The Growing Burden of Endometrial Cancer: A Major Racial Disparity Affecting Black Women.
BACKGROUND
In contrast with the decreasing incidence seen for most cancers, endometrial cancer has been increasing in the United States. We examined whether the increasing incidence and mortality from endometrial cancer are equally distributed by race/ethnicity and tumor histologic subtype.


METHODS
Surveillance, Epidemiology, and End Results (SEER) endometrial cancer incidence and mortality data were obtained from 2000 to 2011. Age-adjusted incidence and incidence-based mortality rates, 95% confidence intervals, and annual percent changes (APC) were calculated. Rate ratios were calculated to compare racial/ethnic groups. Five-year relative survival rates were presented to explore survival by stage at diagnosis.


RESULTS
Incidence rates for endometrial cancers are rising across all racial/ethnic groups, with the greatest APC seen among non-Hispanic black (NHB) and Asian women (APC, 2.5 for both). NHB women have significantly higher incidence rates of aggressive endometrial cancers (clear cell, serous, high-grade endometrioid, and malignant mixed Mullerian tumors) compared with non-Hispanic white (NHW) women. Hispanic and Asian women have incidence rates equal to or lower than NHW women for all tumor subtypes. For nearly every stage and subtype, the 5-year relative survival for NHB women is significantly less than NHW women, whereas Hispanic and Asian women have the same or better survival.


CONCLUSIONS
Endometrial cancer incidence is increasing for all women, particularly the aggressive subtypes. The disparity associated with excess incidence for these aggressive histologic subtypes and poorer survival is limited to NHB women.


CONCLUSIONS
Increasing rates of aggressive endometrial cancers may widen the survival disparity between NHW and NHB women.
Department of Oncology, School of Medicine, Wayne State University, Detroit, Michigan. Karmanos Cancer Institute Population Science and Disparities Research Program, Detroit, Michigan. cotem@karmanos.org.
Michele L
ML
Cote
Department of Oncology, School of Medicine, Wayne State University, Detroit, Michigan.
Julie J
JJ
Ruterbusch
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Research Center, New York, New York.
Sara H
SH
Olson
Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Karen
K
Lu
Department of Pathology, School of Medicine, Wayne State University, Detroit, Michigan.
Rouba
R
Ali-Fehmi
D018262:Adenocarcinoma, Clear Cell / Q000208:ethnology* / Q000401:mortality / Q000473:pathology; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000706:statistics & numerical data; D018269:Carcinoma, Endometrioid / Q000208:ethnology* / Q000401:mortality / Q000473:pathology; D002296:Carcinosarcoma / Q000208:ethnology* / Q000401:mortality / Q000473:pathology; D016889:Endometrial Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000473:pathology; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D018200:Mixed Tumor, Mullerian / Q000208:ethnology* / Q000401:mortality / Q000473:pathology; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000208:ethnology* / Q000401:mortality / Q000473:pathology; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data