05 May Racial Disparities in Rising Incidence and Mortality from Uterine Cancer

MedicalResearch.com Interview with:

Dr. Clarke

Megan Clarke, Ph.D., M.H.S.,
Earl Stadtman Investigator
Division of Cancer Epidemiology and Genetics
National Cancer Institute

MedicalResearch.com:  What is the background for this study? 

• Through our prior work, we have demonstrated that uterine cancer incidence rates have been significantly increasing in the U.S. from 2003 to 2015 and that these increases were primarily driven by rising rates of aggressive (non-endometrioid) subtypes of this cancer. We observed that rates of these aggressive cancers increased among all women and were more than twice as high among Non-Hispanic Black women compared to other racial and ethnic groups. Factors explaining these trends, as well as the disproportionately higher rates of these aggressive subtypes among non-Hispanic Black women, remain unclear, in part because risk factors are poorly understood.
• In addition to differences in incidence rates by race and ethnicity, we have also observed strong disparities in our prior studies, with Non-Hispanic Black women having substantially lower 5-year survival, regardless of subtype or stage at diagnosis, compared to other racial and ethnic populations.
• The next logical step, and the focus of the current study, was to evaluate how increases in the incidence of aggressive, non-endometrioid uterine cancer affects racial disparities and rates of death from uterine cancer.

MedicalResearch.com:  What are the main findings?

•   Uterine cancer mortality rates among women in the U.S. have been increasing from 2010 to 2017, and are highest among Non-Hispanic Black women. These trends are associated with rising deaths from aggressive non-endometrioid subtypes, reflecting recent trends in uterine cancer incidence.
•    More common endometrioid subtypes tend to be diagnosed at earlier stages with favorable prognosis; however, they accounted for approximately 41% of the 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 over the past two decades.
•   Non-Hispanic Black women experience mortality rates twice as high than other racial and ethnic groups for any uterine cancers as well as for only the aggressive non-endometrioid subtypes. Regardless of stage at diagnosis, Non-Hispanic Black women had the highest mortality rates for both subtypes of uterine cancer (endometrioid and non-endometrioid).
• Uterine cancer death rates are rising rapidly among Hispanic and Asian women, particularly for non-endometroid subtypes among Hispanic women. 

MedicalResearch.com: What should readers take away from your report?

•  Uterine cancer is one of the only cancers that is increasing in incidence and mortality in the U.S.
• The concerning rise in deaths among all women from non-endometrioid cancers warrants clinical attention.
• Our findings suggest that racial disparities in uterine cancer mortality appear to be multifactorial. Higher mortality rates among Non-Hispanic Black women are partly attributable to higher incidence of tumors with aggressive subtypes and advanced stages. 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. Other factors—including comorbidities, healthcare 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.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

• Our findings underscore the need for more research in diverse populations to identify risk factors and to improve early detection and treatment approaches for uterine cancer, particularly for aggressive non-endometrioid subtypes.
• Importantly, more work is needed to identify modifiable patient, healthcare professional-, and system-level factors associated with uterine cancer disparities among non-Hispanic Black women.
• At the National Cancer Institute, we have initiated a study in collaboration with clinical investigators at the University of Alabama Birmingham (The DETECT Study) to comprehensively study endometrial cancer risk and outcomes in a diverse population with a strong focus on understanding racial disparities.

The authors have no financial relationships or conflicts of interest to disclose.

Citation:

Clarke MA, Devesa SS, Hammer A, Wentzensen N. Racial and Ethnic Differences in Hysterectomy-Corrected Uterine Corpus Cancer Mortality by Stage and Histologic Subtype. JAMA Oncol. Published online May 05, 2022. doi:10.1001/jamaoncol.2022.0009

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Last Updated on May 5, 2022 by Marie Benz MD FAAD