Disparities in endometrial cancer outcomes between non-Hispanic White and Hispanic women

Objective. To compare demographics, tumor characteristics, the first course of treatment, and cancer-specific survival of non-Hispanic White and Hispanic women with endometrial cancer. Methods. We used public-use data from the Surveillance, Epidemiology, and End Results (SEER) Program. The study included 69,764 non-Hispanic White and Hispanic women diagnosed with endometrial cancer between 2000 and 2010. Using Cox proportional hazards models, demographics, tumor characteristics, and treatment were assessed as potential explanatory variables for the survival disparity between non-Hispanic Whites and Hispanics. Results. Kaplan-Meier estimation with Bonferroni correction showed statistically different cancer-specific survival for U.S.-born and foreign-born Hispanics compared to non-Hispanic Whites, but no difference between birthplace-unknown Hispanics and non-Hispanic Whites. In 2000-2005, U.S.-born and foreign-born Hispanics had a higher risk of endometrial cancer death compared to non-Hispanic Whites after full adjustment (hazard rate (HR) = 1.61, 95% Confidence Interval (CI):1.44-1.79 and 1.27, 95% CI:1.13-1.43). In 2006-2010, the risk of endometrial death was not statistically significant for U.S.-born Hispanics (HR = 1.16, 95% CI:0.99-1.36), but increased for foreign-born Hispanics (HR = 1.31, 95% CI:1.12-1.52). Most of the survival disparity between Hispanic and non-Hispanic White women was mediated by cancer characteristics, specifically, stage and node involvement. Conclusions. Hispanic women have higher cancer-specific mortality compared to non-Hispanic Whites. Compared to 2000-2005, more Hispanics were diagnosed at later stages and fewer received combination therapy in 2006-2010. Early detection is vital to improving endometrial cancer survival as most of the disparity was mediated by stage. Increased efforts are needed to improve education and access to care for Hispanic women.