Projections show uterine cancer cases, mortality rate, on rise in US
Deaths related to this cancer now twice as high for Black vs. white women
The number of uterine cancer cases and related deaths — the disease’s incidence and mortality rates — in the U.S. are expected to substantially rise over the next few decades, especially among Black women, according to new research.
“Our findings underscore the urgent need to develop new strategies to prevent and screen for uterine cancer in high-risk women,” Jason D. Wright, MD, a professor at Columbia University’s medical school and the study’s first author, said in a university press release. The work was done by a team of scientists from institutions across the U.S., led by Wright. The study was funded by a grant from the National Institutes of Health.
Titled “Projected Trends in the Incidence and Mortality of Uterine Cancer in the United States,” the study was published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.
The incidence of many cancers — and the mortality rates associated with them — have declined in recent years due to advances in prevention, screening, and treatment.
But that’s not the case for uterine cancer, the most common form of gynecological cancer. In the U.S., the number of uterine cancer cases increased by more than 50% from 2010 to 2020, rising from about 43,000 to more than 65,000.
The American Cancer Society estimates that nearly 70,000 new cases of uterine cancer will be diagnosed in the U.S. in 2025, and nearly 14,000 women will die from it.
There are also racial disparities in uterine cancer outcomes, with deaths related to the disease being about twice as high among Black women as compared with white women, per published data.
In this new study, the team of researchers conducted an analysis that aimed to predict trends regarding the number of cases of uterine cancer and related deaths in the U.S. over the next few decades.
“Projecting the incidence and mortality of uterine cancer can facilitate future cancer control efforts,” the researchers wrote.
New model simulated trajectory of uterine cancer incidence, mortality rate
To achieve this, the team built a natural history model that could simulate the trajectory of uterine cancer over time based on the type of uterine cancer, age, and race.
It also considered rates of obesity — a known uterine cancer risk factor — as well as surgery to remove the uterus (hysterectomy), which is a protective factor against the disease. Survival estimates were based on currently available uterine cancer treatments.
The results showed that uterine cancer incidence and mortality are expected to keep rising, “for the foreseeable future,” Wright said.
Importantly, according to the researchers, this increase may continue to disproportionately affect Black women. The model predicted that in the next few decades, uterine cancer rates will increase by more 50% among Black women, rising from the 56.8 cases per 100,000 women in 2018 to 86.9 cases per 100,000 women by 2050.
Uterine cancer rates in white women are expected to increase by approximately 29% in the same time frame, from 57.7 cases per 100,000 to 74.2 cases per 100,000.
A similar trend was seen in terms of uterine cancer mortality, which was expected to increase from 6.1 to 11.2 per 100,000 in white women and from 14.1 to 27.9 per 100,000 in Black women.
Use of hypothetical screening and intervention tool changed trajectory
There are a number of factors that could feed that racial disparity, according to Wright.
“Black women often face delays in diagnosis and are more likely to be diagnosed at later stages, when the cancer is more difficult to treat,” the scientist said. “Black women are also more likely to have aggressive types of uterine cancer.”
Indeed, while rates of endometrioid tumors — the most common type of uterine cancer, which has a more favorable prognosis — are expected to considerably rise across all women, the incidence of the more aggressive nonendometrioid tumors is estimated to substantially increase among Black women and only slightly increase among white women.
Black women often face delays in diagnosis and are more likely to be diagnosed at later stages, when the cancer is more difficult to treat. … Black women are also more likely to have aggressive types of uterine cancer.
When a hypothetical screening and intervention tool capable of detecting uterine cancer and precancerous stages was introduced to the model, the trajectory changed.
“Our simulation showed that screening with an effective test starting at age 55 would result in a significant reduction in uterine cancer cases, reinforcing the need to develop new screening and prevention methods,” Wright said.
However, there is no routine screening method now available for detecting uterine cancer in women who don’t have symptoms, like the way a routine Pap smear can detect cervical cancer.
Uterine cancer is typically diagnosed via an ultrasound and tissue biopsy once women complain of symptoms such as abnormal vaginal bleeding. Scientists now are working on developing better screening techniques.
One possible approach could be a liquid biopsy, in which a bodily fluid like blood is analyzed for precancerous or cancerous changes in cells shed from the uterus.
Ultimately, the validation and clinical application of such approaches could help slow down rates of uterine cancer and associated deaths in future decades, the team noted.
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