Black women have substantially higher rates of early death from gynecologic cancers

Key takeaways:

• Black women had higher early death rates from tubo-ovarian, cervical and uterine cancers vs. women of other races or ethnicities.
• Asian women had lowest early death rates from tubo-ovarian and uterine cancers.

Black women have higher rates of early death from tubo-ovarian, cervical and uterine cancers compared with women of other races and ethnicities, data show.

“Studies have repeatedly shown that disparities have persisted throughout the last 2 decades in diagnosis, treatment and survival among cases of uterine, tubo-ovarian and cervical cancers,” Matthew W. Lee, MD, an obstetrician and gynecologist in the division of gynecologic oncology at the University of Southern California, and colleagues wrote. “Studies suggest that disparities are likely due to a multifactorial etiology of decreased survival in certain racial groups reflective of not only health care-specific factors, but also socioeconomic, environmental, systemic and even biologic factors.”

Lee and colleagues evaluated data from 461,300 women with gynecologic malignancies from 2000 to 2020 in the U.S. from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program. The most common malignancy was uterine cancer among 242,709 women, followed by tubo-ovarian cancer among 119,989, cervical cancer among 68,768, vulvar cancer among 22,991 and vaginal cancer among 6,843 women. Researchers analyzed population-level trends and characteristics of early death based on race and ethnicity.

Primary outcome was early death defined as mortality from any cause occurring within 2 months of the index cancer diagnosis.

Results, published in the American Journal of Obstetrics and Gynecology, demonstrated that early death occurred among 4.7% of women. Of these, 10.5% had tubo-ovarian cancer, 5.5% had vaginal cancer, 2.9% had cervical cancer, 2.5% had uterine cancer and 2.4% had vulvar cancer.

In race- and ethnicity-specific analysis, researchers observed the highest early death rate of 14.5% among Black women with tubo-ovarian cancer and the lowest rate of 1.6% among Asian women with uterine cancer. Racial and ethnic differences in early death were largest for tubo-ovarian cancer (6.4% Asian vs. 14.5% Black women; P < .001), followed by uterine (1.6% Asian vs. 4.9% Black women; P < .001) and cervical (1.8% Hispanic vs. 3.8% Black women; P < .001) cancers.

From 2000-2002 to 2018-2020, early death rates for tubo-ovarian cancer decreased from 17.4% to 11.8% for Black (adjusted OR = 0.67; 95% CI, 0.53-0.85), 12.3% to 9.5% for white (aOR = 0.77; 95% CI, 0.71-0.85), 8.9% to 6.3% for Hispanic (aOR = 0.7; 95% CI, 0.55-0.89) and 7.4% to 5.2% for Asian (aOR = 0.62; 95% CI, 0.44-0.87) women, the researchers reported.

Differences in all-cause tubo-ovarian cancer early death rates reduced slightly for white vs. Black women in 2000-2002 (aOR = 0.54; 95% CI, 0.45-0.65) and 2018-2020 (aOR = 0.65; 95% CI, 0.54-0.78).

“Recognition of ‘early death’ as a possible quality metric of health services and outcomes research may be useful. This gap in rates of early death between racial and ethnic groups calls for further evaluation of the causes of a potential disparity,” the researchers wrote. “When these data are considered in addition to the existing literature, our results further indicate a pervasive inequality in overall survival that extends to early death.”