Uterine cancer is the most common gynecologic cancer in the United States and continues to rise in incidence. Black women are less likely than white women to be diagnosed with localized disease and experience a twofold higher mortality rate (9 versus 4.6 deaths per 100,000 women). The reasons for these racial disparities have been poorly understood. However, new research from oncologists at NewYork-Presbyterian and Columbia highlight differences in uterine cancer symptoms and types between Black and white patients, shedding light on the racial gap in outcomes.
Gynecologic oncologist Jason Wright, MD, medical oncologist Dawn Hershman, MD, and their colleagues at NewYork-Presbyterian and Columbia recently published the results of a large retrospective study of Medicare beneficiaries with uterine cancer. They found that Black women are more likely than white patients to experience non-specific uterine cancer symptoms and to be diagnosed with more aggressive disease. Below, Dr. Wright discusses the study's findings and their implications for the management of women presenting with potential uterine cancer symptoms.
Uterine cancer is rising more rapidly than any other solid tumor, and it's projected that uterine cancer will actually be more common than colon cancer in women in the next 10 years. What we don't have is a good understanding of what is causing this differential between Black and white women.
— Dr. Jason Wright
Research Background
It's well known that uterine cancer incidence and mortality are increasing disproportionately in Black women. In fact, uterine cancer is rising more rapidly than any other solid tumor, and it's projected that uterine cancer will actually be more common than colon cancer in women in the next 10 years. What we don't have is a good understanding of what is causing this differential between Black and white women.
One possibility is a difference in the symptoms that patients experience. The hallmark symptom of uterine cancer is postmenopausal bleeding (PMB). But women can also present with non-specific symptoms such as abdominal pain and other GI issues.
Secondly, if there is a difference in symptoms, how quickly are those symptoms being evaluated in the healthcare system, and how quickly can people be diagnosed and treated? Is there a delay in diagnosis for women presenting with non-specific symptoms? That's what prompted our analysis.
Research Methods
Using the Surveillance, Epidemiology and End Results–Medicare database, we identified 2,328 Black and 21,774 white patients diagnosed with uterine cancer between 2008 and 2017. Their symptoms in the 18 months before diagnosis were categorized as PMB alone, PMB with other symptoms (such as abdominal/pelvic pain and bloating), non-PMB symptoms alone, or no symptoms. Stage at diagnosis was classified as either advanced (regional/distant) or localized.
Black patients are less likely than white patients to experience the most common uterine cancer symptom of PMB, which could potentially delay their diagnosis.
— Dr. Jason Wright
Key Findings
We found that Black women had a higher risk of being diagnosed with advanced disease (45% versus 30%). Black women were more likely than white patients to experience PMB with other symptoms (63.1% versus 58%) or non-PMB symptoms alone (13.1% versus 9.4%). Compared with PMB symptoms alone, having non-PMB symptoms — alone or with PMB — increased the risk of being diagnosed with advanced uterine cancer. Black patients were also more likely to have more than two comorbidities (58.4% versus 41.8%). It's possible that in patients with other underlying medical problems, their non-specific symptoms may have been attributed to those conditions, delaying uterine cancer diagnosis.
Future Implications
Black patients are less likely than white patients to experience the most common uterine cancer symptom of PMB. Because they experience non-specific uterine cancer symptoms, this could potentially delay their diagnosis. They're also more likely to be diagnosed with type 2 uterine cancer, which is more aggressive than type 1 and less likely to present with PMB.
Uterine cancer is often a cancer that we don't think about in the United States, but it is a very common cause of cancer in women — particularly among Black women. These findings are a reminder to think about the possibility of uterine cancer not just in patients with PMB, but in those experiencing other non-specific symptoms. This is a potential opportunity to improve earlier detection.
Once we have a better understanding of symptoms, we may be able to intervene to improve their recognition and their association with uterine cancer, so women can be detected at an earlier stage — when the disease is more curable.
— Dr. Jason Wright
At NewYork-Presbyterian, we have a large multidisciplinary team who are experts in the study and management of uterine cancer, including disparities-related research, advanced surgical techniques, and the latest chemotherapy and molecularly-guided treatments. Through our ongoing research, we are prospectively surveying people with uterine cancer to try to better understand the trajectory of their symptoms as well as any difficulties or delays in accessing the healthcare system and getting a diagnosis. Once we have a better understanding of symptoms, we may be able to intervene to improve their recognition and their association with uterine cancer, so women can be detected at an earlier stage — when the disease is more curable.
