A new study led by Columbia University researchers projects a substantial rise in uterine cancer incidence and deaths in the United States over the next three decades, with a disproportionate impact on Black women.
"Our findings underscore the urgent need to develop new strategies to prevent and screen for uterine cancer in high-risk women," says the study's first author, Jason D. Wright, the Sol Goldman Professor of Gynecologic Oncology at Columbia University Vagelos College of Physicians and Surgeons.
"From 2018 to 2050, we expect uterine cancer cases to rise by over 50% in Black women versus about 29% in white women."
Uterine cancer is one of the few cancers where incidence and mortality are rising. Between 2010 and 2020, the number of uterine cancers diagnosed in the United States increased by more than 50%, from approximately 43,000 to over 65,000 cases.
Currently, deaths from uterine cancer are about twice as high in Black women compared with white women.
Rising rates of uterine cancer. The Columbia University Uterine Cancer Model predicts uterine cancer rates will continue to rise in the next 25 years for both Black (left) and white (right) women. The dashed line represents the predicted rise if obesity and hysterectomy rates continue to rise and fall, respectively. The orange line represents the predicted rise if obesity and hysterectomy rates do not change from today's rates.
To predict future trends in uterine cancer incidence and mortality, researchers at Columbia built a natural history model that allowed them to simulate the trajectories of women over time based on age, type of uterine cancer, and race. Survival estimates are based on currently available treatments. The model also includes current rates of obesity, a known risk factor for uterine cancer, and hysterectomy, which reduces the risk.
"Our model predicts that current trends in uterine cancer incidence and mortality will continue for the foreseeable future," notes Wright. "From 2018 to 2050, we expect uterine cancer cases to rise by over 50% in Black women versus about 29% in white women."
The higher burden of uterine cancer among Black women is attributed to several factors.
"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," says Wright. "Black women are also more likely to have aggressive types of uterine cancer."
The researchers "stress-tested" the model by introducing a hypothetical screening tool and intervention that could detect uterine cancer and precancerous changes earlier than is now possible.
"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," says Wright.
Doctors use transvaginal ultrasound and endometrial biopsy to diagnose uterine cancer in women with symptoms such as abnormal bleeding, but there is currently no routine screening method for women who are asymptomatic. Emerging techniques, such as liquid biopsies to look for precancerous or cancerous changes in cells that are shed by the uterus, are being studied as potential screening tools.
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Additional information
The study, "Projected Trends in the Incidence and Mortality of Uterine Cancer in the United States," was published July 1 in Cancer Epidemiology, Biomarkers & Prevention.
Authors (all from Columbia except where noted): Jason D. Wright, Matthew T. Prest, Jennifer S. Ferris, Ling Chen, Xiao Xu, Kevin J.Route, Alexander Melamed (Massachusetts General Hospital), Chin Hur, Brandy M. Heckman-Stoddard (National Cancer Institute), Goli Samimi (National Cancer Institute), Nina A. Bickell (Icahn School of Medicine at Mount Sinai), Tracy M. Layne (Icahn School of Medicine), Evan R. Myers (Duke University Medical Center), Laura J. Havrilesky (Duke University Medical Center), Stephanie V. Blank (Icahn School of Medicine), Natasha K. Stout (National Cancer Institute), William D. Hazelton (Fred Hutchinson Cancer Center), Chung Yin Kong (Icahn School of Medicine), and Elena B. Elkin.
The study was supported by a grant from the National Institutes of Health (1U01CA265739).
Jason Wright has received royalties from UpToDate, honoraria from the American College of Obstetricians and Gynecologists, and research support from Merck. Xiao Xu has received honoraria from the American Association of Gynecologic Laparoscopists. Elena Elkin has received research support from Pfizer. The other authors have no conflicts of interest.
