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. 2025 Sep 1;117(9):1891-1903.
doi: 10.1093/jnci/djaf135.

Trends in uterine cancer incidence and mortality: insights from a natural history model

William D Hazelton  1 , Matthew Prest  2 , Ling Chen  2 , Kevin Rouse  2 , Elena B Elkin  2 , Jennifer S Ferris  2 , Xiao Xu  2 , Nina A Bickell  3 , Chung Yin Kong  3 , Stephanie Blank  3 , Eric J Feuer  4 , Goli Samimi  4 , Brandy M Heckman-Stoddard  4 , Tracy M Layne  3 , Jason D Wright  2 , Evan R Myers  5 , Laura J Havrilesky  5
Affiliations

Trends in uterine cancer incidence and mortality: insights from a natural history model

William D Hazelton et al. J Natl Cancer Inst. .

Abstract

Background: Uterine cancer incidence and mortality are increasing, with concomitant disparities in outcomes between racial groups. Natural history modeling can evaluate risk factors, predict future trends, and simulate approaches to reducing mortality and disparities.

Methods: We designed a natural history model of uterine cancer using a multistage clonal expansion design. The model is informed by National Health and Nutrition Examination Survey, National Health Examination Survey, age, time period, birth cohort, and birth certificate data on reproductive histories and body mass index (BMI). We fit and calibrated the model to Surveillance, Epidemiology, and End Results data by race and ethnicity as well as histologic subgroup. We projected future incidence and estimated the degree of contribution of BMI, reproductive history, and competing hysterectomy to excess uterine cancer incidence.

Results: The model accurately replicated Surveillance, Epidemiology, and End Results incidence for endometrioid, nonendometrioid, and sarcoma subgroups for non-Hispanic Black and non-Hispanic White patients. For endometrioid, nonendometrioid, and sarcomas, BMI-attributable risks are greater for non-Hispanic White than for non-Hispanic Black patients; reproductive history-attributable risks are greater for non-Hispanic Black patients. Between 2018 and 2050, endometrioid incidence is projected to rise by 64.9% in non-Hispanic Black individuals and17.5% in non-Hispanic White individuals; the projected rise for the nonendometrioid subgroup is 41.4% in non-Hispanic Black individuals and 22.5% in non-Hispanic White individuals; the sarcoma incidence projected increase is 36% in non-Hispanic Black individuals and 29.2% in non-Hispanic White individuals.

Conclusions: Uterine cancer risk is substantially explained by reproductive history and BMI, with differences observed between non-Hispanic Black and non-Hispanic White individuals and future projections indicating perpetuation of disparities. Lower rates of hysterectomy and rising obesity rates will likely contribute to continued increases in uterine cancer incidence.

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Conflict of interest statement

All authors disclose funding of the current study by the Cancer Intervention and Surveillance Modeling Network Uterine Incubator U01 grant No. 5U01CA265739. The following authors have no additional disclosures: M.P., C.Y.K., J.F., E.E., G.S., K.R., L.C., T.L., B.H.S., B.H., N.B., and L.H. E.F. discloses a consultancy with Information Management Services Inc to provide support for National Cancer Institute work. E.M. reports consulting fees with Merck (human papillomavirus vaccination), Moderna (cytomegalovirus vaccination) and Hologic (cervical cancer screening). J.W. discloses research grants from Merck as well as royalties/licenses with the American College of Obstetricians and Gynecologists and UpToDate. X.X. discloses honoraria from the American Association of Gynecologic Laparoscopist for service on a practice guideline committee.

References

    1. National Cancer Institute. Annual report to the nation 2020: overall cancer statistics. https://seer.cancer.gov/report_to_nation/statistics.html#:∼:text=Rates%2....
    1. Henley SJ, Miller JW, Dowling NF, et al. Uterine cancer incidence and mortality—United States, 1999-2016. MMWR Morb Mortal Wkly Rep. 2018;67:1333-1338. - PMC - PubMed
    1. SEERStat Database: Incidence—SEER Research Data, 18 Registries, Nov 2020 Sub (2020-2018) Counties, National Cancer Institute, DCCPS, Surveillance Research Program, released April 2024, based on the November 2020 submission.
    1. Hales CM, Carroll MD, Fryar CD, et al. Prevalence of obesity among adults and youth: United States, 2015-2016. NCHS Data Brief. 2017;288:1-8. https://www.ncbi.nlm.nih.gov/pubmed/29155689 - PubMed
    1. Onstad MA, Schmandt RE, Lu KH. Addressing the role of obesity in endometrial cancer risk, prevention, and treatment. J Clin Oncol. 2016;34:4225-4230. - PMC - PubMed