Uterine cancer deaths expected to rise sharply in the United States by 2050

Bottom Line: Uterine cancer incidence and mortality rates are projected to increase significantly over the next three decades in the United States, with incidence-based mortality expected to be nearly three times higher in Black women compared with white women by 2050.

Journal in Which the Study was Published: Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research (AACR)

Author: Jason D. Wright, MD, chief of the Division of Gynecologic Oncology at Columbia University

Background: While incidence and mortality rates for most cancer types have been on the decline in the United States, cases of uterine cancer increased an average of 0.7% each year between 2013 and 2022 and age-adjusted death rates increased 1.6% annually between 2014 and 2023, according to the Surveillance, Epidemiology, and End Results (SEER) Program at the National Cancer Institute (NCI). Black women are disproportionally affected with a death rate from uterine cancer that is about twice as high compared with women of other races or ethnicities. 

Overall, uterine cancer is one of the few cancers where both incidence and mortality have been increasing, and prior studies have consistently shown significant racial disparities among Black and white women. Understanding future trends will help inform the development of robust strategies to reduce the burden and improve outcomes.” 

Jason D. Wright, MD, lead author of the study

How the Study was Conducted: As part of the NCI’s Cancer Intervention and Surveillance Modeling Network (CISNET), Wright and his colleagues built the Columbia University Uterine Cancer Model (UTMO). This natural history model of uterine cancer simulates the trajectories for incidence and mortality based on characteristics from a sample population, taking into account factors such as age (between 18 and 84), race (Black and white), birth cohort (grouped in 10-year intervals starting in 1910-1920), stage (as determined by the American Joint Committee on Cancer), and histologic subtype (the more common endometrioid uterine cancer vs. non-endometrioid cancers, which tend to have a worse prognosis). Survival estimates are based on current available treatments with the model unable to account for potential advances in therapeutics. 

To validate the model, Wright and his team used UTMO to predict the median age of diagnosis, survival rate, and distribution of diagnosis by stage for uterine cancer in 2018, and found those projections were comparable to the actual SEER data from that year. 

Following this validation, they estimated the future rates of uterine cancer based on publicly available sources through 2018.

Results: Incidence was projected to increase from 57.7 cases per 100,000 in 2018 to 74.2 cases per 100,000 in 2050 for white women and from 56.8 cases per 100,000 to 86.9 cases per 100,000 for Black women. Incidence-based mortality was projected to increase from 6.1 per 100,000 to 11.2 per 100,000 among white women and from 14.1 per 100,000 to 27.9 per 100,000 among Black women. 

Further, while the incidence of endometrioid tumors is projected to increase considerably in both Black (34.2 per 100,000 to 50.5 per 100,000) and white (49.2 per 100,000 to 63.4 per 100,000) women, the increased incidence of non-endometrioid tumors was more significant in Black (from 22.5 per 100,000 to 36.3 per 100,000) than white (from 8.5 per 100,000 to 10.8 per 100,000) women. 

The model also showed that should hysterectomy rates continue to decrease and obesity rates continue to increase, the incidence and mortality rates for uterine cancer would increase more drastically for both white and Black women. Obesity is a known risk factor for uterine cancer, and while an increase in the use of obesity treatments like GLP-1s could instead cause obesity rates to decline, Wright explained it is hard to predict if that will be the case. Hysterectomy is known to reduce the risk of uterine cancer, but due to the availability of nonsurgical treatments for gynecologic disease, hysterectomy rates are projected to decline 25.7% from 2020 to 2035. 

Author’s comments: “There are likely a number of factors that are associated with the increased burden of uterine cancer in Black women,” Wright said. “They more commonly have aggressive types of uterine cancer, face delayed diagnosis resulting in later-stage disease at diagnosis, and there are often delays in their treatment.”

Wright and his colleagues also performed a stress test of the model by incorporating hypothetical screening and intervention methods that could detect uterine cancer and precancerous changes prior to clinical diagnosis. The screening and intervention methods were most effective when introduced at age 55 with declines in cancer incidence that lasted up to 15 years in white women and up to 16 years in Black women. 

“The stress testing suggests that if there was an effective screening test, we may be able to substantially reduce the burden of disease,” Wright said. “While there is presently no screening or prevention that is routinely used for uterine cancer, we are currently examining the potential impact of integrating screening for this cancer into practice.” 

Study limitations: Limitations of the study include the fact that the model is based only on population-level estimates, and some of the risk factors, though representing the highest quality of data available, could be outdated. Additionally, not all potential risk factors for uterine cancer were incorporated into the model, but Wright said they are working to develop more precise estimates of other risk factors. Other limitations include the smaller number of annual cases of non-endometrioid tumors, lack of data on uterine sarcomas, and inclusion of data on only Black and white women. 

Funding & disclosures: The study was supported by funds from the NCI. Wright has received royalties from UpToDate, honoraria from the American College of Obstetricians and Gynecologists, and research support from Merck.