Uterine Cancer Mortality Research Articles

US Cancer Mortality Trends Among Asian and Pacific Islander Populations.

Cancer is the leading cause of death among Asian American individuals and the second leading cause of death among Native Hawaiian and Pacific Islander people. To evaluate longitudinal cancer mortality trends from 1999 to 2020 among Asian American and Pacific Islander populations in the US by demographic characteristics. This cross-sectional study used the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database to obtain age-adjusted cancer death rates among Asian American and Pacific Islander individuals of all ages between January 1, 1999, and December 31, 2020. Data were analyzed from January 12 to March 19, 2024. Age, sex, cancer type, and US census regions. Trends and average annual percent changes (AAPCs) in age-adjusted cancer-specific mortality (CSM) rates for non-Hispanic Asian American and Pacific Islander populations were estimated by cancer type, age, sex, and region using Joinpoint regression. Between 1999 and 2020, 305 386 Asian American and Pacific Islander individuals (median [IQR] age, 69.5 [58.5-79.2] years; 51.1% male) died of cancer in the US. Overall, the CSM rate decreased by 1.5% annually. Men experienced a greater CSM rate decrease (AAPC, -1.8%; 95% CI, -2.2% to -1.3%) compared with women (AAPC, -1.1%; 95% CI: -1.2% to -1.0%). For women, death rates decreased for most cancer types but increased for uterine (AAPC, 2.5%; 95% CI, 2.0%-3.0%) and brain and central nervous system (AAPC, 1.4%; 95% CI: 0.7%-2.1%) cancers. Colorectal cancer mortality rates increased among men aged 45 to 54 years (AAPC, 1.3%; 95% CI, 0.5%-2.1%). Liver and intrahepatic bile duct cancer mortality increased for both men and women in all US census regions, uterine cancer mortality increased in all regions for women, and pancreatic cancer mortality increased in the Midwest for both men and women. Although these findings show an overall decrease in CSM among Asian American and Pacific Islander populations, specific cancer types exhibited increased mortality rates, with further disparities by sex and age. Targeted, culturally adapted clinical and public health interventions are needed to narrow disparities in cancer mortality.

Status of uterine cervix cancer mortality and incidence disparities in Appalachian eastern Kentucky.

132 Background: Cervical cancer continues to affect the Appalachian population to a higher degree than the rest of the American population. Researchers believe the increased prevalence of cervical cancer in the Appalachian area is due to health disparities across the area. Methods: We queried the Kentucky Cancer Registries online public Cancer Incidence and Mortality Inquiry System to determine changes in age adjusted invasive cervical cancer incidence and mortality rates in Appalachian (AK) and Non-Appalachian Kentucky (NAK) counties over time. Incidence rate ratios were used to analyze the difference in cervical cancer incidence and mortality between Appalachian KY and non-Appalachian KY populations across several time periods. Results: In 1995-1999, there was a statistically significant difference in cervical cancer incidence between AK and NAK 14.8 vs. 12.7/100,000 people (p= 0.0035) and mortality 4.6 vs. 4.0/100,000 (p=0.0471). The cervical cancer incidence was 16.9% higher in AK versus NAK and mortality was 18.4% higher in AK versus NAK. In 2016-2020, there was a statistically significant difference in cervical cancer incidence between AK and NAK 12.1 vs. 8.9/100,000 people (p≤ 0.0001) and mortality between AK and NAK 3.6 vs. 2.3/100,000 people (p= 0.0001). The cervical cancer incidence was 36% higher in AK versus NAK and mortality was 55.7% higher in AK versus NAK. Conclusions: Disparities between in Appalachian Kentucky and Non-Appalachian Kentucky in cervical cancer incidence and mortality not only have persisted since the 1990’s, but they have widened proportionally over time as survival gains have lagged in Appalachia. The observed cervical cancer outcome disparities are likely contributed to by not only the lack of general health education in the region, but more importantly barriers to care access contributing to a lower use of Pap testing in the area. Higher rates of poverty, increased rates of smoking and HPV infection also likely play a role. Research has been conducted to observe identified opportunities for intervention and begin collaborative efforts in the region engineered towards a cervical cancer risk reduction program, but the need for improvement clearly remains. Cervical cancer mortality rates in Appalachian Kentucky vs. non-Appalachian Kentucky, 1995-2020. Appalachia Non-Appalachia Population at Risk Deaths Crude Rate/100,000 Age-Adjusted Rate 95% Confidence Interval Population at risk Deaths Crude Rate/100,000 Age-Adjusted Rate 95% Confidence Interval 1995-1999 2928468 145 5 4.6 [3.9-5.4] 7209127 301 4.2 4 [3.6-4.5] 2000-2004 2962204 102 3.4 3.2 [2.6-3.9] 7485965 214 2.9 2.7 [2.3-3.1] 2005-2009 2986284 117 3.9 3.5 [2.9-4.2] 7833348 225 2.9 2.6 [2.3-3.0] 2010-2015 3577269 141 3.9 3.4 [2.8-4.0] 9803897 277 2.8 2.5 [2.2-2.9] 2016-2020 2941022 121 4.1 3.6 [3.0-4.4] 8378683 221 2.6 2.3 [2.0-2.7]

The effect of advances in management of uterine-serous-carcinoma on population mortality.

e22516 Background: Incidence and mortality of uterine cancer has reported to be declining. However, mortality trends of endometrial serous carcinoma remain unclear at a population level. Methods: We applied SEER to evaluate uterine-serous- carcinoma mortality and relevant deaths of this disease to incident cases. We assessed trends of population mortality based on specific causes and races. Incidence of uterine serous carcinoma were evaluated based on ethics and calendar year. Trends of incidence and incidence-based mortality were evaluated by Joinpoint software. Results: Incidence of uterine serous carcinoma decreased by 1.51% from 2000 through 2017, followed by increase of 16.58% from 2017 through 2019. Mortality of women with uterine serous carcinoma due to uterine serous carcinoma decreased by 4.33% annually from 2000 to 2010, and then decreased at a rate of 1.88% every year from 2010 to 2017, and then sharply declined by 44.69% from 2017 to 2019. Mortality of women with uterine serous carcinoma due to other causes increased by 0.94% annually from 2000 to 2016, and then increased at a high rate of 35.18% every year from 2016 to 2019. Incidence-based mortality of women with uterine serous carcinoma due to other causes increased by 39.03% annually from 2000 to 2004, and then increased at a rate of 2.93% every year from 2004 to 2019. Incidence-based mortality of patients due to other causes showed similar pattern. Patients’ incidence-based mortality due to uterine serous cancer increased at rates of 111.02% and 9.80% annually from 2000 through 2002, from 2002 through 2006 respectively, followed by a decrease of 3.87% annually from 2006 through 2019, and then a gradual increase of 6.55% annually from 2002 through 2005. Incidence of white patients with uterine serous cancer decreased at a rate of 4.42% from 2000 through 2017 and then increased by 21.61% from 2017 through 2019. Incidence of Asians patients presented similar pattern. However, incidence of Black patients increased at a rate of 0.93% from 2000 through 2015 and then sharply increased by 8.49%. Incidence-based mortality of white patients with uterine serous cancer increased at a rate of 105.16% from 2000 through 2002, and then increased by 10.93% from 2002 through 2006, followed by a decrease of 3.40% from 2006 through 2019. Incidence-based mortality of Black patients elevated at a rate of 114.03% from 2000 through 2002, and flatten out, increased by 1.94% from 2002 through 2019. Incidence-based mortality of Asian patients showed similar pattern. Conclusions: Declined incidence-based mortality from 2006 through 2019 may associate with management advances of uterine serous carcinoma. Decreased incidence-based mortality of White patients with uterine serous carcinoma from 2006 through 2019 and increased incidence-based mortality of Black patients and Asian patients with uterine serous carcinoma in same period may related to better management resource of White patients.

Asian and Pacific Islander cancer mortality trends in the United States between 1999-2020.

e23307 Background: The Asian and Pacific Islander (API) population is the fastest growing in the United States, composing nearly 7% of the US population. Although cancer is the second leading cause of death overall in the U.S., it is the leading cause of death in the API population. Despite this, no study has assessed trends in cancer mortality in API individuals in the US. Our aim was to analyze differences and trends in API cancer mortality in the U.S. between 1999 to 2020. Methods: The CDC WONDER database was used to determine mortality statistics for patients, classified as non-Hispanic Asian or Pacific Islander, with cancer (ICD-10 codes C00-C97) as the underlying cause of death between 1999 and 2020. Age-adjusted mortality rates (AAMR) were calculated per 100,000 deaths, and were stratified by cancer type, sex, population density, U.S. census region, and age. Joinpoint regression software was used to identify temporal trends. Average annual percent change (APC) was considered statistically significant if p < 0.05. Results: Between 1999 and 2020, cancer accounted for 305,386 deaths in API individuals. During this period, there was a 30% decrease in mortality due cancer and a decrease in APC of -1.5% (p < 0.05). When stratified by cancer site, the largest decrease in APC was in stomach cancer at -3.7% (p < 0.05), and the largest increase was in uterine cancer at 2.6% (p < 0.05). In 1999, males experienced an overall cancer-related AAMR of 151, 48% higher than females at 103; however, by 2020 these differences reduced, with males having a cancer-related AAMR of 105.6 vs API females of 80.9, a 25% difference. Males experienced a larger decrease in APC (-1.8%, p < 0.05), compared with females (-1%, p < 0.05). Rural populations had the largest cancer-related AAMR (113.0) and largest drop in APC (-2%, p < 0.05), compared with urban groups with a cancer-related AAMR of 106.7 and APC drop (-1.3%, p < 0.05). The highest cancer related AAMRs was seen in lung cancer (24.3 in urban vs 25.4 in rural). Liver-cancer related AAMR was highest in urban populations at 10.4 and lowest in rural populations at 8.2. Western census regions had the highest AAMR at 113.7 with an APC decrease of –1.4% and Southern census regions had the lowest AAMR at 90.5 with an APC decrease of –1.2%. Adults aged > 65 experienced the highest cancer related AAMR at 588.2, and adults aged 25-44 demonstrated the lowest AAMR at 14.7. However, adults aged 25-44 experienced the largest decrease in APC at -2% (p < 0.05), compared with adults aged > 65 at -1.4% (p < 0.05). Conclusions: Our study identifies a significant decrease in cancer mortality in API individuals between 1999 and 2020. The largest decrease seen was in stomach cancer; however, uterine cancer mortality has increased. Notably, liver cancer mortality was higher in urban rather than rural groups. Further studies may examine differences amongst API and other racial groups, and potential sources for the disparities seen amongst API individuals.

Trends in Uterine Cancer Mortality in the United States: A 50-Year Population-Based Analysis.

Trends in Uterine Cancer Mortality in the United States: A 50-Year Population-Based Analysis.

The global incidence, mortality, and burden of uterine cancer in 2019 and correlation with SDI, tobacco, dietary risks, and metabolic risk factors: An ecological study.

Endometrial cancer (EC) is the sixth most common cancer among women worldwide. Since global studies are based on awareness of the incidence trend, mortality, geographical diversity, and level of social development and income of countries, this study was conducted to investigate the trend of uterine cancer (UC) in the world in 2019. Age-standardized rates (ASR) of incidence, deaths, prevalence, and disability-adjusted life years (DALYs) of UC, as well as targeted risk factors, were extracted from the Global Burden of Disease (GBD) online database 2019. Pearson correlation coefficient and SPSS 16 were used to calculate the correlation between risk factors and ASR of epidemiological indicators. Statistical significance was considered as p < 0.05. In 2019, the age-specific incidence and death rate of UC was peaking at 60-64 and 65-69 years, respectively. The highest age-standardized incidence rate per 100,000 people for UC has been reported in the Northern Mariana Islands, high sociodemographic index (SDI) countries, World Bank High-Income category, Europe continent and among World Health Organization (WHO) regions were found in the European Region. The highest age-standardized death rateper 100,000 people for UC has been reported in Grenada, high SDI countries, the World Bank High-Income category, Europe continent, and among WHO regions found in the European Region. In 2019, the age-standardized DALYs rate was 53.54 per 100,000 inhabitants, of which 48.49 cases were related to years of life lost (YLLs) and 5.05 cases were related to years lived with disability. According to GBD-2019, the highest incidence, mortality, and DALY of UC are in Europe. The evidence and traces of diversity can be seen in the inequalities of UC. Race, ethnicity, economic status, level of education and awareness, co-morbidities, access, grade, and histological type of tumor are the most important causes of this inequality.

Exploring the perspectives of underrepresented voices: Perceptions and experiences of uterine cancer for black African, Caribbean, black British, and mixed-black women in the UK to develop strategies for early symptom presentation

ObjectivesThe uterine cancer (UC) mortality rate in the UK is significantly higher for women who belong to a Black ethnic group compared to those from other ethnic groups. This study aimed to understand the views and experiences of UC amongst Black ethnic minority women in the UK, with a focus on awareness and presentation of red-flag symptoms. MethodsWomen of Black African, Caribbean, Black British and Mixed-Black ethnicity were purposefully recruited to participate in focus groups and individual semi-structured interviews. ResultsTwenty women from different regions in England participated in the study. Reflexive thematic analysis of the data led to the identification of three main themes: 1) Healthcare inequities; 2) Support and sense making with other Black women; and 3) Knowledge dissemination, mobilisation, and empowerment. Perceptions of inequitable healthcare provision and distrust influenced how participants, and their peer networks, approached seeking assistance from healthcare professionals. Concerns were also raised about culturally insensitive information resources, including issues of language, literacy, and representation, all of which served as potential barriers for women within Black ethnic minority groups. ConclusionsThe deficiency of targeted knowledge mobilisation and specific UC information aimed at Black ethnicity women living in the UK, reportedly contributes to the dissemination of misconceptions and an atmosphere of apprehension around a UC diagnosis. The insights from this study highlight the significance of designing culturally sensitive strategies to promote informed decision-making and empower the dissemination of accurate health knowledge amongst Black women.

Trends in Uterine Cancer Mortality in the United States: A 50-Year Population-Based Analysis.

To analyze mortality trends in uterine cancer in the United States over 50 years with an emphasis on age and race and ethnicity. Data on uterine cancer deaths from 1969 to 2018 were obtained from the National Center for Health Statistics. Trends were examined by age and race and ethnicity after adjustment for the hysterectomy rate and pregnancy. Uterine cancer mortality decreased between 1969 and 1997 (from 6.03 to 4.00/100,000) but increased between 1997 and 2018 (from 4.00 to 5.02/100,000). From 2001 to 2018, mortality rates increased by 1.25-fold across all age groups. In 2018, the mortality rate from uterine cancer for patients aged 70 years or older and 60-69 years was sixfold and threefold higher, respectively, than in younger patients (aged 50-59 years) (54.87/100,000 vs 27.80/100,000 vs 8.70/100,000). The mortality rate for non-Hispanic Black women was 2.2-fold higher than for non-Hispanic White, Hispanic, and non-Hispanic Asian or Pacific Islander women (17.6/100,000 vs 7.82/100,000, 6.54/100,000, and 4.24/100,000, respectively). On an intersection analysis of age and race, non-Hispanic Black women aged older than 60 years had a threefold higher mortality rate than non-Hispanic White women (72/100,000 vs 24/100,000). A notable finding was that young non-Hispanic Black and Hispanic women (30-39 years) had the highest annual increases in mortality at 3.3% and 3.8% per year compared with 2.2% in non-Hispanic White women. Since 2001, the uterine cancer mortality rate has increased across all four racial and ethnic groups examined, with the highest increase seen among non-Hispanic Black women. The largest increase in mortality was observed among younger non-Hispanic Black and Hispanic women.

Factors associated with the rising rate of uterine cancer mortality in the United States (2102)

Factors associated with the rising rate of uterine cancer mortality in the United States (2102)

Temporal trends and projections of gynecological cancers in China, 2007–2030

BackgroundGynecological cancer will become a more important public health problem in future years but limited evidence on gynecological cancer burden in China.MethodsWe extracted age-specific rate of cancer cases and deaths during 2007–2016 from the Chinese Cancer Registry Annual Report, and estimated age-specific population size using the data released by National Bureau of Statistics of China. Cancer burden were calculated by multiplying the rates with the population size. Temporal trends of the cancer cases, incidence, deaths, and mortality during 2007–2016 were calculated by JoinPoint Regression Program, and from 2017 to 2030 were projected by grey prediction model GM (1,1).ResultsIn China, total gynecological cancer cases increased from 177,839 to 241,800, with the average annual percentage change of 3.5% (95% CI: 2.7–4.3%) during 2007–2016. Cervical, uterine, ovarian, vulva, and other gynecological cancer cases increased by 4.1% (95% CI: 3.3–4.9%), 3.3% (95% CI: 2.6–4.1%), 2.4% (95% CI: 1.4–3.5%), 4.4% (95% CI: 2.5–6.4%), and 3.6% (95% CI: 1.4–5.9%) respectively. From 2017 to 2030, projected gynecological cancer cases are changing from 246,581 to 408,314. Cervical, vulva and vaginal cancers showed evident upward trend, while uterine and ovarian cancer cases are slightly increasing. The increases for age-standardized incidence rates were similar with that of cancer cases. Temporal trends of cancer deaths and mortality were similar with that of cancer cases and incidence during 2007–2030, except that uterine cancer deaths and mortality were declined.ConclusionsWith the aging of population and other increased risk factors, the burden of gynecological cancers in China is likely to be grew rapidly in the future, comprehensive gynecological cancer control should be concerned.

Uterine cancer mortality and Black women: time to act.

Uterine cancer is the most common gynaecological cancer in the UK. Although the incidence of uterine cancer has been steadily increasing in the UK 1 Cancer Research UKUterine cancer statistics. https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/uterine-cancerDate accessed: April 6, 2023 Google Scholar and many other countries, to date it has attracted much less interest than other gynaecological cancers with regard to symptom awareness. A possible reason is that a high proportion of cases are diagnosed at an early stage, resulting in a good long-term prognosis. However, on Jan 26, 2023, the Office for National Statistics (ONS) published for the first time age-standardised mortality rates for uterine cancer by ethnicity for England and Wales in 2012–19. 2 Office for National StatisticsAge-standardised mortality rates for uterine and cervical cancer by ethnic group, females aged 10 and above, deaths registered in England and Wales: 2012 and 2019. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/adhocs/15495agestandardisedmortalityratesforuterineandcervicalcancerbyethnicgroupfemalesaged10andabovedeathsregisteredinenglandandwales2012and2019Date: 2023 Date accessed: April 6, 2023 Google Scholar These data show substantial disparities in uterine cancer mortality, with Black ethnic groups having substantially higher mortality rates than other ethnic groups (figure).

Abstract IA013: Disparities in uterine cancer incidence and mortality

Abstract Background: Hysterectomy-corrected uterine cancer incidence rates increased have increased by about 1% per year in the U.S. from 2003-2015, with the sharpest increases observed among Hispanic, non-Hispanic Asian, and non-Hispanic Black women, respectively. These increases have been primarily related to rates of aggressive non-endometrioid subtypes, which have been increasing among all women and are particularly high among Non-Hispanic Black women. Non-Hispanic Black women also have substantially lower survival, irrespective of stage at diagnosis or histologic subtype. To follow-up on these findings, we conducted an incidence-based mortality analysis to evaluate subtype- and stage-specific uterine cancer mortality rates by race and ethnicity. Methods: We used the U.S. Surveillance, Epidemiology, and End Results (SEER)-18 Incidence-Based Mortality database, with hysterectomy correction based on hysterectomy prevalence data from the Behavioral Risk Factor Surveillance System. We included uterine cancer deaths occurring between 2010-2017 among cases diagnosed between 2000-2017. Uncorrected and corrected mortality rates were age adjusted to the 2000 US standard population and expressed per 100,000 person-years according to tumor histology, stage at diagnosis, and race and ethnicity. Annual percent changes in rates were calculated using log-linear regression. Results: There were 16,797 uterine cancer deaths between 2010-2017, corresponding to a hysterectomy-corrected mortality rate of 15.7 per 100,000 person-years. Rates were highest among Blacks, overall, by histologic subtype, and stage at diagnosis. Among all women, uterine cancer mortality rates increased significantly by 1.8% per year from 2010-2017, as did rates of non-endometrioid carcinomas (2.7%), with the sharpest increases occurring among Hispanics (6.7%), followed by Blacks (3.5%), Asians (3.4%), and Whites (1.5%). In contrast, endometrioid carcinoma mortality rates remained stable over time. Conclusions: The underlying causes for the significant increase of non-endometrioid uterine carcinoma mortality rates, aligning with recent incidence trends, are not understood. Collectively, our findings underscore the importance of understanding the factors that contribute to the remarkable rise in non-endometrioid carcinoma incidence among all women, and the disproportionately higher incidence of these subtypes among Black women. We intend to follow-up these findings in our clinical study, DETECT, in collaboration with the University of Alabama Birmingham. Citation Format: Megan A. Clarke. Disparities in uterine cancer incidence and mortality [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA013.

Analysis of the disease burden trend of malignant tumors of the female reproductive system in China from 2006 to 2020

BackgroundMalignant tumors of reproductive system seriously threaten women’s life and health. We analyzed the changes in mortality and disease burden of cervical cancer, uterine cancer and ovarian cancer in China from 2006 to 2020 to provide a basis for formulating scientific prevention and control measures.MethodsAnnual death data for cervical cancer, uterine cancer and ovarian cancer were collected from the Chinese Cause of Death Surveillance. The crude mortality rate (CMR), age-standardized mortality rate (ASMR), annual percentage change (APC), and average APC (AAPC) were applied to analyze the trend of mortality. Loss of life expectancy (LLE) and years of life lost (YLL) were used to assess disease burden.ResultsFrom 2006 to 2020, there was no significant change in the total ASMR and standardized YLL rates of malignant tumors of the reproductive system, leading to an average LLE of 0.18 years. The YLL rate was the highest in the 55–59 age group. The mortality rate and disease burden of the three types of cancer have changed from uterine cancer higher than cervical cancer and ovarian cancer in 2006 to cervical cancer higher than ovarian cancer and uterine cancer in 2020. The ASMR and standardized YLL rate of uterine cancer showed a downward trend, and AAPC was − 5.21% (− 9.31% ~ − 0.91%) and − 6.07% (− 9.45% ~ − 2.58%), respectively. The mortality rates of cervical cancer and ovarian cancer remain high.ConclusionThe mortality and disease burden of malignant tumors of the female reproductive system in China are still at a high level. It is necessary to improve screening and prevention strategies as soon as possible, improve the techniques of diagnosis and treatment, and take adequate measures to protect women's life and health.

Alarming trends in high-risk uterine cancer histologies in Black women in the US: Is obesity responsible? (138)

<b>Objectives:</b> The incidence and mortality of uterine cancer are increasing, particularly for Black women. Although lack of access to care may explain some of these findings, high-risk histological cell types also contribute to the poor prognosis. We analyzed the current trends, projections, and potential socio-behavioral factors responsible for high-risk histologies in Black women in the United States. <b>Methods:</b> Data were obtained from the United States Cancer Statistics (USCS) database and the Behavioral Risk Factors Surveillance System (BRFSS) survey from 2001 to 2017. The average annual percent change (AAPC) was calculated using Joinpoint regression. Incidence rates and demographic factors, including age (divided into 5–10-year age groups), sex, and race (non-Hispanic White, Hispanic, non-Hispanic Black, and non-Hispanic Asian/Pacific Islander), were reported. <b>Results:</b> From 2001 to 2017, 778,891 patients were diagnosed with uterine cancer. While uterine cancer incidence increased among all racial/ethnic groups, the rate of increase was 3.6-fold higher in Black women than White women (AAPC: 2.31% vs 0.63%). From 2001 to 2013, white women had the highest incidence of uterine cancer. However, the incidence rates in White and Black women converged in 2014 due to decreasing incidence in White women and increasing incidence in Black women. We then divided uterine cancer histology into low-risk (grade 1 endometrioid) and high-risk cell types (serous, clear cell, carcinosarcoma). By 2017, high-risk types were 2.8-fold higher in Black women than White women (9.11 vs 3.20 per 100,000) and increased at a 1.6-fold higher rate (AAPC: 4.03 vs 2.53). For Black women, low-risk types increased at only 1.30% annually, whereas high-risk histologies rose 4.03% annually. Furthermore, Black women had the lowest incidence of uterine cancer during their premenopausal years but the highest incidence during their postmenopausal years. Using a predictive model with the current rate of increase, we demonstrated that the incidence of high-risk histologies in Black women would be 2.8-fold higher than that of low-risk histologies by the year 2030 (15.2 vs 5.4 per 100,000). Given that the proposed obesity axis explained high-risk histologic type in Black women with breast cancer, we then used the BRFSS data to estimate obesity trends in Black women. Our results showed that the obesity rate was highest in perimenopausal (45-54 years) Black women at 47.3% compared to 30.0% in White women in 2017. <b>Conclusions:</b> Compared to White women, Black women are twice as likely to present with serous, clear cell, and carcinosarcoma compared to low-grade endometrioid uterine cancer with increasing divergence. These findings may only be partially explained by increasing obesity rates. Transdisciplinary studies are warranted to help bridge this disparity with a focus on environmental and genetic risk factors and differential oncogenic pathways.

Uterine Cancer Mortality &amp; Incidence in Racial &amp; Ethnic Disparities

Uterine Cancer Mortality &amp; Incidence in Racial &amp; Ethnic Disparities

Racial and Ethnic Differences in Hysterectomy-Corrected Uterine Corpus Cancer Mortality by Stage and Histologic Subtype

Uterine cancer incidence has been increasing, particularly rates of aggressive, nonendometrioid subtypes, which are disproportionately higher among non-Hispanic Black women. The association of subtype-specific trends with uterine cancer mortality and with the role of tumor subtype and stage at diagnosis with racial disparities in uterine cancer deaths at the population-based level are not known. To estimate histologic subtype- and stage-specific uterine cancer mortality rates by race and ethnicity, corrected for hysterectomy. This cohort study used the US Surveillance, Epidemiology, and End Results-18 Incidence-Based Mortality database, representing approximately 26% of the US population and including deaths that occurred from 2000 to 2017. Hysterectomy correction was based on hysterectomy prevalence data from the Behavioral Risk Factor Surveillance System. Uncorrected and corrected rates associated with uterine corpus cancer cases diagnosed between 2000 and 2017 and uterine corpus cancer deaths occurring between 2010 and 2017 were age-adjusted to the 2000 US standard population and are expressed per 100 000 person-years, and annual percent changes in rates were calculated using log-linear regression. Data analysis was performed from March 10 to May 20, 2021. Tumor histologic subtype, cancer stage at diagnosis, and race and ethnicity. Among 208 587 women diagnosed with uterine cancer during 2000-2017 (15 983 [7.7%] were Asian; 20 302 [9.7%] Black; 23 096 [11.1%] Hispanic; and 149 206 [71.5%] White individuals), there were 16 797 uterine cancer deaths between 2010 and 2017, corresponding to a hysterectomy-corrected mortality rate of 15.7 per 100 000 person-years. Hysterectomy-corrected rates were highest among Black women, overall, by histologic subtype and stage at diagnosis. Among all women, uterine corpus cancer mortality rates increased significantly by 1.8% (95% CI, 1.5%-2.9%) per year from 2010 to 2017, as did rates of nonendometrioid carcinomas (2.7%; 95% CI, 1.8%-3.6%), with increases occurring in Asian (3.4%; 95% CI, 0.3%-6.6%), Black (3.5%; 95% CI, 2.2%-4.9%), Hispanic (6.7%; 95% CI, 1.9%-11.8%), and White women (1.5%; 95% CI, 0.6%-2.4%). In contrast, endometrioid carcinoma mortality rates remained stable. The findings of this cohort study suggest a significant increase of nonendometrioid uterine carcinoma mortality rates, aligning with recent incidence trends. The factors associated with these trends are not well understood and require more investigation of possible mechanisms. Despite stable incidence rates, endometrioid cancer mortality rates have not decreased over the past decade at the population level, suggesting limited progress in treatment for these cancers. The substantial disparities in uterine corpus cancer mortality rates among non-Hispanic Black women cannot be fully explained by subtype distribution and stage at diagnosis.

Selected Articles from This Issue

Racial/ethnic disparities in cancer mortality are well-described and are partly attributable to later stage of diagnosis. It is unclear to what extent reductions in the incidence of late-stage cancer could narrow these relative and absolute disparities. To better understand the potential of enhanced cancer screening in the population at large, Clarke and colleagues previously assessed the population-level potential of earlier detection of common cancer types by examining current rates of diagnosis after metastasis and hypothesizing reductions in deaths that could occur if cancers were diagnosed at earlier stages. Here, that assessment is expanded by estimating these absolute and relative reductions separately for eight contemporary U.S. population subgroups defined by race/ethnicity and sex. Across population subgroups, non-Hispanic Black males have the highest burden of stage IV cancer and would have the most deaths averted from improved detection of cancer before metastasis. Detecting cancer before metastasis could meaningfully reduce deaths in all populations, but especially in non-Hispanic Black populations.This study by Lipshultz and colleagues assessed the burden of potentially modifiable cardiometabolic risk factors among childhood cancer survivors previously treated with anthracycline-containing regimens, compared with population-matched controls. Overall, survivors had similar cardiometabolic profiles compared with general population controls. Survivors had higher rates of pre-hypertension/hypertension, reinforcing the importance of close attention to blood pressure management, even in early adulthood. With more favorable lifestyle habits in this cohort, survivors had a lower predicted cardiovascular risk when applying general population risk factor models, but nonetheless a moderate or greater risk of subsequent symptomatic cardiovascular disease predicted by childhood cancer survivor-specific risk models. Further strategies supporting optimal cardiometabolic risk factor control and risk assessment are warranted in survivors.Breast cancers in recently postpartum women may have worse outcomes, but studies examining tumor molecular features by pregnancy recency have shown conflicting results. This analysis used Carolina Breast Cancer Study data to examine clinical and molecular tumor features among women <50 years of age who were recently (≤10 years prior), or remotely (>10 years prior) postpartum, or nulliparous. Prevalence odds ratios (PORs) and 95% confidence intervals (CIs) were estimated using multivariable models. The results suggest a dominant effect of parity (vs. nulliparity) and a lesser effect of pregnancy recency on tumor molecular features, although tumor immune microenvironments were altered in association with pregnancy recency. This study by Vohra and colleagues is unique in examining tumor immune microenvironment and RNA-based markers according to time since last childbirth.Asian Americans (AA) are the fastest growing and highly diverse population group in the U.S., yet few studies have examined cancer mortality burden by AA ethnicity. Using SEER cancer registry data, Karia and colleagues examined differences in gynecologic cancer mortality between White and AA women by ethnicity (Filipino, Chinese, Japanese, Korean, Vietnamese, Indian/Pakistani). AA women had a lower risk of ovarian and cervical cancer mortality and a higher risk of uterine cancer mortality than White women, with substantial heterogeneity across AA ethnicity. These findings underscore the importance of disaggregation of data by ethnicity to fully understand cancer burden among the diverse AA population.

Spatiotemporal trends in burden of uterine cancer and its attribution to body mass index in 204 countries and territories from 1990 to 2019.

BackgroundUterine cancer is one of the most common female cancers worldwide, with huge heterogeneity in morbidity and mortality. Although a high body‐mass index (BMI) has been linked to uterine cancer, systematic reports about the influence of high BMI and its temporal trends are scarce.MethodsThe annual morbidity, mortality, and disability‐adjusted life years (DALYs) of uterine cancer in 204 countries or territories were retrieved from the GBD 2019 study. To reflect trends in disease burden, we also calculated the estimated annual percentage change (EAPC) based on the age‐standardized rates of uterine cancer from 1990 to 2019.ResultsThe global incident cases of uterine cancer increased 2.3 times from 187,190 in 1990 to 435,040 in 2019. Although the age‐standardized incidence rate (ASIR) of uterine cancer increased worldwide from 8.67/100,000 in 1990 to 9.99/100,000 in 2019, the age‐standardized death rate (ASDR) and DALY rate decreased during the same period. High socio‐demographic index (SDI) countries tended to have a higher ASIR than developing regions, and their increasing trend in ASIR was also more pronounced. The disease was rare before 40 years old, but its risk rose sharply among women aged 50–70. A high BMI was linked to more than one‐third of deaths from uterine cancer in 2019.ConclusionsThe incidence in developed areas was significantly higher than in developing areas and also increased much more rapidly. Elderly females, especially those with a high BMI, have a higher risk of uterine cancer. Therefore, more health resources may be needed to curb the rising burden in specific populations.

Setting the record straight-Correcting uterine cancer incidence and mortality in the Nordic countries by reallocation of unspecified cases.

The incidence of and mortality from cancers of the cervix uteri and corpus uteri are underestimated if the presence of uterine cancers, where the exact topography (site of origin) is not specified, is omitted. In this paper we present the corrected figures on mortality from and incidence of cervix and corpus uteri cancers in the Nordic countries by reallocating unspecified uterine cancer deaths and cases to originate either from the corpus uteri or cervix uteri. To further validate the accuracy of reallocation, we also analyzed how well the reallocation captures the changes occurring as the result of a transition in cause of death coding in Norway that took place in 2005. This study uses data available in the NORDCAN database, which contains aggregated cancer data from all the Nordic countries for the years 1960-2016. The unspecified uterine cancer cases and deaths were reallocated to either cervix uteri or corpus uteri based on the estimated probability that follows the distribution of cases and deaths with verified topography. The estimated proportions of cases and deaths for both cancers were calculated for each combination of age group, year, and country as a proportion of cases (and deaths, respectively) with known topography. Annual age-standardized rates were calculated by direct age-adjustment. The proportions of unspecified uterine cancers were higher in the mortality data than in incidence data, with mean values for 1960-2016 ranging between 5.1% and 26.6% and between 0.2% and 6.8% by country, respectively. In the Nordic countries combined, the reallocation increased the number of cases by 4% and deaths by approximately 20% for both cancers. Finland was the only Nordic country where the mortality rate did not increase substantially after reallocation. The reallocation procedure had a significant impact on mortality from cancers of the cervix and corpus uteri for countries where the proportion of cancer deaths coded as uterus, not otherwise specified, is substantial. More effort to validate cause of death data with incidence data from cancer registries is warranted to avoid erroneous conclusions of temporal trends based on uncorrected cancer burden.

Trends in Incidence and Mortality Rates of Uterine Cancer in Kentucky.

The objective of this analysis was to gauge how the incidence and mortality of uterine cancer in Kentucky have changed from 1995 through 2017. An assessment of the trends in incidence and mortality across different geographic areas and between different races was also performed. Age-adjusted annual incidence and mortality rates for uterine cancer were obtained from the Kentucky Cancer Registry. A meta-regression framework was used to assess changes in incidence and mortality rates during the time frame and to determine differences in these rates between rural versus urban counties, Appalachian versus non-Appalachian counties, and Black versus White women. The incidence of uterine cancer has significantly increased throughout the state of Kentucky since 1995. Uterine cancer incidence was 10% and 22% higher in rural and Appalachian counties, respectively, compared with urban and non-Appalachian counties (P < 0.0001) from 1995 through 2017. In contrast, urban and non-Appalachian women had higher or equivalent age-adjusted mortality from uterine cancer, compared with rural and Appalachian women, respectively. The incidence of uterine cancer was significantly higher in White women compared with Black women from 1995 through 2006, but since 2007, there has been no significant difference in uterine cancer incidence based on race. Black women had higher age-adjusted mortality than White women throughout the entire time period examined. The incidence of uterine cancer is higher in rural and Appalachian Kentucky, without a corresponding geographic trend in mortality. Uterine cancer mortality is significantly higher in Black women.