Uterine Cancer Rates Rising, Mainly Among Black Women

by NCN Health And Science Team Posted on December 7th, 2018

Houston, Texas, USA : Uterine cancer is on the rise in the U.S. and it’s killing black women at a higher rate than any other group, a report says.

Uterine cancer is one of the few cancers with increasing incidence and mortality.

Between 1999 and 2015, Uterine cancer rates rose by 12 percent, from about 24 cases per 100,000 women in 1999 to 27 cases per 100,000 women in 2015, according to a new report from the Centers for Disease Control and Prevention. Deaths from the disease increased from four per 100,000 women in 1999 to five per 100,000 in 2016.

The report comes from the CDC’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology and End Results program.

Rates of uterine cancer were once lower for black women than white women. Black women are now twice as likely to die from the disease.

Since 1999, the number of black women who developed the condition shot up by 46 percent. During the same time, the rate of white women developing uterine cancer rose 9 percent. By 2015, the rate for black women and white women was the same.

Each group has higher rates than Alaskan Indian/Native American, Hispanic and Asian/Pacific Island women.

The National Cancer Institute says women who are overweight or obese are twice to nearly four times as likely to develop uterine cancer. That’s more than 82 percent of black women in the U.S., according to the Health and Human Service.

But being overweight isn’t the only cause of the disease.

“There are many risk factors for developing uterine cancer,” Joseph Davis, an OB-GYN and medical director of the Cayman Fertility Center in the Caribbean, told NBC News.

Lack of physical activity, an increase cases of diabetes and a decline in the use of certain hormone therapies are also linked to development of uterine cancer.

Although population-based screening tests are recommended for several cancers, including breast, cervical, colorectal, and lung cancers, at present, population-based screening tests are not recommended for uterine cancer .

An important early symptom of uterine cancer is abnormal vaginal bleeding, including bleeding between periods or after sex or any unexpected bleeding after menopause (i.e., any bleeding except intermittent bleeding within 1 year after cessation of menses or cyclic bleeding associated with use of cyclic postmenopausal hormone therapy).

Approximately 90% of women with uterine cancer report abnormal vaginal bleeding . A lower percentage of women with uterine sarcomas have abnormal vaginal bleeding (approximately 56%) or nonspecific symptoms, such as pelvic pain (22%); consequently, a higher percentage of sarcomas are not detected until the cancer has already spread.

Uterine cancer outcomes could be improved by increasing awareness among women that abnormal vaginal bleeding should be evaluated promptly by a health care provider. It is also important for health care providers to perform timely evaluation and necessary follow-up of women’s concerns and symptoms. Transvaginal ultrasonography or endometrial tissue sampling are appropriate for initial evaluation of postmenopausal bleeding; further evaluation could include hysteroscopy combined with endometrial sampling .

To help women make informed choices, health care providers can educate women about different procedural options (including surgical choices); discuss the benefits and risks of each procedure; and discuss the risk for cancer. 

The findings in the report are subject to at least five limitations.

First, reporting of race and ethnicity uses data from medical records and death certificates, which might be inaccurate in some cases; ongoing procedures are used to ensure that this information is as accurate as possible,

Second, improved pathologic classification of tumors over time might influence rates and trends.

Third, broad groups were used for histologic type, which might mask varying levels of tumor behavior.

Fourth, in clinical practice, uterine cancers are commonly staged on the basis of histologic type using the International Federation of Gynecology and Obstetrics system ; however, because this information is not routinely collected in cancer registries, this report used SEER Summary Stage to stage cancers.

Finally, rate denominators were not adjusted for hysterectomy prevalence and might include women who did not have an intact uterus and were not at risk for uterine cancer, thus underestimating the actual rate among women at risk, particularly black women, who have higher rates of hysterectomy.

Multifactorial efforts at individual, community, clinical, and systems levels to help women achieve and maintain a healthy weight and obtain sufficient physical activity might reduce the risk for developing uterine cancer. Promoting awareness among women and health care providers of the need for timely evaluation of abnormal vaginal bleeding can increase the chance that uterine cancer is detected early and treated appropriately.

Implications for public health practice

Health care providers and community programs can help women achieve and maintain a healthy weight and get enough physical activity, which can reduce the risk for endometrial cancer, the most common uterine cancer. Promoting awareness of the need for timely evaluation of abnormal vaginal bleeding (between periods, after sex, or after menopause), an important symptom of uterine cancer, increases the chance for early detection and treatment.

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