Risk Factors in African-American Women Michele L. Cote, PhD - - PowerPoint PPT Presentation

Risk Factors in African-American Women

Michele L. Cote, PhD Associate Professor W St t U i it Wayne State University

Age Adjusted Incidence and Mortality Rates for all Endometrial Cancers 2000-2010 by Race/Ethnicity for SEER 18

Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2012 Sub (2000-2010) <Katrina/Rita Population Adjustment> - Linked To County Attributes - Total U.S., 1969-2011 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2013, based on the November 2012 submission.

Endometrial Cancer—large survival disparity disparity

Age Adjusted Incidence and Mortality Rates for Endometrioid and Serous Endometrial Cancer 2000-2010 by Race/Ethnicity for SEER 18

Endometrioid Serous Endometrioid Serous

25 Incidence Mortality 5 Incidence Mortality 15 20 te per 100,000 y 3 4 te per 100,000 y 10 Age Adjusted Rat 2 Age Adjusted Rat 5 NHW NHB Hispanic Asian A 1 NHW NHB Hispanic Asian A p p Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2012 Sub (2000-2010) <Katrina/Rita Population Adjustment> - Linked To County Attributes - Total U.S., 1969-2011 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2013, based on the November 2012 submission.

Age Adjusted Incidence Rates for Endometrioid and Serous Endometrial Cancer, 2000-2010 by , y race/ethnicity and year, SEER 18

Endometrioid Serous Endometrioid Serous

APC =0.4 APC = 3.1* APC 1 9* APC = 1.3* APC = 1.9* APC 10 3* APC = 1.9* APC = 10.3* APC = 2.6* APC = 3.1 Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2012 Sub (2000-2010) <Katrina/Rita Population Adjustment> - Linked To County Attributes - Total U.S., 1969-2011 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2013, based on the November 2012 submission.

Relative 5-year Survival Rates for Endometrioid and Serous Endometrial Cancer by Race/Ethnicity y / y 2000-2005, SEER 18

Endometrioid Serous Endometrioid Serous

90% 100%

NHW NHB

90% 100%

NHW NHB

60% 70% 80% urvival

NHB Hispanic Asian

60% 70% 80% urvival

NHB Hispanic Asian

30% 40% 50% Relative Su 30% 40% 50% Relative Su 0% 10% 20% Local Regional Distant 0% 10% 20% Local Regional Distant g g Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2012 Sub (2000-2010) <Katrina/Rita Population Adjustment> - Linked To County Attributes - Total U.S., 1969-2011 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2013, based on the November 2012 submission.

Hysterectomy common in US women

Jamison PM et al. 2013. “Trends in endometrial cancer incidence by race and histology with a correction for the prevalence of hysterectomy, SEER 1992 to 2008”. Cancer Epi Biomarkers and Prev; 22(2) pgs 233-241

Correcting for hysterectomy, ages 50+

• Without correction for hysterectomy rates
• 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 women

Jamison PM et al. 2013

Background Summary

• Endometrial cancer incidence is increasing among

African Americans

• Increases seen for both endometrioid and serous sub-

Increases seen for both endometrioid and serous sub types

• The survival disparity remains unchanged

Question:

• The survival disparity remains unchanged

Do endometrial cancer risk factors or effect sizes differ between black and white women? between black and white women?

Studies complied through E2C2

Pooled analysis: 11 studies Black women ncases=516/ncontrols=1 495 Black women ncases 516/ncontrols 1,495 White women: ncases=5,693/ncontrols=13,604 Cohort: Black Cases AARP 81 AARP 81 California Teachers Study 12 Multiethnic Cohort Study 128 New York University Women’s Health Study 23 y y 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 g y Fred Hutchinson Cancer Research Center Study 14 Women’s Insight and Shared Experience Study 67

Associations for common risk factors i il f hit d bl k similar 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

Other risk factors

Oral Contraceptives White Black

0 1 f f 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) y ( , ) ( , ) p-trend <0.001 0.04

Hypertension White Black

No ref ref Yes 0.88 (0.66, 1.17) 0.99 (0.90, 1.08)

Limitations

• Even with 11 large studies, power was limited when

g , p examining risk in black women unable to examine histological subtypes by race

• Data harmonization, particularly of hormone use, is

challenging g g could not assess sequential versus continuous HT

• Most common variables between studies were those

for estrogen-dependent cancers already fairly well characterized already fairly well-characterized

Could survival differences be due to underlying tumor biology? underlying tumor biology?

Study: 150 tumors from white (n=66) and African American (n=84) women

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

Conclusions

• Incidence of endometrial cancer is increasing among black women in

the U.S. 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

• 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

Thank you!

Special thanks to Julie Ruterbusch for the current SEER analyses