Endometrial Cancer Type 2 Incidence and Survival Disparities Within Subsets of the US Black Population.

Paulo S Pinheiro,Matthew P Schlumbrecht,Baozhen Qiao,Maria Schymura,Erin N Kobetz,Heidy N Medina,Tulay Koru-Sengul

doi:10.3389/fonc.2021.699577

Paulo S Pinheiro, Matthew P Schlumbrecht + Show 5 more

Open Access

https://doi.org/10.3389/fonc.2021.699577

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Abstract

IntroductionEndometrial cancer type 2 (EC2) carries a worse prognosis compared to EC type 1. EC2 disproportionately affects Black women among whom incidence is higher and survival is poorer compared to Whites. Here we assessed EC2 incidence and survival patterns among US Black ethnic groups: US-born Blacks (UBB), Caribbean-born Blacks (CBB), and Black Hispanics (BH).MethodsWe analyzed population-based data (n=24,387) for the entire states of Florida and New York (2005–2016). Hysterectomy-corrected EC2 incidence rates were computed by racial-ethnic group, and survival disparities were examined using Cox regression adjusting for tumor characteristics, poverty level, and insurance status.ResultsEC2 incidence rates were highest among UBB (24.4 per 100,000), followed by CBB (18.2), Whites (11.1), and Hispanics of all races (10.1). Compared to Whites, the age-adjusted cause-specific survival was worse for non-Hispanic Blacks (aHR: 1.61; 95%CI 1.52–1.71) and Hispanics of all races (aHR:1.09; 95% CI:1.01–1.18). In relation to Whites, survival was worse for non-Hispanic Blacks: UBB (aHR:1.62; 95%CI 1.52–1.74) and CBB (aHR:1.59; 95% CI:1.44–1.76) than for BH (aHR:1.30; 95% CI:1.05–1.61). Surgical resection was associated with a lower risk of death, while carcinosarcoma subtype and advanced stage at diagnosis were associated with a greater risk.ConclusionsAlthough higher EC2 incidence and lower survival are observed among all African-descent groups, there are significant intra-racial differences among UBB, CBB, and BH. This heterogeneity in EC2 patterns among Black populations suggests an interplay between genetic and socioenvironmental factors.

Highlights

Endometrial cancer type 2 (EC2) carries a worse prognosis compared to EC type 1
We aim to examine the incidence and survival of the more aggressive EC2 in the three largest racial-ethnic groups in the US, that is, non-Hispanic Whites, non-Hispanic Blacks, and Hispanics, and to explore the intra-racial differences in populations of African descent, namely, US-born Blacks, Caribbean-born Blacks, and Black Hispanics
High-grade endometrioid was the leading EC2 morphological type among Whites (35%) and Hispanics (32%), followed by serous subtype (23 and 28%, respectively). For both non-Hispanic Blacks and Black Hispanics, the predominant morphological type differed with serous carcinoma being the leading type for US-born Blacks (34%), Caribbean-born Blacks (36%), and Black Hispanics (32%) (p=0.346)

Summary

Introduction

Endometrial cancer type 2 (EC2) carries a worse prognosis compared to EC type 1. Among upward-trending cancers, increasing incidence rates tend to exceed mortality rate increases because of better treatment modalities and earlier detection trends over time This is not the case for uterine cancer, for which mortality is increasing faster than incidence [1, 2]. The incidence of the less common EC2 is increasing faster than EC1 [8], resulting in a shift in the severity of endometrial cancer overall. Confirming this complex trend, survival for all endometrial cancers combined has not shown an improvement in the last decades [2, 9]

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