Uterine Cancer Incidence and Deaths on the Rise in US

Liam Davenport

December 07, 2018

The incidence of uterine cancer and deaths from the disease are on the increase, with black women disproportionately affected, warn researchers at the Centers for Disease Control and Prevention (CDC). They call for greater awareness of the symptoms to allow early detection and treatment.

Uterine cancer "is one of the few cancers with increasing incidence and mortality in the United States," the CDC notes. This reflects, in part, increases in the prevalence of overweight and obesity since the 1980s.

It is the fourth most common cancer diagnosed in US women and is the seventh most common cause of death.

The findings were published online December 7 in the Morbidity and Mortality Weekly Report.

S. Jane Henley, MSPH, from the National Center for Chronic Disease Prevention and Health Promotion, CDC, and colleagues studied the official incidence and mortality rates for uterine cancer from 1999 to 2015/6.

They found that rates of the disease have been increasing by approximately 0.7% per year, with uterine cancer deaths rising by an average of slightly more than 1.0% per year.

Worryingly, in comparision with other groups, black women were more likely to be diagnosed with harder-to-treat forms of the disease and with later-stage disease, in particular in comparision with white women.

"Multifactorial efforts at individual, community, clinical, and systems levels to help women achieve and maintain a healthy weight and obtain sufficient physical activity might reduce the risk for developing uterine cancer," the authors write.

"Promoting awareness among women and health care providers of the need for timely evaluation of abnormal vaginal bleeding can increase the chance that uterine cancer is detected early and treated appropriately," they add.

Study Details

The team gathered incidence data from the CDC's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results Program.

In addition, they obtained mortality data from the National Vital Statistics System, which covered 98% of the overall US population for the period 1999 to 2015/2016.

Uterine cancers were classified by histologic site and stage at diagnosis. Individuals were classified as white, black, non-Hispanic American, Indian/Alaska Native (AI/AN), non-Hispanic Asian/Pacific Islander (API), or Hispanic.

The researchers found that in 2015, there were 53,911 new, confirmed cases of uterine cancer, which occurred at a rate of 27 cases per 100,000 women. The rates were highest among white and black women (27 per 100,000 each).

The most commonly reported form the disease was endometrioid carcinoma, which occurred in 68% of women. The proportion was much lower in black women, at 47%. Black women who were more likely to have other carcinomas, carcinosarcomas, and sarcomas.

In non-black women, uterine cancers were diagnosed at the localized stage in 66% to 69% of cases. In black women, that rate was 55%.

Black women are also more likely to be diagnosed with disease of distant stage than other groups, at 16% vs 8% to 10%. This was particularly the case for sarcoma.

Sarcomas were more likely to be diagnosed at the distant stage (36%) than carcinosarcomas (22%), other carcinomas (18%), and endometrioid carcinomas (3%).

The incidence rate of uterine cancers increased between 1999 and 2015 by 12%, or an average of 0.7% per year.

The increase was far higher among AI/AN (53%), black (46%), API (38%), and Hispanic (32%) women than among white women (9%).

In 2016, there were 10,733 deaths due to uterine cancer, at five deaths per 100,000 women. The rate was highest among black women, at nine per 100,000 women.

The rate of uterine cancer deaths increased between 1999 and 2016 by 21%, or 1.1% per year on average.

The increases were higher in API (52%), Hispanic (33%) and black (29%) women than white women (18%). Rates of uterine cancer deaths remained stable in AI/AN women.

Obesity a Contributing Factor

The researchers say that one contributing factor in the increase in incidence could be "excess body weight," inasmuch as overweight or obese women are two to four times more likely to develop endometrial cancer than women of healthy weight.

"During 2013-2016, approximately 40% of women in the United States had obesity, including 56% of black women and 49% of Hispanic women," they add.

The team points out that, "as with other cancers, the odds of surviving uterine cancer are much higher when it is detected at an early stage, when treatment is more effective." The rate of survival is 90% for patients with localized cancers, vs <30% for patients with distant cancers.

"This report found that black women were more likely to receive a diagnosis at distant stage and with more aggressive histologic types than were other women, which might in part account for the higher death rate among black women," the investigators write.

The authors have disclosed no relevant financial relationships.

MMWR Morb Mortal Wkly Rep. 2018;67:1333-1138. Full text

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