Histologic disparities in uterine cancer diagnosis by race/ethnicity and country of origin

Abstract

Objectives: To investigate uterine cancer diagnoses by race/ethnicity and country of origin. Methods: Women diagnosed with a single primary invasive uterine cancer between 2004-2015 in the National Cancer Database were eligible. Race and ethnicity were merged to classify participants as non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic (HSP), Asian/Pacific Islanders (API) or American Indian/Alaskan Native (AIAN). HSPs and APIs were further subclassified by country of origin. Logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (CI) for a diagnosis of a non-endometrioid cancer (endometrial carcinoma or uterine sarcoma) or an aggressive uterine cancer histology (grade 3 endometrioid, serous, clear cell, carcinosarcoma or leiomyosarcoma) in NHB, HSP, API or AIAN relative to NHW. Relationships in subgroups of HSPs and APIs were also evaluated relative to NHWs. Results: There were 342,246 eligible patients including 37,040 NHBs, 21,564 HSPs, 10,613 APIs and 1,177 AIANs relative to 271,852 NHWs. The risk of a non-endometrioid cancer diagnosis was significantly higher for NHBs (OR=2.98), HSPs (OR=1.33) and APIs (OR=1.27) and was not significantly different for AIANs (OR=1.10) relative to NHWs (Fig. 1A). The likelihood of a non-endometrioid cancer diagnosis was significantly higher for Dominicans (OR=2.47), South/Central Americans excluding Brazilians (OR=1.80), Cubans (OR=1.67), Mexicans (OR=1.45), Puerto Ricans (OR=1.38), Koreans (OR=1.48), Asian Indian/Pakistani (OR=1.41), Filipinos (OR=1.33), Vietnamese (OR=1.27), Chinese (OR=1.25) or Japanese (OR=1.20) relative to NHWs (Fig. 1A). NHBs were significantly more likely than NHWs to be diagnosed with grade 3 endometrioid cancer (OR=2.02), serous cancer (OR=3.06), clear cell cancer (OR=1.90), carcinosarcoma (OR=3.12) or leiomyosarcoma (2.83) (Fig. 1B). HSPs had an increased risk of diagnosis relative to NHWs with serous cancer (OR=1.19), clear cell cancer (OR=1.16), carcinosarcoma (OR=1.19) or leiomyosarcoma (OR=1.77) (Fig 1B). APIs had an increased risk of grade 3 endometrioid cancer (OR=1.18), serous cancer (OR=1.35) or leiomyosarcoma (OR=1.72) than NHWs (Fig 1B). AIANs had an increased risk of serous carcinoma (OR=1.28) over NHWs (Fig 1B). Conclusions: Risk of a non-endometrioid cancer diagnosis and specifically an aggressive uterine cancer histology was dramatically higher in almost all racial and ethnic minority groups within the United States. Those at highest risk included NHBs, Dominicans, South/Central Americans excluding Brazilians, Cubans, Korean and Asian Indian/Pakistani women relative to NHWs. Research is needed to investigate the factors that account for the histologic differences in uterine cancer diagnosis between racial/ethnic groups and country of origin subgroups including ancestral admixture, somatic and epigenetic alterations, social health determinants and environmental factors. To investigate uterine cancer diagnoses by race/ethnicity and country of origin. Women diagnosed with a single primary invasive uterine cancer between 2004-2015 in the National Cancer Database were eligible. Race and ethnicity were merged to classify participants as non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic (HSP), Asian/Pacific Islanders (API) or American Indian/Alaskan Native (AIAN). HSPs and APIs were further subclassified by country of origin. Logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (CI) for a diagnosis of a non-endometrioid cancer (endometrial carcinoma or uterine sarcoma) or an aggressive uterine cancer histology (grade 3 endometrioid, serous, clear cell, carcinosarcoma or leiomyosarcoma) in NHB, HSP, API or AIAN relative to NHW. Relationships in subgroups of HSPs and APIs were also evaluated relative to NHWs. There were 342,246 eligible patients including 37,040 NHBs, 21,564 HSPs, 10,613 APIs and 1,177 AIANs relative to 271,852 NHWs. The risk of a non-endometrioid cancer diagnosis was significantly higher for NHBs (OR=2.98), HSPs (OR=1.33) and APIs (OR=1.27) and was not significantly different for AIANs (OR=1.10) relative to NHWs (Fig. 1A). The likelihood of a non-endometrioid cancer diagnosis was significantly higher for Dominicans (OR=2.47), South/Central Americans excluding Brazilians (OR=1.80), Cubans (OR=1.67), Mexicans (OR=1.45), Puerto Ricans (OR=1.38), Koreans (OR=1.48), Asian Indian/Pakistani (OR=1.41), Filipinos (OR=1.33), Vietnamese (OR=1.27), Chinese (OR=1.25) or Japanese (OR=1.20) relative to NHWs (Fig. 1A). NHBs were significantly more likely than NHWs to be diagnosed with grade 3 endometrioid cancer (OR=2.02), serous cancer (OR=3.06), clear cell cancer (OR=1.90), carcinosarcoma (OR=3.12) or leiomyosarcoma (2.83) (Fig. 1B). HSPs had an increased risk of diagnosis relative to NHWs with serous cancer (OR=1.19), clear cell cancer (OR=1.16), carcinosarcoma (OR=1.19) or leiomyosarcoma (OR=1.77) (Fig 1B). APIs had an increased risk of grade 3 endometrioid cancer (OR=1.18), serous cancer (OR=1.35) or leiomyosarcoma (OR=1.72) than NHWs (Fig 1B). AIANs had an increased risk of serous carcinoma (OR=1.28) over NHWs (Fig 1B). Risk of a non-endometrioid cancer diagnosis and specifically an aggressive uterine cancer histology was dramatically higher in almost all racial and ethnic minority groups within the United States. Those at highest risk included NHBs, Dominicans, South/Central Americans excluding Brazilians, Cubans, Korean and Asian Indian/Pakistani women relative to NHWs. Research is needed to investigate the factors that account for the histologic differences in uterine cancer diagnosis between racial/ethnic groups and country of origin subgroups including ancestral admixture, somatic and epigenetic alterations, social health determinants and environmental factors.