Risk Factors in African-American Women. Michele L. Cote, PhD Associate Professor Wayne State t University

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1 Risk Factors in African-American Women Michele L. Cote, PhD Associate Professor Wayne State t University it

2 Age Adjusted Incidence and Mortality Rates for all Endometrial Cancers by Race/Ethnicity for SEER 18 Surveillance, Epidemiology, and End Results (SEER) Program ( SEER*Stat Database: Incidence - SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2012 Sub ( ) <Katrina/Rita Population Adjustment> - Linked To County Attributes - Total U.S., Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2013, based on the November 2012 submission.

3 Endometrial Cancer large survival disparity

4 Age Adjusted Incidence and Mortality Rates for Endometrioid and Serous Endometrial Cancer by Race/Ethnicity for SEER 18 Endometrioid Serous 25 Incidence 5 Incidence te per 100, Mortality te per 100, Mortality Age Adjusted Rat 10 5 Age Adjusted Rat NHW NHB Hispanic Asian 0 NHW NHB Hispanic Asian Surveillance, Epidemiology, and End Results (SEER) Program ( SEER*Stat Database: Incidence - SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2012 Sub ( ) <Katrina/Rita Population Adjustment> - Linked To County Attributes - Total U.S., Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2013, based on the November 2012 submission.

5 Age Adjusted Incidence Rates for Endometrioid and Serous Endometrial Cancer, by race/ethnicity and year, SEER 18 Endometrioid Serous APC =0.4 APC = 3.1* APC = 1.9* APC = 1.3* APC = 1.9* APC = 10.3* APC = 2.6* APC = 3.1 Surveillance, Epidemiology, and End Results (SEER) Program ( SEER*Stat Database: Incidence - SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2012 Sub ( ) <Katrina/Rita Population Adjustment> - Linked To County Attributes - Total U.S., Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2013, based on the November 2012 submission.

6 Relative 5-year Survival Rates for Endometrioid and Serous Endometrial Cancer by Race/Ethnicity , SEER 18 Endometrioid Serous Relative Su urvival 100% 90% 80% 70% 60% 50% 40% NHW NHB Hispanic Asian Relative Su urvival 100% 90% 80% 70% 60% 50% 40% NHW NHB Hispanic Asian 30% 30% 20% 20% 10% 10% 0% Local Regional Distant 0% Local Regional Distant Surveillance, Epidemiology, and End Results (SEER) Program ( SEER*Stat Database: Incidence - SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2012 Sub ( ) <Katrina/Rita Population Adjustment> - Linked To County Attributes - Total U.S., Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2013, based on the November 2012 submission.

7 Hysterectomy common in US women Jamison PM et al Trends in endometrial cancer incidence by race and histology with a correction for the prevalence of hysterectomy, SEER 1992 to Cancer Epi Biomarkers and Prev; 22(2) pgs

8 Correcting for hysterectomy, ages 50+ Without correction for hysterectomy, rates in black women are increasing and nearly equal to white women With correction, rates in black women are increasing and exceed the rate in white women Jamison PM et al. 2013

9 Background Summary Endometrial cancer incidence is increasing among African Americans Increases seen for both endometrioid and serous sub- types The survival disparity remains unchanged Question: Do endometrial cancer risk factors or effect sizes differ between black and white women?

10 Studies complied through E2C2 Pooled analysis: 11 studies Black women ncases=516/ncontrols=1 1,495 White women: ncases=5,693/ncontrols=13,604 Cohort: Black Cases AARP 81 California Teachers Study 12 Multiethnic Cohort Study 128 New York University Women s Health Study 23 PLCO 23 Southern Community Cohort Study 32 Women s Health Initiative Study 53 Case-control: Bay Area Women s Health Study 44 Estrogen, Diet, Genetics and Endometrial Cancer Study 39 Fred Hutchinson Cancer Research Center Study 14 Women s Insight and Shared Experience Study 67

11 Associations for common risk factors similar il for white and black women *statistically significant at p<0.05 Models adjusted for: age, BMI, smoking status, OC use, diabetes, age at menarche, parity

12 Other risk factors Oral Contraceptives White Black 0<1 year ref ref 1-4 years 1.03 (0.88, 1.20) 0.59 (0.37, 0.97) 5-9 years 0.95 (0.80, 1.13) 0.74 (0.42, 1.29) 10+ years 0.69 (0.58, 0.83) 0.49 (0.27, 0.88) p-trend < Hypertension White Black No ref ref Yes 0.88 (0.66, 1.17) 0.99 (0.90, 1.08)

13 Limitations Even with 11 large studies, power was limited when examining risk in black women unable to examine histological subtypes by race Data harmonization, particularly of hormone use, is challenging g could not assess sequential versus continuous HT Most common variables between studies were those for estrogen-dependent cancers already fairly well-characterized

14 Could survival differences be due to underlying tumor biology? Study: 150 tumors from white (n=66) and African American (n=84) women

15 Cote ML, et al. (2012) Int J Gyn Cancer, 22(8)

16 Conclusions Incidence of endometrial cancer is increasing among black women in the U.S. Survivorship hasn t improved dramatically over the last 3 decades and still worse for black women at every stage The effect sizes for established endometrial cancer risk factors are similar among black and white women We lack the power to adequately assess risk among black women, need to consider histological type Elucidating molecular differences may provide clues to treatment, survival

17 Thank you! Special thanks to Julie Ruterbusch for the current SEER analyses