BETHESDA, MD — Black women are more likely to die of uterine cancer than white women, even though the incidence rate is the same between the two groups. Among white women, the five-year survival rate is 84%; among black women, it is just 62%, according to the American Society of Clinical Oncologists. Why?
A team that included researchers at the Walter Reed National Military Medical Center and the Uniformed Services University of Health Sciences analyzed data from the U.S. Cancer Statistics and the National Cancer Database between 2004 and 2016 to better understand what that disparity is occurring. .
The researchers reviewed data on 488,811 patients with uterine cancer. Of those, 411,904 (84.3%) were white and 51,093 (10.5%) were black.
They determined that the incidence of endometrial carcinoma was about 50% higher in white women than in black women, 19.63 (per 100,000 per year) vs. 12.53.
Black women had a higher incidence of high-risk histologies such as serous tumors (3.32 vs. 1.29), clear cell tumors (0.59 vs. 0.31), carcinosarcoma (2.88 vs. 1.05) and leiomyosarcoma (1.02 vs. 0.48). They also had a higher proportion of high-risk histologies.
White women had about 50% more endometrioid tumors, 75.9% vs. 52.7%. They also had twice the rate of mucinous tumors, 0.8% vs. 0.4%.
Perhaps most significantly, uterine cancer in black women had more often progressed to stage 3 or 4 prior to diagnosis, regardless of histological subtype, 22.8% vs. 17.7%. Black women who had endometrioid and grade 1 tumors were no more likely to have advanced disease than white women, 3.8% vs 4.7%.
The researchers called for additional studies to better understand the differences in the types of uterine cancer common in black women vs. white women as well as why black women more frequently have advanced disease on presentation.
Previous studies have called for better characterization of molecular differences that may be a factor in the disparate outcomes as well as sustained commitment to offering comparable access to appropriate care.
- Abel MK, Liao C-I, Darcy KM, Tian C, Mann AK, McDonald Y, Williams K, Maxwell GL, Kapp DS, Chan JK. “Uterine cancer histology and stage at presentation in black and white women: A cohort study of 488,000 patients.” Abstract 6089. Poster 260. 2020 ASCO Annual Meeting. May 29-31, 2020.