Uterine cancer survival disparities, Hispanic ethnicity, and comorbidities.

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DESCRIPTION (provided by applicant): Overall relative survival for women with uterine cancer is worse now than in 1975. Once thought to be the "curable cancer", the five-year survival for endometrial cancer is now lower than 10 other types of cancer, including breast and prostate. And the burden of this disease is substantial; approximately 1 in 12 American women will be diagnosed with endometrial cancer in their lifetime. Furthermore, there are striking racial/ethnic disparities. Disparities in uterine cancer survival between whites and blacks have been noted and studied, but little is known about disparities between non-Hispanic whites (NHWs) and Hispanic whites (HWs). Based upon our own preliminary examination of Surveillance, Epidemiology and End Results program (SEER) data, we found that HWs experience consistently worse observed survival than NHWs in New Mexico and California. While the reasons for this disparity are unknown, differences in comorbidities between HWs and NHWs is one possible explanation because comorbidities reduce survival following cancer diagnoses. We expect to see a higher prevalence of comorbidities in HWs relative to NHWs at cancer diagnosis because both hypertension and diabetes are established risk factors for endometrial cancer and there is a higher prevalence of comorbidities such as diabetes and hypertension in HWs relative to NHWs. We hypothesize that comorbidities, in particular diabetes and hypertension, may explain part or all of the survival disparities between HWs and NHWs. We propose to explore this question using the SEER-Medicare linked database in New Mexico and three areas in California (Los Angeles, San Francisco-Oakland, San Jose-Monterey). We will compare tumor characteristics, patient characteristcs, and cancer therapy between HW and NHW cases. We will also determine if adjustment for comorbidites reduces or eliminates the difference in survival between HWs and NHWs. If we find that tumor characteristics (e.g., histology, stage) are different between HWs and NHWs, this finding will be the basis for a future line of research exploring the etiologic basis for these differences as well as a further investigation of tumor receptor expression and DNA profiling. If we find that one or more comorbidities explain, at least in part, the survival disparity, this finding will be the basis for a future line of research to investigate interventions (therapeutic or lifestyle) to specifically reduce uterine cancer mortality. By 2050 it is estimated that 103 million Americans will be of Latino/Hispanic ethnicity, representing 24% of the United States (US) population. A research investment to better understand the reasons for uterine cancer disparities will help us develop strategies for improving prognosis and survival for this common gynecologic cancer in this large and growing segment of our population. PUBLIC HEALTH RELEVANCE: Project Narrative This project is directly aimed at understanding the factors that affect differential uterine cancer survival between Hispanic white women and non-Hispanic white women. The results of our study will provide needed clarity about factors that drive this disparity so that further research can be done to establish ways to reduce the survival disparity. In this manner, the results could have a direct impact on improving the long-term health of uterine cancer patients across the nation.