Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan:180:118-125.
doi: 10.1016/j.ygyno.2023.11.029. Epub 2023 Dec 12.

Black-White differences in uterine cancer symptomatology and stage at diagnosis

Xiao Xu  1 , Ling Chen  2 , Marcella Nunez-Smith  3 , Mitchell Clark  4 , Jennifer S Ferris  5 , Dawn L Hershman  6 , Jason D Wright  2
Affiliations

Black-White differences in uterine cancer symptomatology and stage at diagnosis

Xiao Xu et al. Gynecol Oncol. 2024 Jan.

Abstract

Objective: To examine whether uterine cancer symptoms differ between Black and White patients and how this may influence their stage at diagnosis.

Methods: Using the Surveillance, Epidemiology and End Results-Medicare database, we identified 2328 Black and 21,774 White patients with uterine cancer in 2008-2017. Their symptoms in the 18 months before diagnosis were categorized as postmenopausal bleeding (PMB) alone, PMB together with other symptoms (e.g., abdominal/pelvic pain, bloating), non-PMB symptoms alone, or no symptoms. Stage at diagnosis was dichotomized as advanced (i.e., regional/distant) versus localized. The association between race and stage was analyzed using regression models incrementally adjusting for symptoms and other patient characteristics.

Results: A larger proportion of Black than White patients experienced PMB together with other symptoms (63.1% versus 58.0%) or experienced non-PMB symptoms alone (13.1% versus 9.4%) (p < 0.001). Black patients had a higher risk of advanced-stage diagnosis than White patients (45.0% versus 30.3%, unadjusted RR = 1.52, 95% CI: 1.44-1.59). Adjusting for Black-White differences in symptoms attenuated the RR to 1.46 (95% CI: 1.39-1.53). Compared to PMB symptoms alone, having additional non-PMB symptoms (RR = 1.21, 95% CI: 1.15-1.26) and having non-PMB symptoms alone (RR = 1.99, 95% CI: 1.88-2.10) were associated with increased risk of advanced-stage diagnosis. Further adjusting for histology and other patient characteristics reduced Black-White disparity in advanced-stage diagnosis to 1.08 (95% CI: 1.03-1.14) but symptoms remained significantly associated with stage at diagnosis.

Conclusions: Having non-PMB symptoms was associated with more advanced stage at diagnosis. Non-PMB symptoms were more common among Black than White patients, which might hinder symptom recognition/evaluation.

Keywords: Black; Early diagnosis; Racial disparity; Stage; Symptom; Uterine cancer.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest Jason D. Wright has received royalties from UpToDate and received research funding from Merck. The other authors have no conflict of interest to declare.

Figures

Figure 1.
Figure 1.
Differences in uterine cancer symptoms by histologic subtype PMB = postmenopausal bleeding. * “Other symptoms alone” and “No symptoms” were combined to avoid reporting small cells ≤10.
See this image and copyright information in PMC

References

    1. National Cancer Institute. Surveillance, Epidemiology, and End Results Program. Cancer Stat Facts: Uterine Cancer. Bethesda, MD. https://seer.cancer.gov/statfacts/html/corp.html. Accessed March 24, 2023.
    1. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73:17–48. - PubMed
    1. Henley SJ, Miller JW, Dowling NF, Benard VB, Richardson LC. Uterine Cancer Incidence and Mortality - United States, 1999–2016. MMWR Morb Mortal Wkly Rep. 2018;67:1333–8. - PMC - PubMed
    1. Doll KM, Winn AN, Goff BA. Untangling the Black-White mortality gap in endometrial cancer: a cohort simulation. Am J Obstet Gynecol. 2017;216:324–5. - PubMed
    1. ACOG Committee Opinion No. 734: The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding. Obstet Gynecol. 2018;131:e124–e9. - PubMed

Publication types