Disparities in uterine cancer epidemiology, treatment, and survival among African Americans in the United States

Abstract

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.

Clinical Benefits Associated With Medicaid Coverage Before Diagnosis of Gynecologic Cancers

“…Therefore, one would expect Medicaid enrollment to have a greater impact on uterine cancer outcomes than cervical cancer outcomes, where screening availability outside Medicaid enrollment exists and which was the case in the current study. Uterine cancer disproportionately affects minority populations, with an increased incidence among black women, 16,17 and in low-income populations, it is commonly associated with advanced-stage disease at presentation. 18 These populations are especially vulnerable to adverse outcomes from this disease and may benefit from insurance coverage that allows for comprehensive examinations.…”

MicroRNAs in endometrial cancers from black and white patients

“…[17][18][19][20][21][22][23][24][25][26] The molecular drivers of these differences are the focus of significant research effort. For example, breast cancers lacking estrogen and progesterone receptors as well as HER2/neu expression (triple-negative breast cancers) are more common in black compared to white patients and are associated with worse prognosis.…”

Health Care Disparities in Hysterectomy for Gynecologic Cancers

“…[13][14][15] Specifically, studies have shown that black women with endometrial and cervical cancer have increased mortality rates and tend to present with more advanced disease. 16,17 The objective of this study is to provide an overview of the state of hysterectomy in the United States for gynecologic malignancies in 2012. We aim to study the mode of hysterectomy by cancer diagnosis to identify specific patient and health system factors that are associated with the use of minimally invasive techniques.…”