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Black women face worse endometrial cancer outcomes regardless of tumor type
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Non–Hispanic black women with endometrial cancer experienced worse outcomes than women in other racial and ethnic groups diagnosed with the same disease subtypes and stage, according to the results of an observational study.
Endometrial cancer incidence — particularly aggressive subtypes of the disease — is rising among all women in the U.S., according to the researchers.
“Prior studies have suggested that disparities in outcomes from endometrial cancer might be explained by differences in tumor subtype or stage at diagnosis,” Michele L. Cote, PhD, associate professor of oncology at Wayne State University School of Medicine’s Barbara Ann Karmanos Cancer Institute, said in a press release. “Our data suggest that disparities persist even when these factors are controlled for.”
Cote and colleagues sought to determine whether the increasing incidence and mortality from endometrial cancer occurred equally across racial and ethnic subgroups and endometrial cancer subtypes. They evaluated SEER data on endometrial cancer incidence and mortality collected between 2000 and 2011.
The analysis included data from 120,513 women. Non-Hispanic white women comprised the largest racial/ethnic subgroup in the population (n = 90,621), followed by Hispanic women (n = 11,386), non-Hispanic black women (n = 10,365) and Asian women (n = 8,141).
In all subgroups, the highest percentage of women were diagnosed between the ages of 60 years to 69 years.
Endometrial cancer incidence rates increased for all racial/ethnic subgroups during the study period. Non-Hispanic black women and Asian women experienced the greatest yearly increase in endometrial cancer incidence (annual percentage changes [APC] = 2.5 for both), whereas the incidence increased 1.8% yearly among Hispanic women and 0.6% yearly among non-Hispanic white women.
Further, non-Hispanic black women faced a greater likelihood than non-Hispanic white women to be diagnosed with clear-cell tumors (incidence rate ratio [iRR] = 1.9; 95% CI, 1.66-2.18), malignant mixed Müllerian tumors (iRR = 2.48; 95% CI, 2.32-2.64) and serous tumors (iRR = 2.19; 95% CI, 2.05-2.33). The disparity related to these aggressive histologic subtypes occurred only among non-Hispanic black women. Hispanic and Asian women had incidence rate ratios equal to or lower than non-Hispanic white women for all histologic subtypes.
For all stages and tumor subtypes other than low-grade endometrioid tumors, non-Hispanic black women faced significantly greater mortality rates compared with non-Hispanic white women (mortality rate ratio [mRR] = 1.55; 95% CI, 1.5-1.61). The subtypes associated with the greatest risk for mortality among non-Hispanic black women compared with non-Hispanic white women included serous (mRR = 2.6), malignant mixed Müllerian (mRR = 2.9) and clear cell (mRR = 2.4).
Non-Hispanic black women had worse 5-year relative survival rates than non-Hispanic white women at every stage of diagnosis regardless of their histologic subtype. The disparity ranged from 6% risk difference in survival for local stage, low-grade endometrial cancers to 59% lower survival for distant-stage clear-cell cancers.
Hispanic and Asian women had similar or better survival outcomes than non-Hispanic white women.
The researchers acknowledged limitations of their study, including the reliance on SEER data, which do not include tumor samples. Further, because SEER does not collect information on other factors that may be associated with incidence and survival, potential causes for disparities identified in the study could not be examined.
“It was somewhat surprising that the endometrial cancer survival disparity we identified was limited to non–Hispanic black women because many of the challenges previously linked to worse outcomes, including low socioeconomic status and high rates of obesity and diabetes, are also experienced by Hispanic women, but that population did not have poor outcomes,” Cote said. “We are, therefore, interested in investigating whether there are molecular differences in endometrial tumors of the same subtype from women of different races or ethnicities diagnosed at the same stage of disease.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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