1
|
Ferris JS, Prest MT, Hur C, Chen L, Elkin EB, Melamed A, Kong CY, Myers ER, Havrilesky LJ, Blank SV, Hazelton WD, Wright JD. Trends in uterine cancer incidence in the United States: The contribution of age, period and cohort effects. Gynecol Oncol 2024; 187:151-162. [PMID: 38781746 PMCID: PMC11309905 DOI: 10.1016/j.ygyno.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/20/2024] [Accepted: 04/30/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE In the U.S., uterine cancer incidence is rising, with racial and ethnic minorities experiencing the largest increases. We performed age-period-cohort analyses using novel methods to examine the contribution of age at diagnosis (age), year of diagnosis (period), and birth cohort (cohort), to trends in uterine cancer incidence. METHODS We used uterine cancer incidence data from the Surveillance, Epidemiology, and End Result (SEER) 12 database (1992-2019), and performed hysterectomy-correction. We generated hexamaps to visualize age, period, and cohort effects, and used mutual information to estimate the percent contribution of age, period, and cohort effects, individually and combined, on uterine cancer incidence, overall and by race and ethnicity and histology. RESULTS Hexamaps showed an increase in uterine cancer in later time periods, and a cohort effect around 1933 showing a lower incidence compared with earlier and later cohorts. Age, period, and cohort effects combined contributed 86.6% (95% CI: 86.4%, 86.9%) to the incidence. Age effects had the greatest contribution (65.1%, 95% CI: 64.3%, 65.9), followed by cohort (20.7%, 95% CI: 20.1%, 21.3%) and period (14.2%, 95% CI: 13.7%, 14.8%) effects. Hexamaps showed higher incidence in recent years for non-Hispanic Blacks and non-endometrioid tumors. CONCLUSIONS Age effects had the largest contribution to uterine cancer incidence, followed by cohort and period effects overall and across racial and ethnic groups and histologies. IMPACT These findings can inform uterine cancer modeling studies on the effects of interventions that target risk factors which may vary across age, period, or cohort.
Collapse
Affiliation(s)
- Jennifer S Ferris
- Department of Gynecologic Oncology, Columbia University College of Physicians and Surgeons, New York, NY, USA; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Matthew T Prest
- Department of Gynecologic Oncology, Columbia University College of Physicians and Surgeons, New York, NY, USA; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Chin Hur
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, New York, NY, USA; New York-Presbyterian Hospital, New York, NY, USA
| | - Ling Chen
- Department of Gynecologic Oncology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Elena B Elkin
- Herbert Irving Comprehensive Cancer Center, New York, NY, USA; Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Alex Melamed
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Chung Yin Kong
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evan R Myers
- Department of Obstetrics and Gynecology at the Duke University Medical Center, Durham, NC, USA
| | - Laura J Havrilesky
- Department of Obstetrics and Gynecology at the Duke University Medical Center, Durham, NC, USA
| | - Stephanie V Blank
- Department of Obstetrics, Gynecology, and Reproductive Science, and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William D Hazelton
- Herbold Computational Biology Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jason D Wright
- Department of Gynecologic Oncology, Columbia University College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, New York, NY, USA; New York-Presbyterian Hospital, New York, NY, USA.
| |
Collapse
|
2
|
Papatla K, Orfanelli T, Stoffels G, Layne T, Baldwin E, Leibold A, Blank SV, Cohen S. Mitigating disparity?: Treatment patterns, survival, and recurrence rates by race, ethnicity, and hospital site across a large urban health system. Gynecol Oncol Rep 2024; 53:101372. [PMID: 38584803 PMCID: PMC10997945 DOI: 10.1016/j.gore.2024.101372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/11/2024] [Accepted: 03/17/2024] [Indexed: 04/09/2024] Open
Abstract
Objective National data have shown worse endometrial cancer (EC) outcomes among racial and ethnic minorities. We aimed to analyze EC patient outcomes within a large urban academic health system, with a focus on patterns of care and recurrence rates. Methods This was a retrospective chart review of EC patients at three system hospitals from 1/1/07-12/31/17. Demographic and clinical factors, including time from EMB to surgery, rate of chemotherapy completion, persistent or recurrent disease, and palliative care referrals were extracted. Descriptive statistics and survival curves were generated. Analysis was done using SAS version 9.4. Results Black patients had lower overall survival compared to all others on univariate analysis only (p < 0.0001). Hospital site was associated with OS, with the academic anchor and satellite 1 having higher rates of all-cause mortality compared to satellite 2 (HR 4.68 academic anchor, 95 % CI 1.72-12.76, HR 5.36 satellite 1, 95 % CI 1.85-15.52). Time from EMB to surgery and rates of persistent disease following primary treatment were higher in Black patients. After adjusting for stage and grade, chemotherapy completion rate was significantly associated with race. Palliative care was utilized more for Black than White patients after adjusting for stage and grade (p = 0.005). Conclusions Racial disparities in EC are caused by a complex web of interconnected factors that ultimately lead to worse outcomes in Black women. While precision medicine has helped to close the gap, social determinants of health should be addressed, and models focusing on the complex interactions between biologic, genetic, and social factors should be utilized.
Collapse
Affiliation(s)
- Katyayani Papatla
- Icahn School of Medicine at the Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, Division of Gynecologic Oncology, New York, NY, United States
| | - Theofano Orfanelli
- Stony Brook Medicine, Department of Obstetrics, Gynecology, and Reproductive Medicine, Division of Gynecologic Oncology, Stony Brook, NY, United States
| | | | - Tracy Layne
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Elena Baldwin
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Aurora Leibold
- Mount Sinai West, Department of Obstetrics, Gynecology, and Reproductive Science New York, NY, United States
| | - Stephanie V. Blank
- Icahn School of Medicine at the Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, Division of Gynecologic Oncology, New York, NY, United States
| | - Samantha Cohen
- Icahn School of Medicine at the Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, Division of Gynecologic Oncology, New York, NY, United States
| |
Collapse
|
3
|
Stewart CE, Chase D. Dostarlimab for the Treatment of Endometrial Cancer: A Review. TOUCH REVIEWS IN ONCOLOGY & HAEMATOLOGY 2024; 20:9-11. [PMID: 38855381 PMCID: PMC11160968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
There have been many recent changes in the treatment of endometrial cancer, most recently with the US Food and Drug Administration's (FDA) approval of dostarlimab in conjunction with standard-of-care chemotherapy in the frontline setting for mismatch repair-deficient (dMMR) populations. This review sought to summarize the publications and studies that have led to this practice-changing approval. Dostarlimab is an immune checkpoint inhibitor with a favourable safety profile and proven efficacy in the treatment of endometrial cancer, particularly dMMR endometrial cancer. FDA-approved treatments for mismatch repair-proficient endometrial cancer remain limited.
Collapse
Affiliation(s)
- Chelsea E Stewart
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, CA, USA
| | - Dana Chase
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
4
|
Reddy M, Tian C, Liao CI, Winkler S, Johnson CR, Kapp DS, Darcy K, Chan JK. Exploring U.S. Hispanic origin groups diagnosed with uterine cancer - Are there disparities? Gynecol Oncol 2024; 181:118-124. [PMID: 38150836 DOI: 10.1016/j.ygyno.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE To evaluate patterns and trends of uterine cancer among Hispanic subgroups. METHODS The United States Cancer Statistics (USCS), National Cancer Database (NCDB), and World Population Review were used to obtain data on incidence, demographic characteristics, and cancer histology. Joinpoint regression program was used for statistical analysis. RESULTS Based on 2001-2017 USCS data, the overall incidence of uterine cancer was 27.46 vs. 23.29/100,000 in Hispanics vs. non-Hispanic Whites. There was an over 2-fold higher annual increase in the incidence in Hispanics (1.94%; p < 0.001) vs. Whites (0.85%; p < 0.001), particularly in local stage disease. There was an increase in grade 1 endometrioid carcinoma (1.48%; p < 0.001 vs. -0.52%; p = 0.1) and aggressive histologic subtypes (4.04% p = 0.000 vs. 2.53% p = 0.000) in Hispanics vs. Whites. Using the NCDB (2004-2015), we analyzed 17,351 Hispanics by subgroup (Mexican, South/Central American, Puerto Rican, Cuban, and Dominican). Over the 12 years, there was an increase in the proportion of uterine cancer diagnoses in all Hispanics (5.2% to 11.0%; p < 0.0001). Dominican patients experienced the largest increase in diagnosis (2.6% to 14.9%; p < 0.0001), the highest proportion of advanced disease at 28.0% (p < 0.0001), and the highest incidence of non-endometrioid histologies at 37.1% (p < 0.0001). World Population Review 2023 revealed the highest female obesity rates in Puerto Rico (51.4%), the Dominican Republic (34.1%), and Mexico (32.8%). CONCLUSION Uterine cancer incidence is increased in Hispanics, with the largest increase in Dominican women with more advanced stages and high-risk histologic subtypes. The impact of obesity on cancer risk, especially in Puerto Ricans, Dominicans, and Mexicans, warrants further investigation.
Collapse
Affiliation(s)
- Megan Reddy
- California Pacific Medical Center, 795 El Camino Real, San Francisco, CA 94109, USA.
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA
| | - Chen-I Liao
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Stuart Winkler
- Division of Gynecologic Oncology, Department of Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, TX, USA
| | - Caitlin R Johnson
- California Pacific Medical Center, 795 El Camino Real, San Francisco, CA 94109, USA
| | - Daniel S Kapp
- Stanford University School of Medicine, Department of Radiation Oncology, 875 Blake Wilbur Dr, Stanford, CA 94304, USA
| | - Kathleen Darcy
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA
| | - John K Chan
- California Pacific Medical Center, 795 El Camino Real, San Francisco, CA 94109, USA
| |
Collapse
|
5
|
Somasegar S, Bashi A, Lang SM, Liao CI, Johnson C, Darcy KM, Tian C, Kapp DS, Chan JK. Trends in Uterine Cancer Mortality in the United States: A 50-Year Population-Based Analysis. Obstet Gynecol 2023; 142:978-986. [PMID: 37678887 PMCID: PMC10510793 DOI: 10.1097/aog.0000000000005321] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE To analyze mortality trends in uterine cancer in the United States over 50 years with an emphasis on age and race and ethnicity. METHODS Data on uterine cancer deaths from 1969 to 2018 were obtained from the National Center for Health Statistics. Trends were examined by age and race and ethnicity after adjustment for the hysterectomy rate and pregnancy. RESULTS Uterine cancer mortality decreased between 1969 and 1997 (from 6.03 to 4.00/100,000) but increased between 1997 and 2018 (from 4.00 to 5.02/100,000). From 2001 to 2018, mortality rates increased by 1.25-fold across all age groups. In 2018, the mortality rate from uterine cancer for patients aged 70 years or older and 60-69 years was sixfold and threefold higher, respectively, than in younger patients (aged 50-59 years) (54.87/100,000 vs 27.80/100,000 vs 8.70/100,000). The mortality rate for non-Hispanic Black women was 2.2-fold higher than for non-Hispanic White, Hispanic, and non-Hispanic Asian or Pacific Islander women (17.6/100,000 vs 7.82/100,000, 6.54/100,000, and 4.24/100,000, respectively). On an intersection analysis of age and race, non-Hispanic Black women aged older than 60 years had a threefold higher mortality rate than non-Hispanic White women (72/100,000 vs 24/100,000). A notable finding was that young non-Hispanic Black and Hispanic women (30-39 years) had the highest annual increases in mortality at 3.3% and 3.8% per year compared with 2.2% in non-Hispanic White women. CONCLUSION Since 2001, the uterine cancer mortality rate has increased across all four racial and ethnic groups examined, with the highest increase seen among non-Hispanic Black women. The largest increase in mortality was observed among younger non-Hispanic Black and Hispanic women.
Collapse
Affiliation(s)
- Sahana Somasegar
- Division of Gynecologic Oncology and the Department of Radiation Oncology, Stanford University School of Medicine, and the Division of Gynecologic Oncology, California Pacific/Palo Alto/Sutter Health Research Institute, Palo Alto, California; the Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; the Department of Obstetrics & Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; the California Pacific Medical Center Research Institute, San Francisco, California; and the Gynecologic Cancer Center of Excellence Program, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, and the Henry M. Jackson Foundation for Advancement of Military Medicine, Inc., Bethesda, Maryland
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
The Global, Regional, and National Uterine Cancer Burden Attributable to High BMI from 1990 to 2019: A Systematic Analysis of the Global Burden of Disease Study 2019. J Clin Med 2023; 12:jcm12051874. [PMID: 36902661 PMCID: PMC10003834 DOI: 10.3390/jcm12051874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
Uterine cancer (UC) is the most common gynecologic malignancy, and high body mass index (BMI) is a poor prognostic factor for UC. However, the associated burden has not been fully assessed, which is crucial for women's health management and the prevention and control of UC. Therefore, we utilized the Global Burden of Disease Study (GBD) 2019 to describe the global, regional, and national UC burden due to high BMI from 1990 to 2019. The data show that globally, women's high BMI exposure is increasing annually, with most regions having higher rates of high BMI exposure than the global average. In 2019, 36,486 [95% uncertainty interval (UI): 25,131 to 49,165] UC deaths were attributed to high BMI globally, accounting for 39.81% (95% UI: 27.64 to 52.67) of all UC deaths. The age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years (DALY) rate (ASDR) for high BMI-associated UC remained stable globally from 1990 to 2019, with significant differences across regions. Higher ASDR and ASMR were found in higher socio-demographic index (SDI) regions, and lower SDI regions had the fastest estimated annual percentage changes (EAPCs) for both rates. Among all age groups, the fatal outcome of UC with high BMI occurs most frequently in women over 80 years old.
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW To summarize the most recent publications highlighting the trends and disparities among patients diagnosed with high-risk endometrial cancer. RECENT FINDINGS Endometrial cancer mortality continues to rise, driven by the increasing incidence of high-risk histologic subtypes that accounts for a disproportionate number of endometrial cancer deaths. The lack of progress made in endometrial cancer treatment, particularly of high-risk histologic subtypes, disproportionately affects black women who are more likely to be diagnosed with these aggressive tumor types. Even when accounting for high-risk histology, various factors across the spectrum of care may influence the survival disparities between black and white women, including timely access to guideline-concordant care, clinical trial enrollment, and systemic racism that impacts cancer outcomes. SUMMARY In this review, we highlight the disproportionate impact of worsening endometrial cancer mortality and healthcare inequalities contributing to the endometrial cancer survival disparity between black and white women.
Collapse
Affiliation(s)
- Cortney M Eakin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA 90095
| | - Tiffany Lai
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA 90095
| | - Joshua G Cohen
- Division of Gynecologic Oncology, Department of Surgery, City of Hope, Irvine, CA 92618
| |
Collapse
|
8
|
Sarkar A, Singh N, Zangmo R, Ghotra MK, Saha A, Kulshreshtha A. The association of obesity and type I uterine cancer: is this an oversimplification? A comment. Am J Obstet Gynecol 2023; 228:104. [PMID: 36115446 DOI: 10.1016/j.ajog.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/12/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Avir Sarkar
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Third Floor, Teaching Block, New Delhi, 110029, India
| | - Nilanchali Singh
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Third Floor, Teaching Block, New Delhi, 110029, India
| | - Rinchen Zangmo
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Third Floor, Teaching Block, New Delhi, 110029, India
| | - Maninder Kaur Ghotra
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Third Floor, Teaching Block, New Delhi, 110029, India.
| | - Ashmita Saha
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Third Floor, Teaching Block, New Delhi, 110029, India
| | - Anshul Kulshreshtha
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Third Floor, Teaching Block, New Delhi, 110029, India
| |
Collapse
|
9
|
Endometriumkarzinom: Ist die Adipositas auch ein Risikofaktor für Typ-II-Tumoren? Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/a-1924-8999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
|