Racial disparities in young women with endometrial cancer

Abstract

Objective: Although racial disparities in treatment and outcome for endometrial cancer are well recognized, little work has explored disparities in young women. We performed a population-based analysis to compare survival between black and white women with endometrial cancer at <50years of age.

Methods: We used the National Cancer Data Base to identify women <50years of age with endometrial cancer from 1998 to 2012. Clinical and demographic characteristics were compared between black and white women and survival by race analyzed using Kaplan-Meier curves and multivariable Cox proportional hazards models.

Results: We identified a total of 35,850 women <50years of age including 31,947 (89.1%) white and 3903 (10.9%) black patients. Black women were more likely to have advanced stage, poorly differentiated, and non-endometrioid histology neoplasms (P<0.05 for all). In a multivariable model, survival was 19% worse for black patients than white patients (HR=1.19; 95% CI, 1.08-1.32). A similar effect was seen when limited to women with early-stage tumors (HR=1.24; 95% CI, 1.04-1.49), while among patients with advanced stage tumors, no association between race and survival was seen (HR=1.12; 95% CI, 0.89-1.41). Five-year survival rates were 90.6% (95% CI, 88.6-92.3%) for white and 81.5% (95% CI, 73.0-87.5%) for black women with stage IB tumors, and 75.1% (95% CI, 72.5-77.5%) and 63.3% (95% CI, 54.1-71.2%) for white and black women with stage III tumors, respectively.

Conclusions: Young black women are more likely to present with pathologically aggressive, advanced stage tumors. Even after adjusting for these pathologic differences, young black women with endometrial cancer have higher mortality than white women.

Keywords: Disparities; Endometrial cancer; Hysterectomy; Outcomes; Uterine cancer.

Figure 1

Flowchart of cohort selection.

Figure 2

Kaplan-Meier curves by race, stratified by stage. (A) stage I, p-value < 0.001; (B) stage II, p-value < 0.001; (C) stage III, p-value < 0.001; (D) stage IV, p-value = 0.02. Patients with missing follow-up time or vital status were excluded, including 1,691 stage I, 130 stage II, 218 stage III, and 87 stage IV patients. P-values were from log-rank tests.