Black women with cancers of the uterus are less likely to survive the disease than white women, and relatively little progress has been made over the past two decades to narrow this racial difference.
While previous research has shown that black women are more likely to die from uterine cancers than their white counterparts, little is known about the factors involved in this discrepancy. In addition, studies have not looked at whether efforts to provide equal treatment to all patients have lessened this disparity in recent years.
To investigate the issue, Dr. Jason Wright, assistant professor of obstetrics and gynecology at Columbia University College of Physicians and Surgeons, and colleagues studied the clinical data of 80,915 patients, 7 percent of whom were black, who were documented to have uterine cancer between 1988 and 2004 in the Surveillance, Epidemiology and End Results (SEER) Database. The investigators divided the data into three groups based on when women were diagnosed: 1988-1993, 1994-1998, and 1999-2004.
The researchers found that black patients were significantly younger and had more advanced and more aggressive tumors than white women. Advanced cancers (stage III/IV) occurred in 27 percent of blacks between 1988 and 1993 and in 28 percent from 1999 to 2004. The corresponding figures for white women were 14 percent from 1988 to 1993 and 17 percent from 1999 to 2004.
Overall, black women were 60 percent more likely to die from their tumors than white women, and for each of the three time periods, survival was worse for blacks than for whites.
Dr. Wright and his team also found that over time, the incidence of serous tumors and clear cell tumors (two aggressive types of cancer) increased and the use of radiation decreased for both races. Lymph node dissection was performed to determine tumor stage more commonly in both races in recent years, and its use was well matched between the two groups (45 percent of blacks and 48 percent of whites).
The investigators note that differences in tumor characteristics and inequalities in care cannot completely explain the survival disparity between races found in this study. Biological differences might also play a role. Racial differences in risk factors such as obesity, medical comorbidities, and estrogen use have also been proposed as contributing to observed racial disparities in uterine cancer survival.
The authors of the study conclude that further work to delineate the factors that impair survival in black women with uterine cancers is clearly needed.
- Jason D. Wright, Jessica Fiorelli, Peter B. Schiff, William M. Burke, Amanda L. Kansler, Carmel J. Cohen, and Thomas J. Herzog. Racial disparities for uterine corpus tumors: changes in clinical characteristics and treatment over time. Cancer, Online: February 09, 2009; Print Issue Date: March 15, 2009 DOI: 10.1002/cncr.24160
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