Health Disparities in Uterine Cancer: Report From the Uterine Cancer Evidence Review Conference

The American College of Obstetricians and Gynecologists (ACOG) convened a panel of experts to develop evidence-based educational materials for clinicians on health disparities in the treatment, diagnosis, and outcomes for uterine cancer. Based on reviews of the literature, best practices, and guidelines, the panel identified substantive inequities and provided guidance for future research. Clinician educational materials are available online at acog.org. The panel used key questions around incidence and mortality by race and ethnicity, factors that contribute to disparities and inequities in care, and ways to improve outcomes for historically and contemporaneously underserved populations to frame the review of uterine cancer health disparities. Stakeholders from professional organizations and patient advocacy groups reviewed the summary of the review and provided input. Black women and White women had a higher incidence of uterine cancer in 2015 than with any other racial or ethnic group (27 cases/100,000 women vs 19-23 cases/100,000). Between 1999 and 2015, Black women saw larger increases in the incidence rate than White women. Mortality was also higher among Black women than any other racial or ethnic group (9.0 deaths/100,000 vs 3.5-5.0 deaths/100,000). Hispanic women had a higher incidence of uterine cancer in 2016 than White women (23.2 cases/100,000 vs 27.0 cases/ 100,000). Between 1999 and 2015, Hispanic women saw larger increases in the incidence rate than White women (32% vs 9%). After controlling for sociodemographic factors, cancer stage, and treatment, most studies observed similar or improved survival rates among Hispanic women and White women. Asian/Pacific Islander women had a lower incidence of uterine cancer than Black and White women (19.2 cases/100,000 women vs 27 cases/100,000). Between 1999 and 2016, Asian/Pacific Islander women saw larger increases in the incidence rate than White women (38% vs 9%). Recent studies have shown similar or improved morality for Asian/Pacific Islander women and White women. American Indian/Alaska Native women had a lower incidence of uterine cancer in 2016 than Black and White women (23.1 cases/100,000 vs 27 cases/100,000). Between 1999 and 2016, the incidence rate increased 53% among American Indian/Alaska Native. Outcomes for this population were difficult to determine because of the small number of patients in the studies. Black and Hispanic women were more likely to be diagnosed at an advance stage of uterine cancer than White women. In the review's pooled analysis, 54% of Black women presented with localized disease versus 71% of White women (P < 0.001). Across all stages of cancer, Black and Hispanic women were less likely to undergo surgery, hysterectomy, or definitive surgical treatment than White women. They were also less likely to undergo minimally invasive surgery and had lower rates of lymph node sampling or biopsy. Black women were as likely to receive radiation therapy as White women and more likely to receive care from high-volume uterine cancer surgeons or gynecologic oncologists and at high-volume cancer care centers. However, Black, Hispanic, and American Indian/Alaska Native women were less likely to receive guideline-compliant treatment. The panel found that most of the disparities identified were modifiable, but there were no published studies that outlined how to address them. The panel recommended that clinicians make it a priority to achieve equity in diagnosis and treatment to ensure early diagnosis and guideline-concurrent care for uterine cancer. It also recommended that research should not interpret survival disparities as biological and should shift its focus to modifiable, nonbiological factors that contribute to health disparities. Finally, it recommended that clinicians work toward understanding and disrupting the structural barriers for positive outcomes for underserved populations.