Uterine cancer mortality increases significantly, racial disparities appear multifactorial
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Researchers reported a sustained increase in uterine carcinoma mortality rates in the U.S. during the past decade, with the highest hysterectomy-corrected rates observed among Black women, according to a study published in JAMA Oncology.
Black women also had twofold higher mortality rates than any other racial and ethnic group for any uterine cancer type and for aggressive nonendometrioid subtypes, and Hispanic and Asian women had significantly increased uterine cancer death rates, researchers noted.
Rationale and methods
“Through our prior work, we have demonstrated that uterine cancer incidence rates significantly increased in the U.S. from 2003 to 2015 — primarily driven by rising rates of aggressive, nonendometrioid subtypes. We observed that rates of these aggressive cancers increased among all women and were more than twice as high among Black women,” Megan Clarke, PhD, MHS, researcher in the division of cancer epidemiology and genetics at NCI, told Healio. “Factors explaining these trends, as well as the disproportionately higher rates of these aggressive subtypes among Black women, remain unclear, in part because risk factors are poorly understood.”
Clarke said prior studies also revealed strong disparities in mortality, with Black women having substantially lower 5-year survival, regardless of subtype or stage at diagnosis.
“The next logical step, and the focus of the current study, was to evaluate how increases in the incidence of aggressive, nonendometrioid uterine cancer affect racial disparities and rates of death from uterine cancer,” she said.
Investigators examined histologic subtype- and stage-specific uterine cancer mortality rates by race and ethnicity and corrected for hysterectomy among 208,587 women diagnosed with uterine cancer between 2000 and 2017 (71.5% white; 11.1% Hispanic; 9.7% Black; and 7.7% Asian) included in the SEER-18 Incidence-Based Mortality database.
Key findings
Researchers identified 16,797 uterine corpus cancer deaths between 2010 and 2017, which corresponded to a hysterectomy-corrected mortality rate of 15.7 per 100,000 person-years. Black women had the highest hysterectomy-corrected rates, according to histologic subtype and stage at diagnosis.
Results showed uterine corpus cancer mortality rates increased by 1.8% (95% CI, 1.5-2.9) per year between 2010 and 2017 among all women. Researchers additionally observed an overall increase in rates of nonendometrioid carcinomas (2.7%; 95% CI, 1.8-3.6), with specific increases among Hispanic (6.7%; 95% CI, 1.9-11.8), Black (3.5%; 95% CI, 2.2-4.9), Asian (3.4%; 95% CI, 0.3-6.6) and white women (1.5%; 95% CI, 0.6-2.4).
Of note, endometrioid carcinoma mortality rates remained stable.
“More common endometrioid subtypes tend to be diagnosed at earlier stages with favorable prognosis but accounted for approximately 41% of total uterine cancer deaths in our study. Stable mortality and incidence rates of endometrioid cancer subtypes suggest that clinical management of these cancers has not improved on a population level during the past 2 decades,” Clarke said.
Implications
“The concerning rise in deaths among all women from nonendometrioid cancers warrants clinical attention. Our findings suggest that racial disparities in uterine cancer mortality appear to be multifactorial and the higher mortality rates among Black women are partly attributable to higher incidence of tumors with aggressive subtypes and advanced stages,” Clarke said. “However, non-Hispanic Black women in our study who were diagnosed with less aggressive subtypes and early-stage disease also had the highest mortality rates.”
Unequal receipt of high-quality treatment among Black women compared with white women contributes to racial disparities in uterine cancer outcomes, she added.
“Other factors — including comorbidities, health care facility characteristics, treatment preferences and adherence, patient and provider communication, provider bias, discrimination and structural racism, and potential biologic differences in response to treatment — need to be better understood in terms of how they influence racial disparities,” Clarke said. “Our findings underscore the need for more research in diverse populations to identify risk factors and improve early detection and treatment approaches for uterine cancer, particularly for aggressive nonendometrioid subtypes.”
Importantly, more work is needed to identify modifiable patient-, health care professional-, and system-level factors associated with uterine cancer disparities among Black women, she added.
“At the NCI, we initiated the DETECT study in collaboration with clinical investigators at The University of Alabama at Birmingham to comprehensively study endometrial cancer risk and outcomes in a diverse population with a strong focus on understanding racial disparities,” Clarke said.
For more information:
Megan Clarke, PhD, MHS, can be reached at NCI, 9609 Medical Center Drive, Room 6E552, Bethesda, MD 20892; email: megan.clarke@nih.gov.
Perspective
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Christina S. Chu, MD
Uterine cancer mortality has been rising for some time now, following declines in the 1990s. By 2019, mortality rates had risen to 5.1 deaths per 100,000 women. This is in contrast to ovarian cancer — long considered a more deadly disease — for which advances in treatment have led to declining mortality, with a rate of 6 per 100,000.
Deaths due to uterine cancer are beginning to rival those of ovarian cancer. Yet another disturbing trend has been the worsening of racial disparities. In 2005, mortality was similar across racial lines but by 2019, Black women were dying at twice the rate of white women. Fortunately, in 2021 the U.S. government began supporting a Congressionally Directed Medical Research Program focused on endometrial cancer.
More research is needed to help us determine why these trends are occurring and how to reverse them.
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