Changing Landscape of Uterine and Ovarian Cancer in the US

NEW YORK (Reuters Health) – The landscape of gynecologic cancer in the United States is changing rapidly and the risk of dying from uterine cancer is now similar to that for ovarian cancer among women overall, and roughly 60% higher among Black women, researchers say.

“While there is cause for celebration because of the steady reduction in ovarian cancer mortality, the concomitant rise in uterine corpus cancer is concerning, especially given the lack of any advances in treatment or improvement in survival over the past 40 years We suggest that this is partly due to underfunding,” Rebecca Siegel with the American Cancer Society told Reuters Health by email.

“The second take-away is even more alarming. Not only does uterine corpus cancer already have one of the largest disparities in all of cancer (eg, 63% of Black women survive 5 years vs 84% of White women), that gap is increasing,” Siegel noted.

Cancer of the uterus and ovaries are the most common gynecologic malignancies in the United States. And while deaths due to ovarian cancer are steadily declining, mortality rates from uterine cancer rose by 2% annually from 2008 to 2018, a new analysis shows.

“How recent trends have shifted the gynecologic cancer burden and inequalities is unknown,” Siegel and her colleagues point out in Obstetrics & Gynecology.

Using national data, the researchers analyzed mortality for uterine and ovarian cancer between 1990 and 2019. During the study period, close to 233,000 women died from uterine cancer and more than 419,000 died from ovarian cancer, including 11,556 and 13,445, respectively, in 2019.

Ovarian-cancer death rates (per 100,000) fell from 9.3 in 1990 to 6.0 in 2019, with a -2.7% average annual percent change from 2010 to 2019.

Uterine-cancer mortality rates (per 100,000) decreased from 4.3 in 1990 to 4.0 in 1997, then increased to 5.1 in 2019, with a 1.7% average annual percent change from 2010 to 2019.

“The twofold higher risk of death from ovarian compared with uterine cancer in the early 1990s has been virtually eliminated by oppositional mortality trends,” Siegel and colleagues write.

“Among Black women, the crossover has already occurred and the uterine cancer disparity widened, with mortality now twofold higher than for White women (9.1/100,000 vs 4.6/100,000) despite similar incidence,” they say.

These mortality trends reflect changing disease risk and improved treatment.

“Rising rates of obesity and physical inactivity have a much larger effect on occurrence of uterine cancer (70% of cases) than ovarian cancer (4% of cases). Additionally, major treatment advances, including PARP inhibitors, have extended ovarian cancer survival, whereas uterine cancer survival has remained stagnant for 40 years,” the authors say.

A lack of progress for uterine cancer may stem from a shortfall in research investment. For example, funding from the National Cancer Institute for uterine cancer in 2018 was one-seventh that for ovarian cancer, despite a similar mortality projection for 2021 (12,940 vs. 13,770, respectively) and “profound racial disparities,” they point out.

Increased opportunistic salpingectomy, as well as prophylactic bilateral salpingo-oophorectomy for women with predisposing high-risk germline mutations, may also contribute to declines in deaths due to ovarian cancer, Siegel and colleagues say.

They also say the “alarming” disparity in uterine-cancer mortality in Black compared with white women noted in the data is “an underestimate of the true excess burden because rates were uncorrected for higher hysterectomy prevalence among Black women.”

Siegel told Reuters Health, “Black women are more than twice as likely as White women to be diagnosed with the more aggressive nonendometrioid cancers (47% vs 22%), which are also increasing rapidly. Risk factors for these cancers are not well understood, which again, could relate to the lag in research funding. There are no known genetic differences to explain why Black women are diagnosed with more aggressive cancers and it could be related to differences in physical environment.”

SOURCE: https://bit.ly/3gxgQ7d Obstetrics & Gynecology, online February 3, 2022.

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