BACKGROUND AND PURPOSE:

• Rates of uterine cancer have been increasing, particularly aggressive, nonendometrioid subtypes of uterine cancer
  • Rates of uterine cancer are also disproportionally higher among non-Hispanic Black women
• Clarke et al. (JAMA Oncology, 2022) estimated histologic subtype- and stage-specific uterine cancer mortality rates by race and ethnicity, corrected for hysterectomy

METHODS:

• Cohort study
• Population
  • Women in the SEER database with uterine cancer diagnosed between 2000 and 2017
  • <40 years excluded due to low number of deaths in this age cohort
• Exposures
  • Tumor histologic subtype
  • Cancer stage at diagnosis
  • Race and ethnicity
• Study design
  • Hysterectomy correction was based on hysterectomy prevalence data from the Behavioral Risk Factor Surveillance System
    • For the hysterectomy-corrected rates, proportion of women with a hysterectomy were from the denominator
  • The primary outcomes were calculated as corrected and uncorrected rates, and were age-adjusted to the 2000 US standard population
  • Annual percent changes in rates were calculated using log-linear regression
• Primary outcomes
  • Rates of uterine cancer diagnoses
  • Rates of uterine cancer deaths

RESULTS:

• 208,587 women diagnosed with uterine cancer during study period
  • Asian: 7.7%
  • Black: 9.7%
  • Hispanic: 11.1%
  • White: 71.5%
• Uterine cancer deaths during study period: 16,797
  • Hysterectomy-corrected mortality rate: 15.7 per 100,000 person-years
• Hysterectomy-corrected rates were highest among Black women
  • Overall
  • By histologic subtype
  • By stage at diagnosis
• Among all women, cancer mortality rates increased significantly every year
  • Uterine corpus cancer
    • By 1.8% (95% CI, 1.5 to 2.9%) per year
  • Nonendometrioid carcinomas
    • By 2.7% (95% CI, 1.8 to 3.6%) per year
• Increases in cancer mortality rates occurred in women of all race/ethnicities
  • Asian women
    • By 3.4% (95% CI, 0.3 to 6.6%) per year
  • Black women
    • By 3.5% (95% CI, 2.2 to 4.9%) per year
  • Hispanic women
    • By 6.7% (95% CI, 1.9 to 11.8%) per year
  • White women
    • By 1.5% (95% CI, 0.6 to 2.4%) per year
• Endometrioid carcinoma mortality rates remained stable

CONCLUSION:

• From 2000 to 2017 there was a significant increase in nonendometrioid uterine carcinoma mortality rates among US women
• Disparities in uterine corpus cancer rates among non-Hispanic Black women don’t appear to be explained by subtype distribution and stage at diagnosis
• While incident uterine cancer cases among Black women was <10%, mortality was nearly 18%
• The authors state

Increasing nonendometrioid carcinoma mortality rates align with recent incidence trends of these aggressive subtypes, which have been increasing over the past 2 decades

In contrast, mortality rates for endometrioid carcinomas have not changed substantially over time among all racial and ethnic groups

Learn More – Primary Sources:

Racial and Ethnic Differences in Hysterectomy-Corrected Uterine Corpus Cancer Mortality by Stage and Histologic Subtype

Related ObG Topics:

Uterine and Ovarian Cancer Trends Over the Past Two Decades: How Have Mortality Rates Changed Across Race and Ethnicity?

How Common is Unexpected Uterine Cancer at Hysterectomy?

What is the Proportion of Cancer Attributable to Obesity in the U.S.?

Does Assisted Reproduction Increase Risk of Breast, Ovarian, Uterine Cancer?