Uterine cancer is the fourth most common cancer diagnosed in women in the United States, with about 69,120 new cases and nearly 14,000 deaths from the disease expected this year. Black women experience a twice as high mortality rate compared with women of other races and ethnicities, and that number is expected to rise sharply over the coming decades.
According to a study by Wright et al published in Cancer Epidemiology, Biomarkers & Prevention, the incidence and mortality rates of uterine cancer in the United States are projected to increase significantly over the next 3 decades, with incidence-based mortality expected to be nearly three times higher in Black women compared with White women.
Study Methodology
The researchers developed the Columbia University Uterine Cancer Model (CU-UTMO) as part of the National Cancer Institute’s Cancer Intervention and Surveillance Modeling Network (CISNET). This state-transition microsimulation model simulates the trajectories for uterine cancer incidence and mortality based on characteristics from a sample population, taking into account age (between 18 and 84 years); Black and White race; birth cohort grouped in 10-year intervals starting in 1910 to 1920; cancer stage, as determined by the American Joint Committee on Cancer; and separately modeled endometrioid and nonendometrioid tumors, which usually have a worse prognosis.
To validate the model, the researchers used CU-UTMO to predict the median age of diagnosis, survival rate, and distribution of diagnosis by stage for uterine cancer in 2018; they found those projections were comparable to the actual Surveillance, Epidemiology, and End Results data from that year. Then the researchers estimated the future rates of the cancer based on publicly available sources through 2018.
Key Results
The researchers found that the model closely fit population-based incidence and mortality data of uterine cancer. They determined that from 2020 to 2050, the incidence of uterine cancer is projected to increase in White women to 74.2 cases per 100,000 (compared with 57.7 cases per 100,000 in 2018) and to increase to 86.9 cases per 100,000 (compared with 56.8 cases per 100,000 in 2018) in Black women.
Among White women, incidence-based mortality will increase from 6.1 per 100,000 in 2018 to 11.2 per 100,000 in 2050, and incidence-based mortality in Black women will increase from 14.1 per 100,000 to 27.9 per 100,000. In addition, the incidence of endometrioid tumors is expected to increase considerably in both White and Black women. However, although White women will experience only a slight increase in nonendometrioid tumors, the incidence of these tumors in Black women will increase substantially.
“These population-level trends support the urgent need to develop and implement novel primary and secondary prevention strategies for uterine cancer,” concluded the study authors.
Understanding Disease Disparities
“There are likely a number of factors that are associated with the increased burden of uterine cancer in Black women,” said lead study author Jason D. Wright, MD, the Sol Goldman Professor of Gynecologic Oncology at Columbia University Vegelos College of Physicians and Surgeons. “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.”
Reducing Burden of Disease
In addition to building this state-transition microsimulation model of uterine cancer, Dr. 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 a clinical diagnosis. They found that 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. 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,” said Dr. Wright.
Disclosure: Funding for this study was provided by the National Cancer Institute. For full disclosures of the study authors, visit aacrjournals.org/cebp.