title: Endometrial cancer in Kentucky: the impact of age, smoking status, and rural residence.
abstract: BACKGROUND
  The study objectives were to assess the effect of age, to evaluate the impact of smoking, and to determine the effect of rural residence on tumor characteristics, treatment modalities, and outcomes for Kentucky's endometrial cancer patients.
  
  
  METHODS
  The Kentucky Cancer Registry identified Kentucky residents diagnosed with endometrial cancer from 1995 to 2002. Data abstracted included demographics, tumor characteristics, treatment, and recurrence/survival status.
  
  
  RESULTS
  Three thousand five hundred and sixty-two women were diagnosed with endometrial cancer. Mean age at diagnosis decreased significantly (P=0.0388) over the 7-year period. Smokers had higher grade, stage, and worse outcomes. Rural women more often lacked commercial insurance, underwent less comprehensive surgical evaluation, and had less multimodality treatment. Increasing age (P<0.0001), positive or unknown smoking status (P=0.0003), black race (P<0.0001), no commercial insurance (P<0.0001), increasing grade or advanced stage (P<0.0001), small size of treating hospital (P<0.0001), and unknown nodal status (P<0.0001) were negatively associated with disease-specific survival. Lymph node sampling was performed in only 38.6% of women. On multivariate analysis, age (RR 1.38 for 10 year increments; P<0.0001), smoking (RR 1.38; P=0.008), no commercial insurance or Medicaid (RR 1.87; P=0.0007), rural residence (RR 0.77; P=0.011), advanced stage and grade (RR 7.96, 3.96; P<0.0001), and no nodal evaluation or unknown nodal status (RR 2.32, 2.51; P<0.0001) significantly effected disease-specific survival.
  
  
  CONCLUSIONS
  Our data support a trend toward a younger age for endometrial cancer diagnosis, confirm the adverse impact of smoking and socioeconomic factors, and demonstrate an association between incomplete surgical staging and decreased survival.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Chandler Medical Center, 800 Rose Street, Lexington, KY 40536-0298, USA. smode2@uky.edu
authors.forename: Susan C
authors.initials: SC
authors.lastname: Modesitt
authors.forename: Bin
authors.initials: B
authors.lastname: Huang
authors.forename: Brent J
authors.initials: BJ
authors.lastname: Shelton
authors.forename: Stephen
authors.initials: S
authors.lastname: Wyatt
mesh_terms: D000328:Adult; D000367:Age Factors; D016889:Endometrial Neoplasms / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D008875:Middle Aged; D016016:Proportional Hazards Models; D012424:Rural Population; D012907:Smoking / Q000009:adverse effects*; D015996:Survival Rate