A Cancer Moving the Wrong Way: Uterine Cancer Cases and Deaths Rose From 1999 to 2016

Most cancers in the United States have been getting rarer — lung and colorectal among them. Uterine cancer is one of the few going the other way, in both new cases and deaths. It is the fourth most common cancer diagnosed and the seventh most common cause of cancer death among U.S. women.

The numbers

Who is most affected

Age-adjusted uterine cancer incidence by race and ethnicity, 1999–2015. CDC.

Black women died at about twice the rate of women in other groups. Part of the reason: their cancers were more often found late and were more often aggressive types. Endometrioid carcinoma — overall 68% of cases — made up only 47% among Black women, who had more of the other carcinomas, carcinosarcomas and sarcomas. 55% of Black women's cancers were found at a localized stage, against 66–69% in other groups, and 16% at a distant stage, against 8–10%.

Type matters: 36% of sarcomas were diagnosed at a distant stage, against 3% of endometrioid carcinomas. Five-year relative survival is 80–90% for localized uterine cancer and under 30% for distant.

By type, over 1999–2015, endometrioid carcinomas rose 4.5% a year, other carcinomas fell 4.5% a year, carcinosarcomas rose 1.9% a year and sarcomas held steady.

Age-adjusted uterine cancer death rates by race and ethnicity, 1999–2016. CDC.

Why it may be rising

Excess weight is one likely driver: women who are overweight (BMI 25.0–29.9) or have obesity (BMI 30 or more) are about two to four times as likely to develop endometrial cancer as women at a healthy weight. In 2013–2016, about 40% of U.S. women had obesity — 56% of Black women and 49% of Hispanic women. Too little physical activity, more diabetes, and less use of estrogen-plus-progestin menopausal hormone therapy may also contribute.

The U.S. Preventive Services Task Force recommends that clinicians offer or refer adults with obesity to intensive behavioral programs; communities, workplaces, schools and child care can support healthy eating and activity.

The symptom that matters

There is no recommended screening test for uterine cancer, as there is for breast, cervical, colorectal and lung cancer. What catches it early is abnormal vaginal bleeding — between periods, after sex, or any unexpected bleeding after menopause — reported by about 90% of women with uterine cancer. Uterine sarcomas are the exception: only about 56% bleed abnormally and 22% have vague symptoms such as pelvic pain, so more are found after they have spread.

Women should have abnormal bleeding checked promptly, and providers should evaluate it quickly — transvaginal ultrasound or endometrial tissue sampling first, then perhaps hysteroscopy with sampling. CDC's Inside Knowledge campaign raises awareness of uterine and other gynecologic cancers.

Limits

Race and ethnicity on records can be wrong, especially for American Indian/Alaska Native women; tumor classification has improved over time; histologic groups are broad; registries use a simpler staging system than clinicians; and rates were not adjusted for hysterectomy, which leaves some women counted who have no uterus — understating the true rate, especially among Black women, who have higher hysterectomy rates.

Sources

Based on Henley SJ, Miller JW, Dowling NF, Benard VB, Richardson LC, "Uterine Cancer Incidence and Mortality — United States, 1999–2016," MMWR Morbidity and Mortality Weekly Report volume 67, number 48, Centers for Disease Control and Prevention; a work of the United States government in the public domain. The imported copy was cut short; the missing text is from the report's full text in PubMed Central (PMC6329484).