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Uterine cancer has pulled even with ovarian cancer as a leading cause of gynecologic cancer mortality, accompanied by an "alarming" racial disparity, a large epidemiologic study showed.

Annual uterine cancer mortality declined from 4.3 to 4.0 per 100,000 women from 1990 to 1997, then increased to 5.1/100,000 in 2019, representing a 1.7% annual increase. In contrast, ovarian cancer mortality decreased from 9.3/100,000 in 1990 to 6.0/100,000 in 2019 (-2.7%/year from 2010-2019).

During the same time period, mortality patterns were similar across racial and ethnic subgroups until 2005, when uterine cancer mortality increased dramatically in Black women, resulting in a twofold greater mortality rate ratio versus white women by 2019, reported Rebecca L. Siegel, MPH, of the American Cancer Society in Atlanta, and co-authors in .

"The twofold higher risk of death from ovarian compared with uterine cancer in the early 1990s has been virtually eliminated by oppositional mortality trends," the authors wrote. "Among Black women, the crossover has already occurred, and the uterine cancer disparity widened, with mortality now twofold higher than for white women ... despite similar incidence."

"The alarming disparity in uterine cancer mortality in Black compared with white women reported herein is an underestimate of the true excess burden because rates were uncorrected for higher hysterectomy prevalence among Black women," they added. "Nevertheless, the gynecologic cancer landscape is changing rapidly, and the risk of death from uterine cancer is now similar to that for ovarian cancer among women overall and approximately 60% higher among Black women based on national mortality statistics."

The two most common types of gynecologic cancer in the U.S., ovarian and uterine (endometrial) cancer have followed different clinical and epidemiologic paths in recent years. Advances in treatment and increased emphasis on early diagnosis have contributed to a steady decline in ovarian cancer mortality. In contrast, increased 2% annually from 2008 to 2018.

Siegel and co-authors examined the influence of recent trends on gynecologic cancer burden and inequalities. They queried the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results database to determine uterine and ovarian cancer mortality in the U.S. from 1990 to 2019. They stratified mortality by race and calculated the average annual percent change for the most recent decade (2010-2019).

From 1990 to 2019, 232,957 patients died of uterine cancer and 419,085 died from ovarian cancer, including 11,556 and 13,445, respectively, in 2019. Comparing annualized mortality at the beginning and end of the study period, Siegel's group found that excess mortality from ovarian cancer versus uterine cancer decreased from about 5.0/100,000 in the early 1990s to 0.9/100,000 in 2019. The mortality rate ratio for uterine versus ovarian cancer rose from 0.47 to 0.84, reflecting the closing of the mortality gap between the two diseases.

From 2005 to 2019, the racial divergence in mortality resulted in a difference of 3.6/100,000 among Black women for uterine cancer mortality as compared with ovarian cancer mortality (9.3 vs 5.7/100,000, respectively). During the same period, the uterine cancer mortality rate ratio for Black versus white women increased from 1.83 to 1.98 (P<0.001).

The authors cited several explanations for the "oppositional mortality trends" for uterine and ovarian cancer. The ongoing has a greater impact on uterine cancer incidence, associated with an estimated 70% of cases as compared with 4% of ovarian cancers. Treatment advances, such as PARP inhibitors, have helped extend ovarian cancer survival, whereas therapeutic developments in uterine cancer have lagged.

NCI funding for uterine cancer has also lagged far behind the funding for ovarian cancer, the authors noted. Increased rates of opportunistic salpingectomy and prophylactic salpingo-oophorectomy for women with genetic predisposition to ovarian cancer might also have contributed to the decline in ovarian cancer mortality.

The findings are consistent with observations of a of uterine cancer, which highlighted the rising incidence of and mortality from uterine cancer as opposed to declining rates in most other types of cancer. Authors of the review also cited the strong association between obesity and uterine cancer and a growing racial disparity in mortality. They called for new strategies for prevention and treatment, including use of data from the Cancer Genome Atlas to improve understanding of the biologic heterogeneity of the disease.

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