Black-White Differences in Uterine Cancer Symptomatology and Stage at Diagnosis

Details

• Alternative Title:
  Gynecol Oncol
• Personal Author:
  Xu, Xiao ; Chen, Ling ; Nunez-Smith, Marcella ; Clark, Mitchell ; Ferris, Jennifer S. ; Hershman, Dawn L. ; Wright, Jason D.
• Description:
  OBJECTIVE:
  
  To examine whether uterine cancer symptoms differ between Black and White patients and how this may influence their stage at diagnosis.
  
  METHODS:
  
  Using the Surveillance, Epidemiology and End Results-Medicare database, we identified 2,328 Black and 21,774 White patients with uterine cancer in 2008–2017. Their symptoms in the 18 months before diagnosis were categorized as postmenopausal bleeding (PMB) alone, PMB together with other symptoms (e.g., abdominal/pelvic pain, bloating), non-PMB symptoms alone, or no symptoms. Stage at diagnosis was dichotomized as advanced (i.e., regional/distant) versus localized. The association between race and stage was analyzed using regression models incrementally adjusting for symptoms and other patient characteristics.
  
  RESULTS:
  
  A larger proportion of Black than White patients experienced PMB together with other symptoms (63.1% versus 58.0%) or experienced non-PMB symptoms alone (13.1% versus 9.4%) (p<0.001). Black patients had a higher risk of advanced-stage diagnosis than White patients (45.0% versus 30.3%, unadjusted RR=1.52, 95% CI: 1.44–1.59). Adjusting for Black-White differences in symptoms attenuated the RR to 1.46 (95% CI: 1.39–1.53). Compared to PMB symptoms alone, having additional non-PMB symptoms (RR=1.21, 95% CI: 1.15–1.26) and having non-PMB symptoms alone (RR=1.99, 95% CI: 1.88–2.10) were associated with increased risk of advanced-stage diagnosis. Further adjusting for histology and other patient characteristics reduced Black-White disparity in advanced-stage diagnosis to 1.08 (95% CI: 1.03–1.14) but symptoms remained significantly associated with stage at diagnosis.
  
  CONCLUSIONS:
  
  Having non-PMB symptoms was associated with more advanced stage at diagnosis. Non-PMB symptoms were more common among Black than White patients, which might hinder symptom recognition/evaluation.
  
  
• Subjects:
  Aged Black Or African American Female Humans Medicare United States Uterine Neoplasms White
• Source:
  Gynecol Oncol. 180:118-125
• Pubmed ID:
  38091770
• Pubmed Central ID:
  PMC10922746
• Document Type:
  Journal Article
• Funding:
  R01 MD016386/MD/NIMHD NIH HHSUnited States/ ; U58 DP001056/DP/NCCDPHP CDC HHSUnited States/
• Volume:
  180
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:f9da936b71dd077d83a379f17f7f502a6e3d67c428594f61add4a48096bb1a774044ecfc051105c9ec2552485b772fb842d7739a8e8b99271c8f316d5cb7270d
• Download URL:
  https://stacks.cdc.gov/view/cdc/159812/cdc_159812_DS1.pdf
• File Type:
  [PDF - 268.42 KB ]