Abstract
Abstract Background: Despite the lower overall incidence rates for Uterine cancer in black compared to white women mortality rates are known to be very high in blacks. Our focus was to elucidate trends over time and describe differences in clinical characteristics by particular treatment, and survival outcomes between black and white women. Methods: Black and white women diagnosed with uterine cancer during 1991-2000 were identified from SEER 9 database and stratified in two groups by year of diagnosis: 1991-1995 and 1996-2000. Kaplan-Meier and Cox proportional hazard models were developed to compare women by race and accounting for other prognostic variables. Results: A total of 30,673 patients were diagnosed with Uterine cancer (adenocarcinoma Type I, Type II and Sarcoma) between 1991-2000; blacks forming 6.5% of total (1978 patients). Black women were 2 times more likely not to receive therapy (OR 2.29; p<0.0001; 95% CI 1.98-2.66). Most untreated group was black women when diagnosed with Type I Uterine cancer. Difference in treatment distribution between white and black women was significant with Type-I (p<0.0001) and Type-II (p<0.001) carcinomas. During years 1996-2000 percentage of surgical extirpation of cancer increased in black patients with Type-I carcinoma (56.63%), though still not reaching the level administered for whites (67.98%). The combined surgery and radiation treatment increased in black women diagnosed with Type-II and sarcoma which is an improving trend. Radiation decreased for both races in all histological types. Black women had 32% higher risk to die from uterus cancer during 1991-2000 (HR1.32; 95% CI 1.15-1.51). Histological type, age at diagnosis, radiation therapy, advanced stage and grade were significant predictors. However a refreshing trend is that black women had 19% less risk of dying from uterus cancer in 2nd period (HR 0.81; p=0.127; 95%CI 0.63-1.05). While Type II cancers fared better black women had 47% higher risk to die from Type-I carcinoma compare to white women when diagnosed during years 1991-2000 (even after adjusting for time period, histological type, age at diagnosis, therapy, stage, and grade (HR 1.47; 95%CI 1.24-1.75). Conclusions: Treatments for Uterine cancer improved during 2nd period in black women with consequent tendency for improved 5 year survival. Overall percentage of treated versus not-treated cases remained the same between periods, changes in treatment patterns were noted only when stratified by histological types. Black women diagnosed with Type-I Uterine cancer need special targeting with public educational policy: twice as many were not treated compare to white patient and had the greatest disparity in surgery. Overall there is a trend for the better for most recent time period for black women diagnosed with Uterine cancer but challenges remain. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A112.
Published Version
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