Advertisement

Endometrial cancer: Stage at diagnosis and associated factors in black and white patients

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      OBJECTIVE: This study examined the relationship of clinicopathologic, health status, medical system, and socioeconomic factors to differences in stage at diagnosis of endometrial cancer in black and white patients.
      STUDY DESIGN: A population-based study of 130 black and 329 white patients with invasive endometrial cancer was conducted as part of the National Cancer Institute's Black/White Cancer Survival Study. Logistic regression was used to determine the relative importance of factors thought to be related to stage at diagnosis after age and geographic location were adjusted for.
      RESULTS: High-grade (poorly differentiated) lesions increased the risk for stage III or IV disease (odds ratio 8.3, 95% confidence interval 3.4 to 20.3), as did serous histologic subtype (odds ratio 3.5, 95% confidence interval 1.4 to 8.8) and no usual source of care (odds ratio 5.5, 95% confidence interval 1.4 to 20.9). In the final statistical model these three factors also accounted for the majority of the excess risk of advanced stage for blacks.
      CONCLUSION: Black-white racial disparities in stage at diagnosis appear to be related to higher-grade lesions and more aggressive histologic subtypes occurring more frequently in black patients with endometrial cancer.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Boring CC
        • Squires TS
        • Tong T
        Cancer statistics, 1994.
        CA Cancer J Clin. 1994; 44: 7-26
        • Kosary CL
        FIGO stage, histology, histologic grade, age and race as prognostic factors in determining survival for cancers of the female gynecological system: an analysis of 1973–1987 SEER cases of cancers of the endometrium, cervix, ovary, vulva, and vagina.
        Semin Surg Oncol. 1994; 10: 31-46
        • Steinhorn SC
        • Myers MH
        • Hankey BF
        • Pelham VF
        Factors associated with survival differences between black women and white women with cancer of the uterine corpus.
        Am J Epidemiol. 1986; 124: 85-93
        • Ragland KE
        • Selvin S
        • Merrill DW
        Black-white differences in stage-specific cancer survival: analysis of seven selected sites.
        Am J Epidemiol. 1991; 133: 672-682
        • Howard J
        • Hankey BF
        • Greenberg RS
        • et al.
        A collaborative study of differences in the survival rates of black patients and white patients with cancer.
        Cancer. 1992; 69: 2349-2360
        • Cronje HS
        • Fourie S
        • Doman MJ
        • Hehms JB
        • Nel JT
        • Goedhals L
        Racial differences in patients with adenocarcinoma of the endometrium.
        Int J Gynecol Obstet. 1992; 39: 213-218
        • United States Department of Health and Human Services
        Poverty income guidelines: annual revision. 2nd ed. Fed Reg. 51. 1986: 5106-5107
        • Breiman L
        • Friedman JH
        • Olshen RA
        • Stone CJ
        Classification and regression trees.
        Wadsworth, Pacific Grove, California1984
        • Young JL
        • Devesa SS
        • Cutler SJ
        Incidence of cancer in United States blacks.
        Cancer Res. 1975; 35: 3523-3536
        • Beckner ME
        • Mori T
        • Silverberg SG
        Endometrial carcinoma: nontumor factors in prognosis.
        Int J Gynecol Pathol. 1985; 4: 131-145
        • Bain RP
        • Greenberg RS
        • Chung KC
        Racial differences in survival of women with endometrial cancer.
        Am J Obstet Gynecol. 1987; 157: 914-923
        • Aziz H
        • Rotman M
        • Hussain F
        • et al.
        Poor survival of black patients in carcinoma of the endometrium.
        Int J Radiat Oncol Biol Phys. 1993; 27: 293-301
        • Mammoliti S
        • Bruzzone M
        • Chiara S
        • et al.
        Clinical stage I and II endometrial carcinoma: multivariate analysis of prognostic factors.
        Anticancer Res. 1992; 12: 1415-1418
        • Scotto V
        • Cervigni M
        • Mazzon I
        • Viaori G
        • Bertollini R
        • Sbiroli C
        Analysis of the prognostic factors of endometrial carcinoma: a retrospective study of 144 patients.
        Eur J Gynaecol Oncol. 1992; 13: 69-73
        • DiSaia PJ
        • Creasman WT
        • Boronow RC
        • Blessing JA
        Risk factors and recurrent patterns in stage I endometrial cancer.
        Am J Obstet Gynecol. 1985; 151: 1009-1015
        • Morrow CP
        • Bundy BN
        • Kurman RJ
        • et al.
        Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group study.
        Gynecol Oncol. 1991; 40: 55-65
        • Kadar N
        • Malfetano JH
        • Homesley HD
        Determinants of survival of surgically staged patients with endometrial carcinoma histologically confined to the uterus: implications for therapy.
        Obstet Gynecol. 1992; 80: 655-659
        • Christopherson WM
        • Connelly PJ
        • Alberhasky RC
        Carcinoma of the endometrium, V: an analysis of prognosticators in patients with favorable subtypes and stage I disease.
        Cancer. 1983; 51: 1705-1709
        • Deligdisch L
        • Cohen CJ
        Histologic correlates and virulence implications of endometrial carcinoma associated with adenomatous hyperplasia.
        Cancer. 1985; 56: 1452-1455
        • Abeler VM
        • Kjorstad KE
        Endometrial adenocarcinoma with squamous cell differentiation.
        Cancer. 1992; 69: 488-495
        • Giri PGS
        • Schneider V
        • Belgrad R
        Clear cell carcinoma of the endometrium: an uncommon entity with a favorable prognosis.
        Int J Radiat Oncol Biol Phys. 1981; 7: 1383-1387
        • Christopherson WM
        • Alberhasky RC
        • Connelly PJ
        Carcinoma of the endometrium, I: a clinicopathologic study of clear-cell carcinoma and secretory carcinoma.
        Cancer. 1982; 49: 1511-1523
        • Christopherson WM
        • Alberhasky RC
        • Connelly PJ
        Carcinoma of the endometrium, II; papillary adenocarcinoma: a clinical pathological study 46 cases.
        Am J Clin Pathol. 1982; 77: 534-540
        • Chen JL
        • Trost DC
        • Wilkinson EJ
        Endometrial papillary adenocarcinomas: two clinicopathological types.
        Int J Gynecol Pathol. 1985; 4: 279-288
        • Wilson TO
        • Podratz KC
        • Gaffey TA
        • Malkasian GD
        • O'Brien PC
        • Naessens JM
        Valuation of unfavorable histologic subtypes in endometrial adenocarcinoma.
        Am J Obstet Gynecol. 1990; 162: 418-426
        • Sherman ME
        • Bitterman P
        • Rosenshein NB
        • Delgado G
        • Kurman RJ
        Uterine serous carcinoma: a morphologically diverse neoplasm with unifying clinicopathologic features.
        Am J Surg Pathol. 1992; 16: 600-610