Get Informed About Uterine Cancer
Although uterine cancer remains rare, it is one of the few cancers for which incidence and mortality are increasing in the United States, according to the Centers for Disease Control and Prevention. Moreover, a 2019 study carried out by National Cancer Institute (NCI) researchers shows a sharp rise in the incidence of aggressive subtypes of the cancer among African-American women especially. The data also indicated that African-American women have poorer survival rates than other racial/ethnic groups no matter what type of uterine cancer they have.
Endometrioid or Not? The NCI study (Journal of Clinical Oncology, August 1, 2019) focused on two types of uterine cancer: endometrioid and non-endometrioid.
- Endometrioid cancer is more common, and typically occurs after menopause. It develops in the endometrium (the lining of the uterus). Risk factors include using estrogen-only hormone replacement therapy (HRT) as opposed to estrogen with progesterone, never having given birth, obesity (about 70 percent of cases of endometrioid cancer are linked to obesity), diabetes, and high blood pressure.
- Non-endometrioid cancer is rare, and generally develops in the myometrium (the middle layer of the uterine wall). “The risk factors are much less clear for non-endometrioid histologies,” says Stephanie Blank, MD, director of gynecologic oncology at Mount Sinai. “Two are prior radiation exposure to treat cancer, and taking tamoxifen.” Tamoxifen (Nolvadex®) is used to treat a certain type of breast cancer, but while it blocks estrogen in the breasts it mimics estrogen in the uterus, thus raising the risk of uterine cancer. Keep in mind though that the increased risk is small, and likely not enough to outweigh the drug’s treatment benefits.
Prognosis Differs Endometrioid cancer has a better prognosis than non-endometrioid cancer. “Endometrioid cancer tends to present with abnormal bleeding that makes it more likely the disease will be diagnosed early, before it progresses,” Dr. Blank notes. “Endometrioid cancers also are generally slow-growing and often need no treatment beyond surgery to remove the uterus.” However, Dr. Blank adds that clinicians need to factor in the greater surgical risk with older women, particularly if they are frail. “Every woman’s individual situation needs to be considered, since non-surgical treatment approaches may be the best option in some cases,” she explains.
Non-endometrioid cancer often is diagnosed at an advanced stage because it is less likely to cause bleeding early on. “It also is more aggressive and fast growing than endometrioid cancer,” Dr. Blank says. These factors mean that non-endometrioid cancer typically has a poor prognosis.
African-American Women Especially Vulnerable For the study, researchers evaluated trends in uterine cancer incidence rates between 2000 and 2015, analyzing NCI population data on women ages 30 to 79.
Among women who had not had a hysterectomy (removal of the uterus), uterine cancer incidence rates increased by about 1 percent per year. Incidence rates for non-endometrioid cancer increased by 2.9 percent per year, and it also occurred more often in African-American women (25.9 per 100,000 women over the study period) than in white women (11.4), Hispanic women (10.1), and Asian/Pacific Islander women (7.5).
The five-year relative survival rate was lower (about 58 percent) among women with non-endometrioid cancer than among women with endometrioid cancer (92 percent). Overall, African-American women had the lowest survival rates irrespective of when they were diagnosed and their cancer subtype: about 63 percent compared to 86 percent for white women, 81 percent for Hispanic women, and 84 percent for Asian/Pacific Islanders. When it came to non-endometrioid cancer, the five-year survival rate in African-American women was about 42 percent, compared to about 62 percent for white women, and about 58 percent for both Hispanic women and Asian/Pacific Islanders.
It isn’t clear why rates of uterine cancer among African-American women exceed those in white women, but the increase seen in the study likely isn’t explained by the rising prevalence of obesity, since this is more strongly associated with endometrioid cancer. The study authors suggest that biological differences may render African-American women more susceptible to non-endometrioid cancer, and Dr. Blank agrees. She adds that differences in access to care also may contribute. “There is some evidence that black women presenting with abnormal bleeding are less likely to receive guideline-based care,” she says, “so even if they have access to care, the care they are provided is not on par with that received by a white woman.”
Protecting Yourself When it comes to protecting yourself against endometrioid cancer, maintaining a healthy weight is key. Doing this can mitigate other endometrioid cancer risk factors, like high blood pressure and type 2 diabetes (the type most likely to affect seniors), but if you have these conditions follow your doctor’s advice for controlling them. “It also is advisable to avoid estrogen-only HRT,” Dr. Blank adds, “and tell your doctor if you have abnormal bleeding after menopause.”
Less is known about preventing non-endometrioid cancer—further research is needed to clarify its underlying causes and effective early detection methods. Until then, don’t panic—keep in mind that overall, uterine cancer is relatively rare.
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