Uterine cancer mortality rate rising
Uterine cancer has been on the rise over the past five years, and researchers are trying to find reasons behind the trend.
Endometrial cancer develops in the lining of the uterus. Cases in the United States in 1987 numbered 35,000. By 2023, that number had nearly doubled to more than 66,000. What’s even more worrisome is that deaths from the disease in the U.S. during the same period climbed from 3,000 to more than 13,000.
The disease is becoming more common in all women, at younger ages and especially among Black women. Incidence of uterine cancer and the death rate are rising nearly one-and-a-half times more quickly in Black women compared to white.
“This is a very important area of concern within our community,” said Dr. Sarah Taylor, a gynecologic oncologist with UPMC Magee-Womens Hospital. “There are likely many factors that are playing into it. If we look back over the last 20-plus years, we have seen a consistent gap in mortality rates between Black and white individuals diagnosed with endometrial cancer. Unfortunately, we are seeing a widening in this gap.”
Taylor points to data showing Black women are more likely to be diagnosed with more aggressive forms of endometrial cancer as playing into higher recurrence and mortality rates. “We also see that more Black individuals have a higher stage at time of diagnosis,” she said. “This may be from the more aggressive forms of endometrial cancer, as these subtypes of endometrial cancer are more likely to present with advanced stages of disease.”
She also points to other factors that have kept Black individuals from accessing early care as well.
“These include but are not limited to misinformation and/or lack of education around postmenopausal bleeding and irregular or abnormal uterine bleeding, mistrust of the medical system, given longstanding history of systemic racism and testing parameters and cutoffs for what is ‘normal’ being based on tests carried out in predominantly white populations.”
Taylor said she sees similar numbers to the national trends here in Southwestern Pennsylvania. “We have seen an increase in the number of individuals diagnosed with endometrial cancer in this region over the last 15 to 20 years, which is reflective of the national trend,” she said. “There has also been an increase in mortality over the same time period, but the rise in incidence is greater than the rise in mortality.”
Over the past 40 years, uterine cancer is the only cancer that has had decreasing survival rates. As for treatment, surgery remains the mainstay, especially if diagnosed early.
“Chemotherapy and radiation are also used to treat when the cancer has high-risk features or is diagnosed at a later stage,” Taylor said. “There are new treatment options for individuals with advanced stage disease or recurrent disease. Immunotherapies and targeted therapies are showing promise to help people live longer; however, it has not been enough to see a switch in the survival trend. This may be because of the continued rise in cases of new disease.”
One big risk factor in this type of cancer is obesity.
“The most common form of endometrial cancer is driven by excess estrogen in the body,” Taylor said. “Our fat cells convert male hormones called androgens into estrogen, which leads to higher levels that can make the lining of the uterus, or endometrium, grow unchecked and can turn into a pre-cancer or cancer.”
She encourages women to maintain a healthy diet and increase physical activity to help lower the risk of endometrial cancer.
“Other things that can decrease the risk of endometrial cancer include use of hormonal contraception that includes progestins, making sure a progestin is used in combination with estrogen when hormone replacement therapy is prescribed, and breastfeeding.”
Warning signs can include abnormal uterine bleeding, pelvic pain or discomfort, vaginal discharge, changes in bladder or bowel habits and abdominal bloating or fullness. One of the biggest warning signs is post-menopausal bleeding.
“After an individual has gone through menopause, they should not have vaginal bleeding or even spotting,” Taylor said. “If this happens, they need to contact their doctor for evaluation right away. For those individuals who are still premenopausal, if their periods become irregular, heavy or prolonged, they should also see their doctor for evaluation.”