Objective The objective of this article is to comprehensively review the scientific literature and summarize the available data regarding the outcome disparities of African American women with uterine cancer. Methods Literature on disparities in uterine cancer was systematically reviewed using the PubMed search engine. Articles from 1992-2012 written in English were reviewed. Search terms included endometrial cancer, uterine cancer, racial disparities, and African American. Results Twenty-four original research articles with a total of 366,299 cases of endometrial cancer (337,597 Caucasian and 28,702 African American) were included. Compared to Caucasian women, African American women comprise 7% of new endometrial cancer cases, while accounting for approximately 14% of endometrial cancer deaths. They are diagnosed with later stage, higher-grade disease, and poorer prognostic histologic types compared to their Caucasian counterparts. They also suffer worse outcomes at every stage, grade, and for every histologic type. The cause of increased mortality is multifactorial. African American and white women have varying incidence of comorbid conditions, genetic susceptibility to malignancy, access to care and health coverage, and socioeconomic status; however, the most consistent contributors to incidence and mortality disparities are histology and socioeconomics. More robust genetic and molecular profile studies are in development to further explain histologic differences. Conclusions Current studies suggest that histologic and socioeconomic factors explain much of the disparity in endometrial cancer incidence and mortality between white and African American patients. Treatment factors likely contributed historically to differences in mortality; however, studies suggest most women now receive equal care. Molecular differences may be an important factor to explain the racial inequities. Coupled with a sustained commitment to increasing access to appropriate care, on-going research in biologic mechanisms underlying histopathologic differences will help address and reduce the number of African American women who disproportionately suffer and die from endometrial malignancy.

Objective To investigate disparities in the frequency of ovarian cancer-related surgical procedures and access to high-volume surgical providers among women undergoing initial surgery for ovarian cancer according to race. Methods The California Office of Statewide Health Planning and Development database was accessed for women undergoing a surgical procedure that included oophorectomy for a malignant ovarian neoplasm between 1/1/06 and 12/31/10. Multivariate logistic regression analyses were used to evaluate differences in the odds of selected surgical procedures and access to high-volume centers (hospitals≥20 cases/year) according to racial classification. Results A total of 7,933 patients were identified: White=5,095 (64.2%), Black=290 (3.7%), Hispanic/Latino=1,400 (17.7%), Asian/Pacific Islander=836 (10.5%) and other=312 (3.9%). White patients served as reference for all comparisons. All minority groups were significantly younger (Black mean age 57.7 years, Hispanic 53.2 years, Asian 54.5 years vs. 61.1 years, p <0.01). Hispanic patients had lower odds of obtaining care at a high-volume center (adjusted OR (adj. OR)=0.72, 95% CI=0.64-0.82, p<0.01) and a lower likelihood of lymphadenectomy (adj. OR=0.80, 95%CI=0.70–0.91, p<0.01), bowel resection (adj. OR=0.80, 95% CI=0.71–0.91, p<0.01), and peritoneal biopsy/omentectomy (adj. OR=0.69, 95% CI=0.58–0.82, p<0.01). Black racial classification was associated with a lower likelihood of lymphadenectomy (adj. OR=0.76, 95%CI=0.59–0.97, p=0.03). Conclusions Among women undergoing initial surgery for ovarian cancer, Hispanic patients are significantly less likely to be operated on at a high-volume center, and both Black and Hispanic patients are significantly less likely to undergo important ovarian cancer-specific surgical procedures compared to White patients.