How Race, Neighborhood, and More Play a Part in Endometrial Cancer Disparities.

How Race, Neighborhood, and More Play a Part in Endometrial Cancer Disparities.

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A nurse sits and talks with a patient, who is wearing a head scarf, on a couch.

MedStar Health researcher leverages her prior research in New York to inform how information about neighborhood affluence can be used to improve healthcare in Washington, DC.

 

It’s no secret that your health doesn’t start or end at the hospital. What we eat, what we do, and even where we live can significantly impact our health—and even the likelihood of positive outcomes from diseases such as endometrial cancer.


The last few years have seen rising rates of endometrial cancer, which occurs in the layer of cells that make up the lining of the uterus. The American Cancer Society estimates that almost 70,000 new cases of cancer of the uterus will be diagnosed this year, and about 12,500 people will die from these cancers. Rates of new cases have risen 0.6% each year since 2010, and death rates have climbed 1.7% per year over the same time.


Some researchers think the rise in these cancers may be related to the obesity epidemic. Excess fatty tissue can produce hormones that promote uncontrolled overgrowth in the lining of the uterus. Researchers have determined that for every five-unit increase in body mass index (BMI), the risk of developing endometrial cancer rises by 50%. The Black community is disproportionately affected by obesity. According to the U.S. Department of Health and Human Services, four out of every five African American women are overweight or obese. 


Though more white patients develop the disease, studies show that Black women with endometrial cancer are twice as likely to have more aggressive cancer, have surgery less often, and are more likely to be diagnosed after their cancer has advanced. The National Cancer Institute (NCI) noted in 2022 that Black women are more than twice as likely to die from uterine cancers than all other groups. 


For a complex web of reasons, Black patients often don’t receive the same standard of care as white patients—systemic racism impacts every level of care. As a Black woman and a gynecologic oncologist, my patients’ experiences feel very personal. I am passionate about understanding why these disparities exist and how to correct them in the national healthcare system. 


In collaboration with Columbia Population Research Center and Columbia University Department of Obstetrics and Gynecology, we examined neighborhood socioeconomic status and wealth among patients with endometrial cancer in New York State to determine whether there was a correlation between these factors and patients’ receipt of appropriate treatment and their survival.


Earlier this year, I presented these preliminary findings at the 2022 Society of Gynecologic Oncology annual meeting in Phoenix, AZ.

Connections between race, neighborhood, and cancer outcomes.

Examining the data from the New York State Cancer Registry, NY Statewide Planning and Research Cooperative System, and NY Vital Statistics revealed several state-wide trends:


  • Patients who lived in vulnerable neighborhoods (incomes in the poorest 20%) were less likely to receive follow-up chemotherapy after surgery for endometrial cancer than women from affluent areas (incomes in the wealthiest 20%). 
  • Patients from vulnerable neighborhoods were less likely to have timely surgery for endometrial cancer than their wealthy counterparts.
  • Living in a vulnerable neighborhood was associated with a 20-30% greater likelihood of death within five years after diagnosis.

These results were not found in New York City, perhaps because of the proximity of several major hospitals and the city’s unique mix of housing, including rent-controlled apartments that reduce neighborhood stratification by income.


Our research showed that racial disparities in care widen with increasing neighborhood affluence. For white women, living in an affluent neighborhood increases their likelihood of surviving endometrial cancer. For Black women, there was no change in their survival rate based on neighborhood wealth. This suggests an important distinction:
wealth isn’t enough to overcome race-based disparities in cancer outcomes.

Our study was designed to understand whether these disparities exist, not why. The answers are likely complex, and the solutions will be even more complicated. Yet this important work helps us understand the challenges we face when working to eliminate disparities and provide all patients with equally excellent care.

Related reading: What Data From the ‘Hair Straightener and Uterine Cancer’ Study Mean for Black Women.

Further research to reveal disparities.

Part of my work is to understand whether the relationship between race, wealth, and cancer we found in New York State is similar for patients who live here in Washington, DC. I continue to learn from listening to patient stories and feedback about navigating the health system. Through these conversations, we aim to learn how to better our processes to provide more seamless care to vulnerable patients. 

At the same time, our research is taking a deeper dive into how neighborhood environments might present challenges that increase cancer risk on a molecular level. Our research will examine how exposure to chronic stress, daily racism, and other environmental factors might alter genomic signatures and DNA in ways that could lead to cancer.

Endometrial cancer research is funded at much lower levels than studies of other cancers, receiving just $18 million in NCI funding in 2019 compared to more than $100 million for most other research areas. There are hopeful signs that will soon change. NCI has designated endometrial cancer as an area of interest and developed a new task force dedicated to funding research to improve our understanding.

Making health care better for everyone.

Learning the answers to questions about disparities and patient experiences requires nuanced science and researchers interested in learning the healthcare system from a patient’s perspective. 

Building a deep understanding of the vulnerable patients’ experience can help transform how we deliver care throughout MedStar Health and beyond. By improving care for historically minoritized patients, we will be able to streamline process and communication pathways.


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