Original Article

CME Article: Trends in Incidence and Mortality Rates of Uterine Cancer in Kentucky

Authors: Matthew R. Nichols, MD, Jeremy T. Gaskins, PhD, Daniel S. Metzinger, MD, Sarah L. Todd, MD, Harriet B. Eldredge-Hindy, MD, Scott R. Silva, MD, PhD

Abstract

Objectives: The objective of this analysis was to gauge how the incidence and mortality of uterine cancer in Kentucky have changed from 1995 through 2017. An assessment of the trends in incidence and mortality across different geographic areas and between different races was also performed.

Methods: Age-adjusted annual incidence and mortality rates for uterine cancer were obtained from the Kentucky Cancer Registry. A meta-regression framework was used to assess changes in incidence and mortality rates during the time frame and to determine differences in these rates between rural versus urban counties, Appalachian versus non-Appalachian counties, and Black versus White women.

Results: The incidence of uterine cancer has significantly increased throughout the state of Kentucky since 1995. Uterine cancer incidence was 10% and 22% higher in rural and Appalachian counties, respectively, compared with urban and non-Appalachian counties (P < 0.0001) from 1995 through 2017. In contrast, urban and non-Appalachian women had higher or equivalent age-adjusted mortality from uterine cancer, compared with rural and Appalachian women, respectively. The incidence of uterine cancer was significantly higher in White women compared with Black women from 1995 through 2006, but since 2007, there has been no significant difference in uterine cancer incidence based on race. Black women had higher age-adjusted mortality than White women throughout the entire time period examined.

Conclusions: The incidence of uterine cancer is higher in rural and Appalachian Kentucky, without a corresponding geographic trend in mortality. Uterine cancer mortality is significantly higher in Black women.
Posted in: Gynecologic Cancer7 Uterine Disorders2

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin 2021;71:7–33.
 
2. Henley SJ, Miller JW, Dowling NF, et al. Uterine cancer incidence and mortality - United States, 1999-2016. MMWR Morb Mortal Wkly Rep 2018;67:1333–1338.
 
3. Brooks RA, Fleming GF, Lastra RR, et al. Current recommendations and recent progress in endometrial cancer. CA Cancer J Clin 2019;69:258–279.
 
4. Kurman R, Carcangiu M, Herrington S, et al, eds. World Health Organization Classification of Tumours of Female Reproductive Organs. Lyon, France: IARC Press; 2014.
 
5. Braun MM, Overbeek-Wager EA, Grumbo RJ. Diagnosis and management of endometrial cancer. Am Fam Physician 2016;93:468–474.
 
6. Shaw E, Farris M, McNeil J, et al. Obesity and endometrial cancer. Recent Results Cancer Res 2016;208:107–136.
 
7. America’s Health Rankings. Minnetonka, MN: United Health Foundation; 2019.
 
8. Kentucky Department of Health, Cabinet for Health and Family Services. Kentucky Cancer Registry, 1994-2017. https://www.kcr.uky.edu/. Accessed August 8, 2021.
 
9. Silva SR, Gaskins JT, Nichols MR, et al. Cervical cancer incidence and mortality rates in Kentucky. Gynecol Oncol 2020;158:446–451.
 
10. Ingram DD, Franco SJ. 2013 NCHS urban-rural classification scheme for counties. Vital Health Stat 2014;2:1–73.
 
11. Rice EL, Patel M, Serrano KJ, et al. Beliefs About behavioral determinants of obesity in Appalachia, 2011-2014. Public Health Rep 2018;133:379–384.
 
12. Harrer M, Cuijpers P, Furukawa TA, et al. Doing Meta-Analysis with R: A Hands-on Guide. https://www.protectlab.org/meta-analysis-in-r. Accessed August 8, 2021.
 
13. R Core Development Team. A language and environment for statistical computing R Foundation for Statistical Computing. https://www.r-project.org/. Accessed August 8, 2021.
 
14. Trivedi T, Liu J, Probst J, et al. Obesity and obesity-related behaviors among rural and urban adults in the USA. Rural Remote Health 2015;15:3267.
 
15. McDonald ME, Bender DP: Endometrial cancer: obesity, genetics, and targeted agents. Obstet Gynecol Clin North Am 2019;46:89–105.
 
16. Johnson MS, Tucker TC, Chen Q, et al. Uterine corpus malignancies in Appalachia Kentucky: incidence, survival, and related health disparities. South Med J 2020;113:29–36.
 
17. DeSantis CE, Miller KD, Goding Sauer A, et al. Cancer statistics for African Americans, 2019. CA Cancer J Clin 2019;69:211–233.
 
18. Fryar CD, Carroll MD, Afful J. Prevalence of overweight, obesity, and severe obesity among adults aged 20 and over. NCHS Health E-Stats. Hyattsville, MD: National Center for Health Statistics; 2020.
 
19. Sud S, Holmes J, Eblan M, et al. Clinical characteristics associated with racial disparities in endometrial cancer outcomes: a surveillance, epidemiology and end results analysis. Gynecol Oncol 2018;148:349–356.
 
20. Donkers H, Bekkers R, Massuger L, et al. Socioeconomic deprivation and survival in endometrial cancer: the effect of BMI. Gynecol Oncol 2020; 156:178–184.
 
21. Afshin A, Reitsma MB, Murray CJL. Health effects of overweight and obesity in 195 countries. N Engl J Med 2017;377:1496–1497.
 
22. Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. Adult obesity facts. https://www.cdc.gov/obesity/data/adult.html. Accessed April 2020.
 
23. Creutzberg CL, Nout RA, Lybeert ML, et al. Fifteen-year radiotherapy outcomes of the randomized PORTEC-1 trial for endometrial carcinoma. Int J Radiat Oncol Biol Phys 2011;81:e631–e638.
 
24. Wortman BG, Creutzberg CL, Putter H, et al. Ten-year results of the PORTEC-2 trial for high-intermediate risk endometrial carcinoma: improving patient selection for adjuvant therapy. Br J Cancer 2018;119:1067–1074.
 
25. Keys HM, Roberts JA, Brunetto VL, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol 2004;92:744–751.
 
26. Harkenrider MM, Block AM, Alektiar KM, et al. American Brachytherapy Task Group Report: adjuvant vaginal brachytherapy for early-stage endometrial cancer: a comprehensive review. Brachytherapy 2017;16:95–108.
 
27. Matei D, Filiaci V, Randall ME, et al. Adjuvant chemotherapy plus radiation for locally advanced endometrial cancer. N Engl J Med 2019;380:2317–2326.
 
28. de Boer SM, Powell ME, Mileshkin L, et al. Adjuvant chemoradiotherapy versus radiotherapy alone in women with high-risk endometrial cancer (PORTEC-3): patterns of recurrence and post-hoc survival analysis of a randomised phase 3 trial. Lancet Oncol 2019;20:1273–1285.
 
29. Sturdza A, Viswanathan AN, Erickson B, et al. American Brachytherapy Society working group report on the patterns of care and a literature review of reirradiation for gynecologic cancers. Brachytherapy 2020;19:127–138.
 
30. Ryan NAJ, Blake D, Cabrera-Dandy M, et al. The prevalence of Lynch syndrome in women with endometrial cancer: a systematic review protocol. Syst Rev 2018;7:121.
 
31. Washington CR, Haggerty A, Ronner W, et al. Knowledge of endometrial cancer risk factors in a general gynecologic population. Gynecol Oncol 2020; 158:137–142.
 
32. Goodwin PJ, Chlebowski RT. Obesity and cancer: insights for clinicians. J Clin Oncol 2016;34:4197–4202.
 
33. Connor EV, Raker CA, Clark MA, et al. Obesity risk awareness in women with endometrial cancer. Arch Gynecol Obstet 2017;295:965–969.
 
34. Haggerty AF, Hagemann A, Barnett M, et al. A randomized, controlled, multicenter study of technology-based weight loss interventions among endometrial cancer survivors. Obesity (Silver Spring) 2017;25(suppl 2): S102–S108.
 
35. Sekhon S, Massad LS, Hagemann AR, et al. Patients with endometrial cancer continue to lack understanding of their risks for cancer. Gynecol Oncol Rep 2019;29:106–110.
 
36. Stegenga H, Haines A, Jones K, et al. Identification, assessment, and management of overweight and obesity: summary of updated NICE guidance. BMJ 2014; 349:g6608.
 
37. Park HY, Jung WS, Kim J, et al. Changes in the paradigm of traditional exercise in obesity therapy and application of a new exercise modality: a narrative review article. Iran J Public Health 2019;48: 1395–1404.
 
38. Clark LH, Ko EM, Kernodle A, et al. Endometrial cancer survivors' perceptions of provider obesity counseling and attempted behavior change: are we seizing the moment? Int J Gynecol Cancer 2016;26:318–324.