There's a lack of research and awareness, which influences endometrial cancer rates

Uterine cancer is deemed to be the most common gynecologic malignancy in developed countries. Despite all the breakthroughs, the issue has received considerable critical attention as the mortality rate for uterine cancer is on the rise. This elevated incidence could be multifactorial (Siegel et al., 2012; Niyazi et al., 2016). The raised prevalence of endometrial cancer in US-born generations of Chinese and Japanese Americans when compared with their counterparts who were born in Asia demonstrated that the exposure to some environmental features or lifestyle modifications may alter the race-specific factors of this malignancy (Frumovitz et al., 2014). 

The association of endometrial cancer with such dominant characteristics as age, BMI, race, familial history, and polycystic ovary, diet, physical activity, smoking, parity, breastfeeding, birth rate, hormone-replacement therapy, hypertension, diabetes, histology, the socio-economic status, and the exposure to infertility treatment are still controversial in terms of incidence and mortality (Brinton et al., 1992; Salazar-Martínez et al., 2000; Soliman et al., 2005; Beral et al., 2007; Zhou et al., 2008; Furness et al., 2009; Liat et al., 2012; Liao et al., 2014; Filomeno et al., 2015). Several attempts have been made to distinguish the contributing factors behind Type I endometrial cancer from Type II. Flix et al. (2010) concluded that type 2 was associated with excess age, nonwhite race, and the history of additional primary tumors. 

Renehan et al. (2008) also recognized that excess adiposity played a critical role. Despite all the reported data, much uncertainty still exists about the factors associated with uterine cancers in the developing and less developed countries. The limited knowledge of the known symptoms, the late diagnosis at a higher-grade phase of the disease, the poorer quality of life, and the impaired socioeconomic status make women in developing and less developed counties more vulnerable to endometrial cancer (Soliman et al., 2008; Hirth et al., 2016). Research on the issue has been mostly limited to imperfect statistics from women who were involved with uterine malignancy prior to higher-grade stages, patients who died of cancer at home and those with misdiagnosis of metastases from organs adjacent to uterine. Accordingly, these women suffer disproportionately from adverse disease-specific prognosis of endometrial malignancy.

Cervical cancer has been proved to be preventable, but the statistics concerning the uterine cancer in regions adjacent to Asia that may have similar ethnicity with Iran indicate that the trend for diminishing the mortality rate due to uterine corpus cancer has not been found yet (Jemal et al., 2011; Lee et al., 2014). Uterine and cervical cancers still have the second greatest incidence among all cancers in East Asian countries despite all the efforts made for the reduction of the mortality rate in these countries (Arbyn et al., 2010; Torre et al., 2015). This study, however, strove to assess the association between endometrial cancer and the possible etiological agents.

 

Cancer is the second leading cause of death in the US, outdone only by heart disease, according to the CDC—but cancer is significantly less deadly today than it was 20 years ago. From 1999 to 2016, the cancer death rates for men, women, and children in the US all declined, per the ACS. For women, death rates for the three most common cancers (breast, lung, and colorectal) decreased from 2012 to 2016. During that same time period, only five cancers that affect women saw increasing death rates, with liver and endometrial cancers seeing the steepest rise. But while many cancers are becoming less common in the US, endometrial cancer is actually becoming more common—and it's rising at a faster rate for Black women, George Maxwell, MD, who works in gynecologic oncology at Inova Fairfax Hospital in Falls Church, Virginia, tells Health. According to the National Cancer Institute, there were 24.4 new observed cases of uterine cancers and 4.2 deaths among every 100,000 people in the US in 1992. By 2017, those numbers had risen to 28.1 new observed cases and five deaths per 100,000 people. The American Cancer Society predicts that about 12,940 women will die from cancers of the uterine body, the main part of the uterus, in 2021.

Dr. Hoskins says the lack of funding for research dedicated to endometrial cancer definitely doesn't help the increasing death rate. "I think funding is the bigger issue. That's certainly a factor," Dr. Hoskins says. "We all know that this exists, [but] what exactly are we doing to study it?" Dr. Cote highlights the need for more funding with an alarming truth: "We have made really zero progress in terms of five-year survival from the 1970s to now."

National Institutes of Health (NIH) research funding amounts spell out just how relatively little money goes toward further understanding endometrial cancer. In the 2018 fiscal year, breast cancer research received $574.9 million in NIH research money, and $120.8 million went to ovarian cancer research. That's compared to $17.5 million devoted to endometrial cancer research. One reason: The usually treatable cancer is also fairly uncommon compared to the deadliest cancers in the US. "Breast, colon, and lung get a ton of funding," Pamela Soliman, MD, a gynecologic oncologist at MD Anderson Cancer Center, tells Health. "Understandably: There's 250,000 cases of breast cancer a year." (The ACS forecasts there will be 66,570 new uterine cancer cases diagnosed in 2021.)

Another reason endometrial cancer gets less attention is that it's usually treatable. Patients don't necessarily need chemotherapy or radiation, says Dr. Cote. This suggests that endometrial cancer is much less worrisome than other cancers. "For the majority of people who get endometrial cancer, it's just a bump in the road." As a result, "There's not much attention on the morbidity associated with it."

Ultimately, the less common a type of cancer is, the less attention it gets. "Everybody has a friend or relative that's been affected by breast cancer. It makes it a little bit more personal," Dr. Soliman says. "There's a lot of breast cancer survivors. So there's a lot of attention to it because women [survive it] and advocate for themselves or their family members." That patient advocacy presence isn't nearly as vocal within the endometrial cancer community. "The general population risk of endometrial cancer is 3%. So most women don't know someone who had it," adds Dr. Soliman.

African American women have also been underrepresented in clinical trials focused on gynecologic oncology, according to a June 2019 paper published in Gynecologic Oncology. The authors of the paper state that, among 357 publications that involved 9,492 patients, a racial breakdown was provided for just 83 studies. Five percent of the patients in those 83 studies were African American, the paper says. This research highlights the fact that even when research on endometrial cancer is conducted, it doesn't necessarily mean all women are equally represented within that research. The paper concludes: "A significant racial disparity in phase 1 gynecologic oncology clinical trials has existed for nearly three decades. Based on this study, significant attention should be directed toward strategies to enhance equity of African American patient enrollment onto phase 1 gynecologic oncology clinical trials."