Uterine Cancer Incidence and Mortality — United States, 1999–2016

S. Jane Henley, MSPH; Jacqueline W. Miller, MD; Nicole F. Dowling, PhD; Vicki B. Benard, PhD; Lisa C. Richardson, MD

Disclosures

Morbidity and Mortality Weekly Report. 2018;67(48):1333-1338. 

In This Article

Abstract and Introduction

Introduction

Uterine cancer is one of the few cancers with increasing incidence and mortality in the United States, reflecting, in part, increases in the prevalence of overweight and obesity since the 1980s.[1] It is the fourth most common cancer diagnosed and the seventh most common cause of cancer death among U.S. women.[1] To assess recent trends in uterine cancer incidence and mortality by race and ethnicity, CDC analyzed incidence data from CDC's National Program of Cancer Registries (NPCR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program and mortality data from the National Vital Statistics System.[2] Most recent data available are through 2015 for incidence and through 2016 for mortality. Uterine cancer incidence rates increased 0.7% per year during 1999–2015, and death rates increased 1.1% per year during 1999–2016, with smaller increases observed among non-Hispanic white (white) women than among women in other racial/ethnic groups. In 2015, a total of 53,911 new uterine cancer cases, corresponding to 27 cases per 100,000 women, were reported in the United States, and 10,733 uterine cancer deaths (five deaths per 100,000 women) were reported in 2016. Uterine cancer incidence was higher among non-Hispanic black (black) and white women (27 cases per 100,000) than among other racial/ethnic groups (19–23 per 100,000). Uterine cancer deaths among black women (nine per 100,000) were higher than those among other racial/ethnic groups (four to five per 100,000). Public health efforts to help women achieve and maintain a healthy weight and obtain sufficient physical activity can reduce the risk for developing cancer of the endometrium (the lining of the uterus), the most common uterine cancer. Abnormal vaginal bleeding, including bleeding between periods or after sex or any unexpected bleeding after menopause, is an important symptom of uterine cancer.[3] Through programs such as CDC's Inside Knowledge* campaign, 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.

Data on new cases of invasive uterine cancer diagnosed during 1999–2015 were obtained from population-based cancer registries affiliated with NPCR and SEER. Data from all registries met data quality criteria for U.S. Cancer Statistics§ in 2015, and data from 48 states met these criteria each year during 1999–2015, covering 98% of the U.S. population. Uterine cancers were classified by histologic type (endometrioid carcinoma, other carcinoma, carcinosarcoma, and sarcoma).** Stage at diagnosis (localized, regional, distant, or unknown) was characterized using SEER Summary Stage.†† Data on uterine cancer deaths during 1999–2016 were based on death certificate information reported to state vital statistics offices and compiled into a national file through the National Vital Statistics System, covering 100% of the U.S. population. Data were examined by five mutually exclusive racial/ethnic groups: white, black, non-Hispanic American Indian/Alaska Native (AI/AN), non-Hispanic Asian/Pacific Islander (API), and Hispanic; as well as by histologic type, stage at diagnosis, and year of diagnosis or death.

Population estimates for rate denominators were a modification of annual county population estimates by age, sex, bridged-race, and ethnicity produced by the U.S. Census Bureau in collaboration with CDC's National Center for Health Statistics and with support from the National Cancer Institute.§§ Annual incidence and death rates per 100,000 women were age-adjusted to the 2000 U.S. standard population. Average annual percent change (AAPC) was used to quantify changes in incidence rates during 1999–2015 and death rates during 1999–2016 and was calculated using joinpoint regression, which allowed different slopes for three periods; years at which slope changed could vary.¶¶ To determine whether AAPC was significantly different from zero, a t-test was used for zero joinpoints, and a z-test was used for ≥1 joinpoint. Rates were considered to increase if AAPC >0 (p<0.05) and to decrease if AAPC <0 (p<0.05); otherwise rates were considered stable. All statistical tests were two-sided.

In 2015, 53,911 new microscopically confirmed uterine cancer cases, corresponding to 27 cases per 100,000 women, were reported in the United States (Table). Uterine cancer incidence was higher among white women and black women (27 cases per 100,000 in each group) compared with AI/AN and Hispanic women (23 each) and API women (19). Overall, endometrioid carcinomas were the most common uterine cancers (68%). However, endometrioid carcinomas accounted for 47% of uterine cancers among black women, who had a higher percentage of other carcinomas, carcinosarcomas, and sarcomas than did women in other racial/ethnic groups. Approximately two thirds of uterine cancers were diagnosed at a localized stage among white (69%), AI/AN (68%), API (67%), and Hispanic women (66%), compared with 55% among black women. A higher proportion of sarcomas were diagnosed at distant stage (36%) than were endometrioid carcinomas (3%), other carcinomas (18%), or carcinosarcomas (22%). The proportion of uterine cancers diagnosed at distant stage was higher among black women than among women of other racial/ethnic groups, overall (16% versus 8%–10%) and for each histologic type, particularly sarcoma (45% versus 30%–34%).

During 1999–2015, uterine cancer incidence rates increased 12%, about 0.7% per year on average, with larger increases observed among AI/AN (53%; AAPC = 2.7%), black (46%; 2.4%), API (38%; 2.0%), and Hispanic (32%; 1.8%) women than among white women (9%; 0.5%) (Figure 1). During 1999–2015, incidence rates of endometrioid carcinomas increased 4.5% per year, other carcinomas decreased 4.5% per year, carcinosarcomas increased 1.9% per year, and sarcoma incidence remained stable (Supplementary Figure, https://stacks.cdc.gov/view/cdc/60809).

Figure 1.

Trends* in age-adjusted uterine cancer incidence rates, by racial/ethnic group§ — United States, 1999–2015
Sources: CDC's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results program.
Abbreviations: AAPC = average annual percent change; AI/AN = American Indian/Alaska Native; API = Asian/Pacific Islander.
* Trends were measured with AAPC in rates and were considered to increase or decrease if p<0.05; otherwise, rates were considered stable. AAPC is the weighted average of the annual percent change over the period 1999–2015 using a Joinpoint regression model (up to 2 joinpoints).
Per 100,000 women, age-adjusted to the 2000 U.S. standard population. Uterine cancers were defined as microscopically confirmed cancers of the corpus uteri (International Classification of Diseases for Oncology, Third Edition [ICD-O-3] site codes C54.0–C54.3, C54.8, C54.9) and uterus, not otherwise specified (C55.9), excluding cases that were identified by autopsy or death certificate only.
§ Mutually exclusive racial/ethnic groups are based on information about race/ethnicity that was collected separately and combined for this report. White, black, AI/AN, and API race categories are all non-Hispanic. Hispanic persons can be any race.
Cancer incidence compiled from cancer registries that meet the data quality criteria for each year during the period 1999–2015, covering 98% of the U.S. population.

In 2016, 10,733 uterine cancer deaths, corresponding to five deaths per 100,000 women, were reported in the United States (Table). Uterine cancer death rates among black women (nine deaths per 100,000) were higher than those among white (five), AI/AN (four), API (four), and Hispanic (four) women. During 1999–2016, uterine cancer death rates increased 21%, approximately 1.1% per year on average, with larger increases among API (52%; AAPC = 2.5%), Hispanic (33%; 1.7%), and black (29%; 1.5%) women, than among white women (18%; 1.0%); rates were stable among AI/AN women (Figure 2).

Figure 2.

Trends* in age-adjusted uterine cancer death rates, by racial/ethnic group§ — United States, 1999–2016
Source: CDC's National Center for Health Statistics National Vital Statistics System.
Abbreviations: AAPC = average annual percent change; AI/AN = American Indian/Alaska Native; API = Asian/Pacific Islander; NS = not significant.
* Trends were measured with AAPC in rates and were considered to increase or decrease if p<0.05; otherwise rates were considered stable. AAPC is the weighted average of the annual percent change over the period 1999–2016 using a Joinpoint regression model (up to 2 joinpoints).
Per 100,000 women, age-adjusted to the 2000 U.S. standard population. Uterine cancer deaths were defined as deaths from cancers of corpus uteri (International Classification of Diseases 10th Edition [ICD-10] codes C54.0–C54.3, C54.8, C54.9) and uterus, not otherwise specified (C55.9).
§ Mutually exclusive racial/ethnic groups are based on information about race/ethnicity that was collected separately and combined for this report. White, black, AI/AN, and API race categories are all non-Hispanic. Hispanic persons can be any race.

* https://www.cdc.gov/cancer/knowledge/.
Uterine cancer cases were defined as microscopically confirmed invasive cancers of the corpus uteri (International Classification of Diseases for Oncology, Third Edition [ICD-O-3] site codes C54.0 [isthmus uteri], C54.1 [endometrium], C54.2 [myometrium], C54.3 [fundus uteri], C54.8 [overlapping lesion of corpus uteri], C54.9 [corpus uteri]) and uterus, not otherwise specified (C55.9), excluding cases that were identified by autopsy or death certificate only. Only cases defined as malignant under International Classification of Diseases for Oncology, Second Edition (ICD-O-2) and ICD-O-3 were included in this report. Uterine cancer deaths were defined as deaths from cancers of corpus uteri (International Classification of Diseases for Oncology, Tenth Edition [ICD-10] codes C54.0–C54.3, C54.8, C54.9) and uterus, not otherwise specified (C55.9).
§ https://www.cdc.gov/cancer/uscs/index.htm.
Cancer registries' incidence data met the following U.S. Cancer Statistics criteria: 1) ≤5% of cases ascertained solely on the basis of death certificate; 2) ≤3% of cases missing information on sex; 3) ≤3% of cases missing information on age; 4) ≤5% of cases missing information on race; and 5) ≥97% of registry's records passed a set of single-field and interfield computerized edits that test the validity and logic of data components. https://www.cdc.gov/cancer/npcr/uscs/technical_notes/criteria.htm.
** Subtypes were classified by ICD-O-3 histology codes as endometrioid carcinomas (8380); other carcinomas (8000–8379, 8381–8790, 8981, 9700–9701); carcinosarcomas (8950 [Müllerian tumors], 8951, 8980); and sarcomas (8800–8932, 8934–8941, 8959–8975, 9141–9582).
†† Cases diagnosed in 1999 were classified using SEER Summary Stage 1977, cases diagnosed during 2000 to 2003 were classified using SEER Summary Stage 2000, and cases diagnosed during 2004 to 2015 were classified using Derived SEER Summary Stage 2000. https://seer.cancer.gov/tools/ssm.
§§ Population estimates incorporate bridged single-race estimates derived from the original multiple-race categories in the 2010 U.S. Census. https://seer.cancer.gov/popdata.
¶¶ https://surveillance.cancer.gov/joinpoint/.

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