Differences in treatment and outcome between African-American and white women with endometrial cancer.
OBJECTIVE
To investigate disparities in treatment and outcomes between African-American and white women with endometrial cancer.


METHODS
We analyzed 1992 to 1998 Surveillance, Epidemiology, and End Results data for 21,561 women with epithelial cancers of the endometrium. Sequential Cox proportional hazard models were used to determine the association between tumor characteristics (stage, grade, and histologic type), sociodemographic characteristics (age and marital status), and treatment (surgery and radiation therapy) and the racial difference in mortality.


RESULTS
The unadjusted hazard ratio (HR) for death from endometrial cancer for African-American women compared with white women was 2.57. However, African-American women were significantly more likely to present with advanced-stage disease and have poorly differentiated tumors or tumors with an unfavorable histologic type and were significantly less likely to undergo definitive surgery at all stages of disease. Adjusting for tumor and sociodemographic characteristics lowered the HR for African-American women to 1.80. Further adjustment for the use of surgery reduced the HR to 1.51. The association between surgery and survival was stronger among white women (HR, 0.26) than among African-American women (HR, 0.44).


CONCLUSIONS
African-American women with endometrial cancer are significantly less likely to undergo primary surgery and have significantly shorter survival than white women with endometrial cancer. Racial differences in treatment are associated with racial differences in survival. The association between use of surgery and survival is weaker among African-American than white women, raising questions about potential racial differences in the effectiveness of surgery.
Randall
Thomas C
TC
Department of Obstetrics and Gynecology, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Armstrong
Katrina
K
D000230:Adenocarcinoma / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D000231:Adenocarcinoma, Papillary / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D002294:Carcinoma, Squamous Cell / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D018284:Cystadenocarcinoma, Serous / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D016889:Endometrial Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012042:Registries; D012307:Risk Factors; D018426:SEER Program; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States; D044465:White People; D001741:Black or African American