: A Major Racial Disparity Affecting Black Women

Coté, Michele L.; Ruterbusch, Julie J.; Olson, Sara H.; Lu, Karen H.; Ali-Fehmi, Rouba

doi:10.1158/1055-9965.epi-15-0316

Cited by 198 publications

(173 citation statements)

References 41 publications

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“…1,44,45 In addition, far less is known about their etiology. In a 2013 report from the Gynecologic Oncology Group trial, which included 2,244 type I endometrial cancers and 581 type II endometrial cancers from 62 U.S. institutions, type II endometrial cancer was positively associated with multiparity and smoking, and inversely associated with obesity.…”

Section: Discussionmentioning

confidence: 99%

“…1 After accounting for hysterectomy, black women have higher incidence rates of endometrial cancer than white women. 2–5 Black women are also more likely to be diagnosed with aggressive endometrial cancers (clear cell, serous, high-grade endometrioid, and malignant mixed Mullerian tumors) compared with non-Hispanic white women.…”

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confidence: 99%

“…For nearly every stage and subtype of endometrial cancer, mortality rates are significantly higher among black women than white women. 1 …”

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confidence: 99%

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History of uterine leiomyoma and risk of endometrial cancer in black women

Wise

Sponholtz

Rosenberg

et al. 2016

Cancer Causes Control

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Background Previous studies have found an association between uterine leiomyomata (UL) and uterine malignancies. This relation has not been studied in black women, who are disproportionately affected by UL. Methods We investigated prospectively the association between self-reported physician-diagnosed UL and endometrial cancer in the Black Women’s Health Study. During 1995–2013, 47,267 participants with intact uteri completed biennial health questionnaires. Reports of endometrial cancer were confirmed by pathology data from medical records and cancer registries. Cox regression was used to derive incidence rate ratios (IRR) and 95% confidence intervals (CI). Results There were 300 incident endometrial cancer cases during 689,546 person-years of follow-up. In multivariable models, UL history was associated with a 42% greater incidence of endometrial cancer compared with no such history (95% CI: 1.12–1.80). IRRs for cancer diagnosed 0–2, 3–9, and ≥10 years after UL diagnosis were 3.20 (95% CI: 2.06–4.98), 0.95 (95% CI: 0.60–1.52), and 1.35 (95% CI: 1.03–1.77), respectively. Stronger overall associations between UL history and endometrial cancer were observed for later stages at cancer diagnosis (IRR=2.25, 95% CI: 1.09–4.63) and type II/III cancers (IRR=3.13, 95% CI: 1.64–5.99). Conclusions In this large cohort of black women, a history of UL was positively associated with endometrial cancer, particularly type II/III tumors. The strongest association was observed for cancer diagnosed within two years of UL diagnosis, a finding that might be explained by greater surveillance of women with UL or misdiagnosis of cancer as UL. However, an association was also observed for cancer reported ≥10 years after UL diagnosis.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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History of uterine leiomyoma and risk of endometrial cancer in black women

Wise

Sponholtz

Rosenberg

et al. 2016

Cancer Causes Control

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“…Therefore, one would expect Medicaid enrollment to have a greater impact on uterine cancer outcomes than cervical cancer outcomes, where screening availability outside Medicaid enrollment exists and which was the case in the current study. Uterine cancer disproportionately affects minority populations, with an increased incidence among black women, 16,17 and in low-income populations, it is commonly associated with advanced-stage disease at presentation. 18 These populations are especially vulnerable to adverse outcomes from this disease and may benefit from insurance coverage that allows for comprehensive examinations.…”

Section: Medicaid Enrollment Timing and Mortalitymentioning

confidence: 99%

Clinical Benefits Associated With Medicaid Coverage Before Diagnosis of Gynecologic Cancers

Doll

Basch

Meng

et al. 2016

JOP

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Purpose: Many low-income patients enroll in Medicaid at the time of cancer diagnosis, which improves survival outcomes. Medicaid enrollment before cancer diagnosis may confer additional benefits. Our objective was to compare stage at diagnosis and overall mortality between women with and without Medicaid enrollment before gynecologic cancer diagnosis. Methods and Materials: Women younger than 65 years with a gynecologic cancer (2003 to 2008) were identified through the North Carolina Central Cancer Registry and linked to state Medicaid enrollment files. Those with and without Medicaid enrollment within 6 months before diagnosis were identified. Propensity matching was used to balance the exposure groups. Stage at diagnosis was evaluated by using logistic regression, and all-cause mortality was assessed with Cox proportional hazard models. Results: Of 564 women, one half (n = 282) had prediagnosis Medicaid enrollment. Disease sites included the cervix (44%), uterus (25%), ovary (26%), and vulva/vagina (5%). More than one half (51%) of cancers were advanced stage. Women without prediagnosis Medicaid had an increased odds of advanced-stage disease (hazard ratio, 1.46; 95% CI, 1.03 to 2.05). Crude survival outcomes differed significantly between the groups; however, when adjusted for stage at diagnosis, lack of prediagnosis Medicaid coverage had a hazard ratio of 1.19 (95% CI, 0.92 to 1.53). Conclusion: Medicaid enrollment before gynecologic cancer diagnosis is associated with an earlier stage at presentation. Given the existence of a cervical cancer screening program in North Carolina and lack of Medicaid expansion, these data suggest that screening programs alone are not sufficient to counteract the delay in diagnosis that is common for uninsured individuals.

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“…Several studies reported significantly worse survival outcomes in AA DOI: 10.1159/000495613 women with EC compared to NAA women [4][5][6][7]. Disparities in outcome among AA women with EC do exist and continue to grow [8]. A higher prevalence of adverse prognostic factors in AA women such as advanced stage at diagnosis [4,9,10], higher tumor grade at diagnosis [9,10], lack of adequate access to healthcare [11], or combination of causes [12][13][14] have all contributed to this racial disparity in outcome.…”

Section: Introductionmentioning

confidence: 99%

A Matched Analysis on the Prognostic Impact of Race on Survival Endpoints of Women with Early-Stage Endometrial Cancer

Feldman

Chaugle

Burmeister

et al. 2018

Gynecol Obstet Invest

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Objective: To compare survival endpoints between African American (AA) and non-AA (NAA) women with endometrial carcinoma (EC) stage I–II using a robust matching analysis. Methods and Materials: Patients were matched by stage, grade, adjuvant management (surveillance, vaginal brachytherapy or pelvic radiation treatment), age, and year of hysterectomy. Recurrence-free survival (RFS), disease-specific survival (DSS) and overall survival (OS) were calculated. Results: A total of 758 patients were included. Body mass index and Age-Adjusted Charlson comorbidity index was significantly higher in AA compared to NAA women. There were no significant differences between the AA and NAA groups in regard to 5-year RFS (94 vs. 93%), DSS (96 vs. 98%) or 5-year OS (90 vs. 92%). On multivariate analysis of survival endpoints for the entire study cohort, it was found that race (AA vs. NAA) was not a significant predictor of RFS, DSS, or OS. Grade 3 tumors and the presence of lymphovascular space invasion (LVSI) were the only 2 independent predictors of RFS and DSS, while age-adjusted Charlson comorbidity score, grade 3, stage II and the presence of LVSI were independent predictors of shorter OS. Conclusions: When matched based on the tumor stage, grade, adjuvant treatment, age, and year of surgery, our study suggests that there is no statistically significant difference in any survival endpoints between AA and NAA women with early-stage EC. Based on these data, disparities in outcome likely do not stem from uterine cancer-related causes. The increased comorbidity burden in AA women is likely a factor contributing to the racial disparity in endometrial cancer.

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The Growing Burden of Endometrial Cancer: A Major Racial Disparity Affecting Black Women

Cited by 198 publications

References 41 publications

History of uterine leiomyoma and risk of endometrial cancer in black women

History of uterine leiomyoma and risk of endometrial cancer in black women

Clinical Benefits Associated With Medicaid Coverage Before Diagnosis of Gynecologic Cancers

A Matched Analysis on the Prognostic Impact of Race on Survival Endpoints of Women with Early-Stage Endometrial Cancer

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