Racial Disparities in Mortality from Type II Endometrial Cancer Underscores Need for Research On ‘Disproportionate Disease Burden’

Non-Hispanic Black patients appeared to have higher disease-specific mortality rates than patients of other races, with clinicopathologic factors playing the greatest role in the disparity.

Non-Hispanic Black patients could be at greater risk of cancer-specific mortality from type II endometrial cancer vs their Hispanic, non-Hispanic White, and non-Hispanic Asian/Pacific Islander (API) counterparts; the disparities appear to be driven primarily by differences in clinicopathologic factors, according to findings from a study published in Gynecologic Oncology.

The data showed a significantly higher risk of cancer-specific death in Black patients compared with White patients (HR 1.22; 95% Cl, 1.12-1.33). Differences in clinicopathologic factors, including disease stage, tumor grade, and histologic subtype, accounted for 43.5% of the difference in risk of cancer-specific death.

Sociodemographic factors—insurance type, geographic region, and neighborhood socioeconomic status (SES)—accounted for a further 8.1%, and treatment-related factors—treatment type and lymphadenectomy—accounted for 7.3%.

“Endometrial cancer is one of the few cancer types in the United States with increasing mortality. Recent studies have shown that these increases are primarily due to increases in type II endometrial cancer, an aggressive subtype that disproportionately affects Black women,” lead author Pritesh S. Karia, MD, PhD, said in a conversation with CancerNetwork®. “The findings of our study underscore the need for additional research on factors underlying the disproportionate burden of type II endometrial cancer in Black women.”

Conversely, investigators found API patients (HR 0.88; 95% Cl, 0.78-0.99) and Hispanic patients (HR 0.91; 95% Cl, 0.81-1.01) had a smaller risk of cancer-related death than White patients.

The study derived these findings from an assessment of 14,710 cases of type II endometrial cancer diagnosed between 2007 and 2016. Most of the assessed patients were White (n = 9169). The median age at diagnosis was 65.4 years in the White group, 65.3 years in the Black cohort (n = 2503), 62.6 years in the Hispanic cohort (n = 1714), and 62.2 years in the API cohort (n = 1324).

Investigators gathered these data from the Surveillance, Epidemiology, and End Results (SEER) database.

Insurance and geographic characteristics, as well as neighborhood SES, varied widely between patient groups. Black and Hispanic patients were more likely to live in low SES neighborhoods. Moreover, Black, Hispanic, and API patients were all more likely to be uninsured, or insured through Medicaid, than White patients. White patients were also less likely to reside in urban areas.

The 5-year cancer-related death rate was 40.6% (95% Cl, 38.3%-42.8%) among Black patients compared with 32.4% (95% Cl, 29.7%-35.0%) among Hispanic patients, 31.7% (95% Cl, 30.6%-32.8%) among White patients, and 30.1% (95% Cl, 28.2%-34.0%) among API patients (P <.001).

The overall incidence of death mirrored that of cancer-related death, with a rate of 53.7% (95% Cl, 51.3%-56.2%) among Black patients, 42.9% (95% Cl, 39.9%-45.9%) among Hispanic patients, 41.1% (95% CI, 39.9%-42.3%) among White patients, and 39.7% (95% Cl, 36.6%-43.1%) among API patients (P <.001).

“Our study suggests that targeted efforts to reduce the high burden of type II endometrial cancer mortality in Black women should be a priority and will require a multidisciplinary and multilevel approach that integrates social and biological factors. Future efforts should focus on the contribution of understudied factors, such as structural racism, chronic stress, and the vaginal microbiome, that may inform possible intervention strategies,” Karia concluded.

Reference

Karia PS, Huang Y, Tehranifar P, Wright JD, Genkinger JM. Racial and ethnic differences in type II endometrial cancer mortality outcomes: the contribution of sociodemographic, clinicopathologic, and treatment factors. Gynecol Oncol. 2022;168:119-126. doi:10.1016/j.ygyno.2022.11.015