Racial disparities in high-risk uterine cancer histologic subtypes: A United States Cancer Statistics study

Abel, Mary Kathryn; Liao, Cheng-I; Chan, Chloe; Lee, Danny; Rohatgi, Atharva; Darcy, Kathleen M.; Tian, Chunqiao; Mann, Amandeep; Maxwell, G. Larry; Kapp, Daniel S.; Chan, John K.

doi:10.1016/j.ygyno.2021.02.037

Cited by 33 publications

(18 citation statements)

References 27 publications

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“…Prior studies that corrected for hysterectomies showed more pronounced racial disparities given that Black women are more likely to undergo hysterectomy 35. However, a prior study using the same database correcting for hysterectomy found no significant changes in trends 36…”

Section: Discussionmentioning

confidence: 95%

The increasing incidence of stage IV cervical cancer in the USA: what factors are related?

Francoeur

Liao

Casear

et al. 2022

Int J Gynecol Cancer

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ObjectiveCervical cancer (International Federation of Gynecology and Obstetrics (FIGO)) stage IVA-B (distant stage) is a rare diagnosis with an approximate 5 year survival rate of 17% and with limited treatment options. The objective of this study was to determine the trends in distant stage cervical cancer in the USA and identify possible factors related to these trends.MethodsData were obtained from the United States Cancer Statistics program from 2001 to 2018. Rates of cervical cancer screening and vaccination were evaluated using the Behavioral Risk Factor Surveillance System and TeenVaxView. SEER*Stat 8.3.8.9.2 and Joinpoint regression program 4.9.0.0 were used to calculate incidence trends.ResultsOver the last 18 years, 29 715 women were diagnosed with distant stage cervical carcinoma. Black women have disproportionately higher rates at 1.55/100 000 versus 0.92/100 000 in White women (p<0.001). When examining the trends over time, there has been an annual increase in distant stage cervical cancer at a rate of 1.3% per year (p<0.001). The largest increase is seen in cervical adenocarcinoma with an average annual percent change of 2.9% (p<0.001). When performing an intersection analysis of race, region and age, White women in the South aged 40–44 have the highest rise in distant cervical cancer at a rate of 4.5% annually (p<0.001). Using the Behavioral Risk Factor Surveillance System and TeenVax data, compared with Black women, we found that White women have a nearly two-fold higher rate of missed or lack of guideline screening, 26.6% vs 13.8%. White teenagers (13–17 years) have the lowest human papillomavirus vaccination rate at 66.1% compared with others at 75.3%.ConclusionsBlack women have a higher incidence of distant stage disease compared with White women. However, White women have a greater annual increase, particularly in adenocarcinomas. Compared with Black women, White women also have lower rates of guideline screening and vaccination.

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Section: Discussionmentioning

confidence: 95%

The increasing incidence of stage IV cervical cancer in the USA: what factors are related?

Francoeur

Liao

Casear

et al. 2022

Int J Gynecol Cancer

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“…Annual uterine cancer mortality now matches ovarian cancer mortality, 26 and the incidence of aggressive subtypes of uterine cancer, which more commonly affect Black women, Hispanic women, and Asian women, have steadily increased over the past 20 years. [27][28][29] American Indian women, who represented fewer than 1.0% of trial participants, are diagnosed with cervical and uterine cancer at younger ages than White women, and have higher mortality. 30 Failure to enroll diverse cohorts of patients in precision oncology trials of uter-ine and cervical cancer is of particular concern in light of these trends.…”

Section: Discussionmentioning

confidence: 99%

Enrollment of Individuals From Racial and Ethnic Minority Groups in Gynecologic Cancer Precision Oncology Trials

Mattei

Robb

Banning

et al. 2022

Obstetrics &Amp; Gynecology

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To characterize whether enrollment patterns in precision oncology clinical trials for gynecologic cancers reflect the racial and ethnic diversity of patients with gynecologic cancers in the United States. METHODS:ClinicalTrials.gov was queried to perform this cross-sectional review. We included precision oncology trials-defined as trials using molecular profiling of a tumor or the patient genome to identify targetable alterations to guide treatment-of ovarian, uterine, cervical, and vulvar cancers in the United States. National Cancer Institute Surveillance, Epidemiology, and End Results and United States Census Bureau data were used to estimate cancer burden and the expected number of trial participants by race and ethnicity for each gynecologic cancer. The ratio of actual-to-expected participants was calculated. A ratio greater than 1 signified overenrollment. A random effects meta-analysis was performed to assess the relative weights of individual trials. RESULTS:We identified 493 trials, 61 of which met inclusion criteria. There were 2,573 patients enrolled in ovarian cancer trials, 1,197 in uterine cancer trials and 162 in cervical cancer trials. Non-Hispanic White women were overrepresented overall (enrollment ratio 1.26, 95% CI 1.20-1.32) and across all cancer types on subgroup analysis. Asian women, non-Hispanic Black women, and Hispanic women were underrepresented overall (enrollment ratios 0.63, 95% CI 0.41-0.86; 0.51, 95% CI 0.36-0.66 and 0.30, 95% CI 0.23-0.36, respectively). In subgroup analyses, Asian women and non-Hispanic Black women were underrepresented in ovarian and uterine cancer trials and Hispanic women were underrepresented across all cancer types. CONCLUSION: Non-Hispanic Black women, Asian women, and Hispanic women with gynecologic cancers are underrepresented in precision oncology trials. Few U.S.-based precision oncology trials exist for uterine and cervical cancers, which have a high burden of morbidity and mortality among racial and ethnic minority groups. Failure to equitably enroll patients who belong to racial and ethnic minority groups may perpetuate existing disparities in gynecologic cancer outcomes.

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“…When correcting for a history of hysterectomy, Black women developed HGEC at 2 to 4 times the incidence of NHW patients and have lower cancer-specific and all-cause mortality rates than White women. 6,15,21 The causes of this are likely multifactorial, and significant effort must be made across all aspects of patient care to close the racial gap in the survival of patients with HGEC.…”

Section: Research Implicationsmentioning

confidence: 99%

Disparities in adjuvant treatment of high-grade endometrial cancer in the Medicare population

Corey

Coté

Ruterbusch

et al. 2022

American Journal of Obstetrics and Gynecology

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Racial disparities in high-risk uterine cancer histologic subtypes: A United States Cancer Statistics study

Cited by 33 publications

References 27 publications

The increasing incidence of stage IV cervical cancer in the USA: what factors are related?

The increasing incidence of stage IV cervical cancer in the USA: what factors are related?

Enrollment of Individuals From Racial and Ethnic Minority Groups in Gynecologic Cancer Precision Oncology Trials

Disparities in adjuvant treatment of high-grade endometrial cancer in the Medicare population

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