A recent 8-year snapshot of uterine cancers shows that death rates from these common reproductive malignancies have increased significantly in all women in the United States, but disproportionately affect Black women. The population-based analysis, published in JAMA Oncology, found that Black women have twice the death rate, overall, from other racial and ethnic groups, especially from a rare, aggressive, subtype of the disease (2022; doi:10.1001/jamaoncol.2022.0009). These cancers, often detected late and difficult to treat, also rose more generally in all women, about 2.7 percent per year, accounting for nearly half of deaths in the study period.
The analysis casts a spotlight on a growing public health concern, according to the researchers: a sharp mortality jump in uterine cancers-an estimated 1.8 percent per year from 2010 to 2017-at a time when incidence and mortality in other gynecologic cancers have begun to decline.
"The increase in uterine cancer is not only statistically significant, it also has public health significance," said Megan Clarke, PhD, MHS, the study's principal investigator and an epidemiologist with the National Cancer Institute's Division of Cancer Epidemiology and Genetics. She called for better public health messaging about possible warning signs, such as postmenopausal bleeding, a "very common symptom of endometrial cancer," in over 90 percent of pooled cases in an earlier study.
Although that study did not distinguish between aggressive and non-aggressive subtypes of the disease, Clarke noted that women over age 40 experiencing abnormal bleeding between periods or after menopause should contact their doctors for a diagnostic workup as soon as possible. Early detection in uterine cancer, as in most cancers, is associated with better survival-80 percent or greater with 5-year relative survival, compared with less than 20 percent when these cancers have spread.
However, while abnormal bleeding may trigger concern, no early screening test is recommended or yet exists for uterine cancer. And Black women commonly develop benign fibroid tumors, Clarke and others have noted, leading to irregular bleeding patterns and a higher prevalence, historically, of surgical hysterectomy. The NCI-led researchers corrected for these differences between Black women and other racial and ethnic groups in the SEER-based database, but still identified profound racial disparities.
In 2022, an estimated 65,950 women in the U.S. will be newly diagnosed with uterine cancer with 12,550 expected to die of their disease. However, if current increases in incidence and mortality persist, the study suggests that by 2040 uterine cancer could surpass colorectal cancer as the third-leading cancer in women behind lung and breast cancers and the fourth-leading cause of cancer death.
"It's an alarming trend," said Leslie Boyd, MD, Director of Gynecologic Oncology at NYU Langone Health's Perlmutter Cancer Center, referring to the annual rise in both incidence and mortality in these cancers. Although, as an observational study, translating its findings to the clinic is difficult, and she has seen increasing numbers of women with uterine cancer at the NYU center, especially Black women with advanced disease.
Aside from race, however, there's still no clear explanation for why this is happening, Boyd noted. Obesity, an established risk factor for less-aggressive uterine cancer, may play a small role in the aggressive kind as well, she said. And evidence shows that mutations in the P53 gene greatly increase risk, as they frequently do in other aggressive tumors. But additional research is needed.
Fortunately, many researchers are actively pursuing possible biological and behavioral factors that may contribute to the higher incidence, worse survival, and higher mortality seen in Black women, Boyd noted. "The urgency here is palpable. This is a tremendous unmet need."
At least one large case-control study, recently launched by the NCI at the University of Alabama Birmingham and now under way, hopes to address that need. The DETECT Study: Discovery and Evaluation of Tests in Endometrial Cancer in Tampons has recruited about 350 women so far with an ultimate enrollment target of 1,000 women. All the women will undergo a hysterectomy either for endometrial cancer or benign conditions. As part of the study, Clarke said the women will self-collect vaginal tampon samples prior to surgery and again after surgery, which will later be tested for abnormal molecular and tissue changes in the lower reproductive tract.
By tracking such changes in a diverse population of women as cancer evolves, the investigators say the goal is to evaluate risk factors associated with tumor subtype and stratify them by race; assess delays in care related to symptoms, such as postmenopausal bleeding; evaluate molecular biomarkers for early endometrial cancer detection; and characterize the risk of recurrence, as well as survival, by race and overall.
Susan Jenks is a contributing writer.