The End of the Hysterectomy Epidemic and Endometrial Cancer Incidence: What Are the Unintended Consequences of Declining Hysterectomy Rates?

Abstract

Population-level cancer incidence rates are one measure to estimate the cancer burden. The goal is to provide information on trends to measure progress against cancer at the population level and identify emerging patterns signifying increased risk for additional research and intervention. Endometrial cancer is the most common of the gynecologic malignancies but capturing the incidence of disease among women at risk (i.e., women with a uterus) is challenging and not routinely published. Decreasing rates of hysterectomy increase the number of women at risk for disease, which should be reflected in the denominator of the incidence rate calculation. Furthermore, hysterectomy rates vary within the United States by multiple factors including geographic location, race, and ethnicity. Changing rates of hysterectomy are important to consider when looking at endometrial cancer trends. By correcting for hysterectomy when calculating incidence rates of cancers of the uterine corpus, many of the disparities that have been assumed for this disease are diminished.

Keywords: cancer; corpus uterus; endometrial; hysterectomy.

Figure 1

E-adjusted hysterectomy rates by race among women age 50 and older in the SEER-13 states 1992–2008. Footnote: data from the Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention. States included are: California, Connecticut, Iowa, Georgia, Hawaii, Michigan, New Mexico, Utah, and Washington.

Figure 2

Age-adjusted endometrial cancer incidence rates by race among women age 50 and older in SEER-13, 1992–2008. (A) All types; (B) Type I cancers; (C) Type II cancers.