Endometrial cancer (EC) incidence is on the rise. Although early-onset endometrial cancer (EOEC, age at diagnosis <50) is relatively uncommon, the incidence of EOEC has been reportedly increasing in recent decades. However, the rising EOEC has not been thoroughly described with regard to the racial/ethnic disparities and in comparison with the late-onset EC (LOEC, age at diagnosis ≥50). We used the CiNA Analytic File, 1995-2018, from the North American Association of Central Cancer Registries (NAACCR), which allowed us to examine trends in invasive EC incidence by racial/ethnic groups and by age at diagnosis. We found striking differences for demographic and tumor characteristics as well as racial/ethnic patterns and time trends in EC incidence between EOEC and LOEC. The faster increases in EOEC incidence rates, especially among non-White women, mirror similar observations in other cancers pointing to a possible link with rising obesity epidemic in younger generations.

BACKGROUND: Endometrial cancer (EC) is the most common gynecologic cancer and the fourth most common cancer among women in the United States (US). Although early-onset endometrial cancer (EOEC, diagnosed under age 50) is relatively uncommon, several studies have reported the incidence of EOEC has been increasing in recent decades. Because few studies have examined differences in incidence trends across race/ethnicity between EOEC and late-onset endometrial cancer (LOEC, diagnosed at age 50 or older), we compared the incidence trends between EOEC and LOEC in the US by race/ethnicity across two decades. METHODS: We used the CiNA Analytic File, 1995-2018, Public Use, obtained from the North American Association of Central Cancer Registries (NAACCR) and identified 930,176 invasive endometrial cancer cases (ICD-O-3 site code C54.1, excluding histology codes 9050-9055, 9140, and 9590-9992), of which 12.6% were EOEC and 87.4% LOEC. We examined the characteristics of these cases including race/ethnicity, year of diagnosis, tumor stage and grade by EOEC and LOEC status. We calculated the yearly race/ethnicity-specific age-adjusted incidence rates (AAIR) and the average annual percent change (AAPC) in the AAIRs for EOEC and LOEC respectively. RESULTS: Compared with LOEC cases, women with EOEC were less likely to be non-Hispanic (NH) White, more likely to be Hispanic or NH Asian/Pacific Islander (API), and less likely to have advanced stage or poorly differentiated grade. The AAIRs were highest in NH Whites in 1995 for both EOEC and LOEC. By 2018, the highest AAIR was found in Hispanics for EOEC and in NH Blacks for LOEC, resulting from faster increases in EC risk among the non-white groups. AAIRs for EOEC and LOEC increased over the study period, with the overall AAPC being three times as high for EOEC as LOEC (AAPC 1.72 vs. 0.57). For EOEC, the largest increases were observed in NH Blacks (AAPC=3.52) followed by Hispanics (AAPC=2.77) and NH API (AAPC=2.06). For LOEC, the largest increases were observed in NH APIs (AAPC=2.42) followed by NH Blacks (AAPC=2.28) and Hispanics (AAPC=1.71). For both EOEC and LOEC, the AAPCs were highest in NH Blacks and lowest in NH Whites. CONCLUSIONS: The faster increases in EOEC incidence among NH Black, Hispanic, and NH API women likely reflect racial/ethnic differences in the prevalence and trends of endometrial cancer risk factors. This indicates that these higher-risk populations might benefit from targeted surveillance and interventions. Future studies should evaluate whether these differences across race/ethnicity are attributable to specific tumor characteristics, biomarkers, or other sociodemographic factors. Citation Format: Talar S. Habeshian, Lihua Liu, Juan-Juan Zhang, Margaret Du, Immaculata De Vivo, Veronica W. Setiawan. Rising incidence and racial disparities of early-onset endometrial cancer in the United States, 1995-2018 [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C119.

Background: Few studies have evaluated the effect of statin exposure on metastasis risk among prostate cancer patients not receiving curative treatment. Methods:We included men diagnosed with localized prostate cancer at an integrated health care system between 1997 and 2006 who did not receive curative treatment within 6 months of diagnosis. We followed these men until a metastatic event, disenrollment, death, or 12/31/2016. We collected all data from electronic health records supplemented by chart review. We used Cox regressions to examine the association between post-diagnostic statin exposure and metastasis, controlling for clinical characteristics and pre-diagnostic statin exposure.Results: There were 4245 men included. Mean age of diagnosis was 68.02 years.46.6% of men used statins after prostate cancer diagnosis. During follow-up, 192 men developed metastasis (cumulative incidence rate: 14.5%). In the adjusted Cox model, statin use post-prostate cancer diagnosis was not significantly associated with a metastatic event (HR = 0.97, 95% CI = 0.69, 1.36). Pre-diagnostic statin use was also not associated with development of metastasis (HR = 0.76, 95% CI = 0.53, 1.10).We did not observe a dose-response for the proportion of person-time at-risk postprostate cancer diagnosis on statins (HR = 0.98 per 10% increase in person-time exposed [95% CI = 0.93, 1.03]). Conclusions:We did not find an inverse association between post-diagnosis statin exposure and metastasis development in localized prostate cancer patients who did not receive active treatment. Our results did not offer support to the chemopreventive potential of post-diagnostic statin use among men on active surveillance.

36 Background: Risk-stratified survivorship care pathways are critical for meeting needs of cancer survivors and the oncology workforce. To support a clinical trial evaluating a survivorship model that transitions low-risk survivors to a primary care physician (PCP)-led survivorship clinic within an integrated healthcare system, we captured data on real-time clinical risk stratification of low-risk patients potentially eligible between 6 and 36 months after treatment cessation. Methods: After oncology stakeholder input, we developed a screening algorithm to identify low-risk breast and colorectal cancer (CRC) survivors from the electronic medical record based on data from pathology, treatment, and utilization records. The algorithm identified patients meeting study eligibility criteria: adult stage 0-IIb breast cancer or stage I-II CRC patients diagnosed with first primary cancer, excluding those with treatments indicative of high-risk or metastatic disease, ongoing ovarian suppression or trastuzumab treatment (breast), neoadjuvant chemotherapy (breast), or enrollment in other cancer clinical trials. Next, the treating oncologist was asked to confirm or deny patient eligibility based on low-risk criteria; if denied, ineligibility reason was requested. Characteristics and proportions of low-risk patients confirmed/denied eligibility and reasons for ineligibility are summarized. Results: 530 patients were identified and evaluated: 488 breast and 42 CRC. Mean age was 61 years (SD: 11.6, range 23-95); 96% female; 22% had stage 0 disease (breast only), 51% stage I, and 28% stage II. By cancer type, 390 breast patients were deemed eligible (80%); 31 CRC patients were eligible (74%). A greater proportion of Asian and Black patients were categorized eligible vs. ineligible (13% vs. 9%, and 25% vs.14%, respectively), and a smaller proportion of Hispanic and White were categorized eligible (26% vs. 33%, and 31% vs. 42%, respectively). Reasons for ineligibility included: suspicious for recurrence (6%), new primary disease (3%), complex case/condition (36%), patient preference (34%), and other/none (22%). “Complex case/condition” included reasons such as intolerance of chemotherapy, patient declined chemotherapy and/or endocrine treatment (breast), co-occurring hematology disorder; “other/none” included reasons such as current pregnancy Lynch syndrome, and no reason. Conclusions: Oncologists confirmed eligibility for 80% of algorithm-identified low-risk patients for referral to the PCP-led survivorship clinic. Of those ineligible, patient preference and complex case/condition were the most common reasons reported for ineligibility. Consensus-based risk algorithms supported by clinician review can quickly and effectively perform case identification of low-risk patients who may be appropriately transitioned to other settings for survivorship care.