Racioethnic Disparities in Endometrial Cancer Outcomes

Abstract

Black women are twice as likely to die from endometrial cancer (EC) compared with white women. This represents one of the worst racioethnic disparities amongst all cancers globally. Compared with white women, black women are more likely to be diagnosed with advanced EC, have more barriers to accessing care and experience increased delays in obtaining an EC diagnosis and commencing treatment. Histological and molecular differences place black women at higher risk of being diagnosed with more aggressive EC subtypes that carry less favourable outcomes. Furthermore, EC diagnostic pathways are less reliable in black women, and black women are less likely to receive evidence-based treatment for EC. This racioethnic disparity in EC outcomes exists both in the UK and US, despite differences in healthcare systems. This review methodically describes the key factors along the patient journey that contribute to the disparity in black women and proposes multifaceted approaches to lessen these gaps.

Keywords: black women; endometrial cancer; endometrial cancer disparities; racial disparities.

Figure 1

Differences in EC mortality in black and white women. Age-standardised mortality rate from EC in the UK and US between 2015 and 2019. Based on data from the UK Office of National Statistics (ONS) [7] and the US Statistics, Epidemiology, and End Results (SEER) Program [5]. Footnote: The ‘Black’ group from UK data refers to women from Black African, Black Caribbean, and Black Other ethnic groups.

Figure 2

Summary of the patient diagnostic pathway. The patient pathway in EC leading to diagnosis and treatment, including types and causes of delays in the pathway.

Figure 3

Summary of the EC diagnostic pathway. The diagnostic pathway for EC is similar in the UK and US, consisting of a TVS and endometrial biopsy dependent on TVS findings. TVS = transvaginal ultrasound, ET = endometrial thickness, and EC = endometrial cancer. Footnote: * Accepted as the norm but the cut-offs may vary according to the centre/country (3 mm, 4.5 mm, and 5 mm cut-offs are also used).

Figure 4

Molecular subtypes of endometrial cancer. The four molecular subtypes of endometrial cancer based on The Cancer Genome Atlas (TCGA) classification [69] and known racioethnic differences. POLE = DNA polymerase epsilon, MMR = mismatch repair genes, and NSMP = no specific molecular profile.