June 3, 2024
By Warren Froelich
Black women with endometrial cancer face delayed diagnosis and less use of surgery-based treatments compared to White and Asian women, contributing to a significant survival disparity among these racial and ethnic groups in the United States, according to a study presented at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract 5608). Results suggest that clinicians and policymakers could help bridge this survival gap, at least in part, by improving access to earlier diagnosis and treatment options regardless of race or ethnicity, the researchers said.
“The general population should be aware there are available treatment options in the country for this cancer, and an early consultation and detection at early stages of the disease have been shown to improve survival,” said Henry Becerra, MD, Internal Medicine Resident in The Brookdale University Hospital and Medical Center in New York, and the study’s lead investigator.
“We have identified that surgery-based treatments are impactful in the survival of patients with endometrial carcinoma, and there is room for improvements in the access to those therapies.”
Unlike many other cancers, cases of endometrial cancer have been on the rise over the past decade and it is now the fourth most commonly diagnosed cancer among women.
Studies show that Black women with endometrial cancer have nearly twice the risk of dying from their disease than White women—lone of the greatest disparities seen among common solid tumors. This disparity can be attributed, at least in part, to more aggressive and advanced forms of endometrial cancer harbored by black women. But many social factors affecting access to health care may play a vital role as well.
Becerra and colleagues sought to specify how a variety of socioeconomic factors affect prognosis and survival outcomes for endometrial cancer patients based on race in the United States.
A total of 219,301 cases of endometrial cancer were included and analyzed in this study based on 2000-2009 data from the Surveillance, Epidemiology, and End Results (SEER) Research Plus data and 17 cancer registries. Median age of study patients was 62 years with a racial and ethnic makeup consisting of 69.5 percent White, 8.6 Black, and 8.4 Asian. Treatments consisted of surgery (91.8%), radiotherapy (26.1%), and chemotherapy (18.1%). Median follow-up was 64 months.
Results showed a median overall survival (OS) of 209 months for this group, with Black women experiencing the shortest median OS of 118 months versus 205 months for White women. Median OS for Asian women was not reached. Compared to White individuals, Black women exhibited the poorest prognosis (HR=1.39, 95% CI: 1:35-1.43) whereas Asians demonstrated the best prognosis (HR=0.88, 95% CI: 85-0.91).
When compared to Asian individuals, there was a higher proportion of Black women 60 years or greater (66.9% vs. 44%) with incomes of $60,000 or less (31.3% vs, 3.6%) and diagnosed at a more advanced stage (37.4% vs. 28.9%).
Those with access to surgery-based treatments experienced the best prognosis, with Asian individuals more prone to receive surgical treatment independent of disease stage compared to Black women. About 93 percent of Asian women and 90 percent of White women received surgery-based treatments that included chemotherapy plus surgery, radiotherapy plus surgery, chemotherapy and radiotherapy plus surgery, or surgery alone. By comparison, some 84.7 percent of Black women received any form of surgery-based treatment.
“Notably, compared to Asians, Blacks appear to face delayed diagnosis, lower income, and less frequent use of surgery-based treatments,” the researchers wrote. “This highlights the importance of early access to diagnosis and treatment as potential avenues to improve survival.”
Becerra acknowledged in an interview that a “major limitation” of this study was the lack of information in the analyzed databases about obesity, body mass index, and diet, which previous studies have shown to be critical risk factors for endometrial and other cancers.
“Yet, there are clear variables that could potentially be improved in the general population of women with endometrial cancer that has been shown in real life that has the opportunity to improve, i.e., access to surgery-based treatments,” he said.
“At the individual level with each patient, I think it is important to address the factors identified in our study and the ones previously described in the literature to increase the chance of improving survival,” Becerra noted. “At the population level, studies exploring the behavior of those variables with the ones that we explored would be highly desired.”
As for next steps, Becerra said those planning clinical trials in the future should include the variables identified in this study when stratifying population “to adequately identify if a treatment is really efficacious or not, avoiding bias. Also, it would be great that, at a policy-maker level, decisions could be made to increase early access to diagnosis and adequate treatment based on current needs of patients,” he added.
Warren Froelich is a contributing writer.