E166: Racial Disparities in Endometrial Cancer in the U.S.

Introduction: Endometrial cancer is the most commonly diagnosed female genital tract malignancy in the United States of America. Racial disparities surrounding this particular disease have been extensively investigated for over 25 years. We sought to determine if research in this area has led to any significant improvements in the racial gaps.

Methods: We performed a review of published literature in the English language on racial disparities in endometrial cancer among African American (AAW) and white American women (WAW), from 1997 through 2023. We looked at trends in incidence and survival; impact of known poor prognostic factors (stage at diagnosis, histological subtypes, grade); co-morbidities; differences in treatment (surgery, radiation and chemotherapy); socioeconomic factors; differences in biological and genetic markers; and policies/declarations.

Results: During the period under review (1997-2023), there was a notable increase in both disease incidence (40%) and mortality (28%) rates for AAW, in comparison to WAW among whom the incidence rates decreased by 1.5% and mortality rates rose by 19%. [Table 1] It should be noted that the current incidence rates in AAW (29.4) and WAW (26.6) represent a reversal of what they were 26 years ago, when incidence rates among WAW (27.0) were higher in comparison to those among AAW (17.8%). In comparison to WAW, AAW had a higher prevalence of poor prognostic variables, more co-morbidities, lower income levels, less insurance coverage, and were more frequently under treated with surgery, chemotherapy and radiation. To date no actionable molecular/genetic markers have been identified. We were unable to locate any published recommendations of implementation strategies designed to effectively eliminate the documented racial gaps.

Conclusions: During the past 26 years there has been a plethora of research in the academic domain of racial disparities in endometrial cancer. During this same period the racial gaps in disease incidence and mortality rates have widened. Correctable determinants of these findings (lack of access to care related to absence of healthcare insurance, lower socioeconomic status, poverty, living in rural locations, lower educational levels, under treatment of AAW by institutions and physicians) predominate and undergird this disparity. Focused, aggressive action is needed by all interested parties including government, healthcare industry, medical societies and civil society to establish actionable policies that will resolve and reverse these pernicious and deleterious social variables.