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UNC Lineberger Comprehensive Cancer Center

Disparities in Endometrial Cancer

Racial DisparityA woman sits at a desk in front of a large computer screen. Her gaze is downward as she writes in a notebook. She is wearing an orange blouse with white polka dots and coordinating orange eyeshadow.

Endometrial cancer represents one of the largest racial cancer disparities in North Carolina and the United States.

Non-Hispanic Black women have a 55% higher five-year mortality rate from endometrial cancer than Non-Hispanic White women.

Although not completely clear, reduced access to care, higher likelihood of cancer with worse histologic and molecular features, and greater rates of both obesity and diabetes in Non-Hispanic Black women are believed to influence this disparity in outcomes.

 

Obesity

Endometrial cancer the 4th most common cancer in U.S. women, and alarmingly the frequency and mortality from endometrial cancer continues to rise, most likely due to the obesity epidemic.

Obesity and diabetes are well-known factors associated with both increased risk of developing endometrial cancer and increased risk of death. Just for perspective, over 60% of endometrial cancer patients are obese.

There have been a number of challenges related to studying cancer disparities in endometrial cancer:

  • Lack of prospective population-based epidemiologic studies detailing histologic and molecular subtype with race, obesity and co-morbid treatments, access and receipt of NCCN recommended treatment and follow-up care.
  • Small representative numbers of endometrial cancer samples from Non-Hispanic Black women in large scale molecular profiling studies such as TCGA (46 Non-Hispanic Black cases, 291 Non-Hispanic White cases).
  • Limited understanding of the impact of obesity and its related co-morbidities as modulators of endometrial cancer progression and treatment efficacy in Non-Hispanic Black women.
  • Insufficient knowledge of the inter-relationship of race, obesity and the uterine/gut microbiome on the progression and treatment of endometrial cancer.
  • Paucity of racially and molecularly defined mouse models as tools to study this disease.

 

UNC TREND approach to address disparities

  • Conduct a prospective population-based study across the state of NC that will use a comprehensive approach to integrate tumor biology, socioeconomic and other risk factors as contributors to worse outcomes in Non-Hispanic Black endometrial cancer patients.
  • Compare the prevalence of known prognostic subtypes between Non-Hispanic Black and Non-Hispanic White patients that will include the largest number of endometrial cancers from Non-Hispanic Black women to date.
  • Conduct a follow-up of the endometrial cancer cohort patients and perform preliminary multivariable analyses to identify Non-Hispanic Black/Non-Hispanic White differences and assess variation in presenting symptoms and receipt of guideline-concordant diagnostic procedures and endometrial cancer treatment among Non-Hispanic Black and Non-Hispanic White women.
  • Delineate for the first time the malignant uterine and gut microbiota of obese Non-Hispanic Black vs Non-Hispanic White patients as they undergo hysterectomy and, for Stage III/IV, standard-of-care paclitaxel/carboplatin treatment, and correlate this with endometrial cancer molecular subtype and therapeutic response.
  • Develop and use racially diverse, molecularly characterized patient-derived xenograft models from both Non-Hispanic Black and Non-Hispanic White women to explore the inter-relationship of race, molecular subtype, and the uterine/gut microbiome on endometrial cancer pathogenesis.

Learn more about TREND