In a study reported in JAMA Oncology, Clarke et al found that hysterectomy-corrected rates of mortality from uterine corpus cancer overall and from nonendometrioid carcinomas have increased in recent years, with mortality rates being highest in Black women.
The study involved data from the U.S. Surveillance, Epidemiology, and End Results–18 Incidence-Based Mortality database on women aged ≥ 40 years diagnosed with uterine corpus cancer between 2010 and 2017. Rates of hysterectomy-corrected mortality and annual percent change in mortality were calculated.
Among 208,587 women included in the analysis (7.7% Asian, 9.7% Black, 11.1% Hispanic, 71.5% White), 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.
Among all women, overall corrected uterine corpus cancer mortality rates increased significantly, with an annual percent change of 1.8% (95% confidence interval [CI] = 1.5%–2.9%) from 2010 to 2017. Significant annual percent changes were observed among Hispanic women (3.5%) and White women (1.4%), whereas annual percent changes were nonsignificant for Asian women (3.1%) and Black women (2.2%). Mortality rates increased significantly for nonendometrioid carcinomas overall (annual percent change = 2.7%, 95% CI = 1.8%–3.6%), with significant annual percent changes for Asian (3.4%), Black (3.5%), Hispanic (6.7%), and White women (1.5%). Endometrioid carcinoma mortality rates remained stable over time.
Hysterectomy-corrected mortality rates were highest among Black women: overall, by histologic subtype, and by stage at diagnosis. Overall rates per 100,000 person-years were 31.4 among Black women vs 9.0 among Asian women, 12.3 among Hispanic women, and 15.2 among White women. According to localized, regional, and distant disease stage, rates were 7.3, 10.7, and 11.4 among Black women, compared with 2.1, 3.0, and 3.3 among Asian women; 3.1, 4.3, and 4.2 among Hispanic women; and 4.2, 5.4, and 4.6 among White women. Rates per 100,000 person-years for nonendometrioid carcinomas were 18.5 among Black women vs 4.0 among Asian women, 5.9 among Hispanic women, and 6.5 among White women, with rates by each stage being highest in Black women. Rates for endometrioid carcinomas were 8.4 among Black women vs 3.5 among Asian women, 4.6 among Hispanic women, and 6.8 among White women, with rates by each stage being highest among Black women.
The investigators concluded, “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.”
Megan A. Clarke, PhD, MHS, of the Division of Cancer Epidemiology and Genetics, National Cancer Institute, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was supported by the Intramural Research Program of the National Institutes of Health and the National Cancer Institute. For full disclosures of the study authors, visit jamanetwork.com.