Uterine Corpus Cancer in AfricanAmerican Women:

1
Uterine Corpus Cancer in African-American Women
Same Disease, Different Outcomes?
Stephanie Yap M.D. Assistant Professor Morehouse
School of Medicine Division of Gynecologic
Oncology
2
2005 Estimated US Cancer Cases
Men710,040
Women662,870
32 Breast 12 Lung and bronchus 11 Colon and
rectum 6 Uterine corpus 4 Non-Hodgkin
lymphoma 4 Melanoma of skin 3
Ovary 3 Thyroid 2 Urinary
bladder 2 Pancreas 21 All Other Sites
Prostate 33 Lung and bronchus 13 Colon and
rectum 10 Urinary bladder 7 Melanoma of
skin 5 Non-Hodgkin 4
lymphoma Kidney 3 Leukemia 3 Oral
Cavity 3 Pancreas 2 All Other Sites 17
Excludes basal and squamous cell skin cancers
and in situ carcinomas except urinary
bladder. Source American Cancer Society, 2005.
3
Black to White Cancer Incidence Rate Ratiosfor
Women, 1997-2001
Ratio
Site
Black
White

• All sites 400.2 435.1 0.9
• Myeloma 10,2 4.2 2.4
• Stomach 9.8 4.5 2.2
• Esophagus 3.9 2.0 2.0
• Uterine cervix 12.2 7.8 1.6
• Pancreas 14.2 9.5 1.5
• Colon and rectum 56.1 46.8 1.2
• Liver and intrahepatic bile duct 3.9 2.6 1.5
• Oral cavity and pharynx 5.9 6.6 0.9
• Breast 118.6 143.2 0.8
• Urinary bladder 7.8 10.2 0.8
• Uterine corpus 17.8 26.6 0.7

Source SEER Program, 1975-2001, Division of
Cancer Control and Population Sciences, NCI, 2004
4
Cancer Sites Where Black Death Rates Exceed White
Death Rates for Women, 1997-2001
Ratio
Site
Black
White

• All sites 196.5 165.5 1.2
• Myeloma 6.6 2.9 2.3
• Stomach 6.3 2.8 2.3
• Uterine cervix 5.6 2.6 2.2
• Esophagus 3.2 1.7 1.9
• Larynx 0.9 0.5 1.8
• Uterine corpus 6.9 3.9 1.8
• Pancreas 12.8 8.9 1.4
• Colon and rectum 24.5 17.1 1.4
• Liver and intrahepatic bile duct 3.8 2.7 1.4
• Breast 35.4 26.4 1.3
• Urinary bladder 2.9 2.3 1.3
• Oral cavity and pharynx 2.0 1.6 1.3

Source SEER Program, 1975-2001, Division of
Cancer Control and Population Sciences, NCI,
2004 ACS 2005
5
5-year Relative Survival Rates by Site Race,
1995-2000
White
Difference
Black
Site
All Sites 66 55 11 Uterine
corpus 86 63 23 Oral cavity 61 39 22 Urinary
bladder 83 62 21 Breast (female) 89 75 14 Colo
n 64 54 10 Rectum 65 55 10
Leukemia 48 39 9 Non-Hodgkin
lymphoma 60 51 9 Esophagus 16 9
7 Uterine cervix 74 66 8
Source SEER Program, 1975-2001, Division of
Cancer Control and Population Sciences, NCI,
2004 ACS 2005
6
SEER Relative Survival by Race, 1988-2001
Source SEER Program, 1975-2001, Division of
Cancer Control and Population Sciences, NCI,
2004 ACS 2005
7
WHY?

• Endometrial cancer prognostic features
• Stage
• Histopathology
• Grade
• Age
• Tumor biology
• Molecular markers
• Socioeconomic cultural factors
• Length of time to care
• Recommendations and receipt of guideline therapy
• Psychosocial support
• Comorbid factors
• Tumor-host interactions

8
Analysis of Differences Stage Distribution
Source SEER Program, 1975-2001, Division of
Cancer Control and Population Sciences, NCI,
2004 ACS 2005
9
Disparity in Survival by Stage Race
White
Black
Source SEER Program, 1975-2001, Division of
Cancer Control and Population Sciences, NCI,
2004 ACS 2005
10
Incidence by Race Histopathology
White Hispanic
Black
White NH
(Sherman Devesa, Cancer 200398176-86)
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Survival Disparity by Race Histopathology
(Sherman Devesa, Cancer 200398176-86)
12
Tumor Type Race Impact on Mortality
(Sherman Devesa, Cancer 200398176-86)
13
Race Tumor Grade
(Sherman Devesa, Cancer 200398176-86)
14
Age-Adjusted U.S. Mortality Rates, Agegt50
Source SEER Program, 1975-2001, Division of
Cancer Control and Population Sciences, NCI,
2004 ACS 2005
15
Relative Survival by Race Age
(Sherman Devesa, Cancer 200398176-86)
16
Molecular Basis for Disparity PTEN p53
PTEN
p53
(Maxwell et al., Clin Cancer Res
200062999-3005 Clifford et al., Am J Obstet
Gynecol 1997176S229-32)
17
p53 in Advanced-Stage Cancers
All 179 cases with p53 overexpression
121 cases with metastases p53 overexpression
Median survival (years)
(Kohler et al., Am J Obstet Gynecol
19961751246-52)
18
Her2-neu in Serous Cancers
(Santin et al., Am J Obstet Gynecol
2005192813-8)
19
Socioeconomic Cultural Factors

• Lower socioeconomic status
• Less often treated (9 v 4)
• Limited income lack of treatment for black
  women with stage IV disease
• Lower rates of surgery (79 v 91)
• (Hicks, Cancer 1998832629-37)
• Greater medical comorbidity
• Diabetes, hypertension, higher BMI
• (Hill, Obstet Gynecol 199688919-26)

20
Therapeutic Differences

• Treatment Parameters
• Time interval
• (Liu, Obstet Gynecol 199586486-90Matthews,
  Gynecol Oncol 199765206-12)
• Recommendations delivery of guideline therapy
• (Trimble, Gynecol Oncol 200596741-8 Maxwell,
  SGO 2005, abst38)
• Rate of surgery in black women
• (Randall, J Clin Oncol 2003214200-6)
• Treatment Effectiveness
• Decreased reduction in mortality associated with
  surgery
• (Randall, J Clin Oncol 2003214200-6)

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Summary

• Black women experience poorer survival
• stage for stage, grade for grade, age for age
• Potential contributors
• Disparity in diagnosis treatment
• Disparity in access, support education
• Tumor biology
• Etiologic exposures comorbidities
• Treatment effectiveness
• Treatment preferences