Affiliations of authors: Hormonal and Reproductive Epidemiology (MES, JDC, JVL) and Biostatistics (SSD) Branches, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
Correspondence to: Mark E. Sherman, MD, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, Room 7080, Rockville, MD 20892-7374 (e-mail: shermanm{at}mail.nih.gov).
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ABSTRACT |
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Using data for cases diagnosed during 19922000 collected by nine registries in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program (Connecticut, metropolitan Atlanta, Iowa, New Mexico, Seattle Puget Sound, Utah, San FranciscoOakland, San JoseMonterey, and Los Angeles), we tabulated endometrial carcinoma rates per 105 woman-years by racial/ethnic group and age. We identified endometrial carcinomas as tumors with International Classification of Diseases for Oncology (9) codes 8140 (adenocarcinoma, not otherwise specified, n = 10 275), 8380 (endometrioid adenocarinoma, n = 7285), 8560 (adenosquamous carcinoma, n = 562), and 8570 (adenocarcinoma with squamous metaplasia, n = 635). Our analysis was based on 640 incident cases among blacks, 673 among Hispanics, and 9173 among white non-Hispanics. To reestimate age-specific incidence rates for women with intact uteri, we reduced SEER age-specific at-risk populations by age-specific hysterectomy prevalences (5-year age groups) using 19922000 data from the Behavioral Risk Factor Surveillance Survey (BRFSS) for those states that also maintained SEER registries included in this analysis (10,11). We limited our analysis to women aged 3074 years (among whom most incident endometrial carcinomas are found). We standardized rates for age in 5-year groups using the 2000 U.S. standard population.
In all age groups, the prevalence of hysterectomy was higher among blacks than among Hispanics and white non-Hispanics. Rates among the latter two groups were similar. Hysterectomy prevalence for blacks and for white non-Hispanics was as follows: ages 3044 years, 13.7% and 8.5%, respectively; ages 4559 years, 43.2% and 33.1%, respectively; and ages 6074 years, 51.6% and 43.8%, respectively. Our results are consistent with previous analyses showing that hysterectomy prevalence is higher among young blacks as compared with whites (8). Although the reasons for this difference are unclear, blacks more frequently reside in the South, where hysterectomy procedures have been performed more often (8). In addition, factors such as limited education, high parity, and a history of miscarriagesall of which have been associated with increased risk of hysterectomy (12)are more common among blacks than among whites.
Endometrial carcinoma rates per 105 woman-years for 19922000, tabulated without considering hysterectomy prevalence, were 29.2 for all women, 14.6 for blacks, 18.8 for Hispanics, and 33.2 for white non-Hispanics. Endometrial carcinoma rates corrected for hysterectomy prevalence were substantially higher than uncorrected rates, rising to 48.7 overall (a 66.8% increase), to 28.5 among blacks (a 95.3% increase), to 29.6 among Hispanics (a 57.6% increase), and to 54.9 among white non-Hispanics (a 65.1% increase). Therefore, accounting for hysterectomy prevalence reduced the endometrial carcinoma rate ratio for white non-Hispanics compared with blacks from 2.27 to 1.93, although the absolute rate difference increased.
In all three racial/ethnic groups, uncorrected endometrial carcinoma rates increased sharply among women aged 3059 years and then increased more slowly among older women (Fig. 1). Correcting endometrial cancer rates for hysterectomy prevalence produced a steeper rise with increasing age, especially among blacks and Hispanics.
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Growing enthusiasm for treating benign uterine diseases without surgery could expand the population of women with intact uteri, thereby increasing the endometrial carcinoma burden in the United States. Although averting hysterectomy is desirable, women with endometrial carcinoma risk factors might experience increased endometrial carcinoma incidence and mortality if hysterectomy prevalence declines. In the future, monitoring of endometrial carcinoma incidence rates using improved methods that correct for hysterectomy prevalence and include information about the characteristics of women who undergo hysterectomy are needed to address these concerns and to provide the basis for prevention efforts.
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Manuscript received May 16, 2005; revised September 7, 2005; accepted September 14, 2005.
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