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Differences in Treatment and Outcome Between African-American and White Women With Endometrial Cancer

Thomas C. Randall, Katrina Armstrong

From the Departments of Obstetrics and Gynecology and Medicine, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine; Abramson Cancer Center and Leonard Davis Institute of Health Economics, University of Pennsylvania; and Center for Health Equity Research and Promotion, Philadelphia, PA.

Address reprint requests to Katrina Armstrong, MD, MSCE, 1204 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104-6021; e-mail: karmstro{at}mail.med.upenn.edu.

Purpose: To investigate disparities in treatment and outcomes between African-American and white women with endometrial cancer.

Patients and Methods: We analyzed 1992 to 1998 Surveillance, Epidemiology, and End Results data for 21,561 women with epithelial cancers of the endometrium. Sequential Cox proportional hazard models were used to determine the association between tumor characteristics (stage, grade, and histologic type), sociodemographic characteristics (age and marital status), and treatment (surgery and radiation therapy) and the racial difference in mortality.

Results: The unadjusted hazard ratio (HR) for death from endometrial cancer for African-American women compared with white women was 2.57. However, African-American women were significantly more likely to present with advanced-stage disease and have poorly differentiated tumors or tumors with an unfavorable histologic type and were significantly less likely to undergo definitive surgery at all stages of disease. Adjusting for tumor and sociodemographic characteristics lowered the HR for African-American women to 1.80. Further adjustment for the use of surgery reduced the HR to 1.51. The association between surgery and survival was stronger among white women (HR, 0.26) than among African-American women (HR, 0.44).

Conclusion: African-American women with endometrial cancer are significantly less likely to undergo primary surgery and have significantly shorter survival than white women with endometrial cancer. Racial differences in treatment are associated with racial differences in survival. The association between use of surgery and survival is weaker among African-American than white women, raising questions about potential racial differences in the effectiveness of surgery.

K.A. is supported by a Robert Wood Johnson Generalist Physician Faculty Scholar Award and an American Cancer Society Clinical Research Training Grant.

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