Race Influences Uterine Cancer Survival
Uterine Cancer Treatment and Survival
African-American women with uterine cancer have worse survival rates than Caucasian women who received similar treatment even though they had similar prognostic factors, according to a new review of four clinical trials. Published in the November 1, 2006 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the review found significant racial disparities in survival and clinical presentation of advanced/recurrent endometrial cancer. African-Americans presented with worse disease, but even after controlling for clinical features and treatment, African-Americans survived significantly fewer months than Caucasians, suggesting that other factors, such as socioeconomic, biologic, and cultural issues may have a strong influence on this disease outcome.
Ethnic and racial differences are observed in many cancers, such as breast and colon cancers. Population-based studies have also demonstrated clear racial disparities in the presentation, course and outcome of endometrial cancer. These studies clearly show that African-Americans present with more advanced disease and have lower survival rates than other racial groups. Analysis suggests that the cause is multifactorial and may be related to inequality of access to healthcare, cultural variations in response to disease, and differences in disease stage at presentation. Etiology, however, is difficult to discern due to methodological shortcomings in many studies, such as too few patients.
To further characterize the cause of outcome differences between African-Americans and Caucasians, G. Larry Maxwell, M.D. of the Department of Obstetrics and Gynecology at the Walter Reed Army Medical Center in Washington, DC and investigators analyzed demographic and clinical data from 1,151 patients who were enrolled in any of four randomized, control treatment trials with stage III, IV or recurrent endometrial cancer.
The authors identified racial disparities in outcome, even after controlling for presentation and treatment. African-Americans were at 26 percent greater risk of death from uterine cancer than Caucasians, even if they had similar diseases and treatments. "When response to treatment was analyzed, Blacks appeared to have lower tumor response to each of the chemotherapy regimens employed in the trials," the authors observe.
Analyzed by time, Africans-Americans survived a median 10.6 months compared to 12.2 months among Caucasians. At presentation, African-Americans were more likely than Caucasians to present with more serious disease, including papillary serous histology, stage IV disease, and higher tumor grade.
"While the causes of this survival difference remain to be elucidated, socioeconomic, biologic and cultural etiologies may be involved," conclude the authors.