Endometrial cancer in black women

描述（由申请人提供）：尽管黑人女性的年龄调整子宫内膜癌发病率比白人女性低12%，但黑人女性的年龄调整死亡率却高出87%，而且这种种族差异在过去二十年中持续增加。来自子宫内膜癌流行病学协会（E2C2）的初步证据表明，口服避孕药的使用、胎次、头胎和末胎年龄对黑人妇女预防子宫内膜癌的保护作用不如白人妇女。我们建议在黑人妇女健康研究（BWHS）中评估人体测量学、生殖、激素和代谢因素对18年随访（1995-2013）诊断的子宫内膜癌发病率的影响，这是一项针对美国黑人妇女的大型前瞻性队列研究。然后，我们建议对来自BWHS、病例对照监测研究（CCS）和E2C2的另外10项研究（包括黑人妇女）的结果进行荟萃分析，以调查发病率和组织学（I型、II型和II型）的预测因素。II型和II型肿瘤比I型肿瘤更具侵袭性，在黑人女性中也更为普遍。对于II型和III型肿瘤的危险因素知之甚少。我们对不同组织学类型的子宫内膜癌的评估有可能解决关于死亡率的黑白差异的重要问题。这项荟萃分析将涉及800多名黑人子宫内膜癌患者。我们将计算每项研究的相对风险（RR），评估RR的异质性，然后根据研究设计（例如，队列与病例对照）估计所有研究的相对风险（RR）。此外，我们将对组织学类型进行单独分析，以评估相关环境因素是否能预测黑人女性中更为普遍的II型和III型癌症。黑人妇女对子宫内膜癌病因的研究不足。我们建议研究的许多假定的风险因素与黑人妇女特别相关；例如，美国黑人妇女肥胖、2型糖尿病和子宫肌瘤的发病率明显高于白人妇女，而且生育年龄更早，生育的孩子也更多。关于可改变危险因素的新数据有可能影响疾病的初级预防。由于几乎所有关于子宫内膜癌决定因素的数据都来自于对白人妇女的研究，这项针对服务不足、死于子宫内膜癌风险增加的少数群体的拟议研究将解决研究中的空白。由于数据收集和基础设施由其他赠款支持，拟议的研究可以以适度的成本进行。

DESCRIPTION (provided by applicant): Although the age-adjusted incidence of endometrial cancer is 12% lower among black women than white women, age-adjusted mortality among black women is 87% higher and this racial disparity has continued to increase over the past two decades. Preliminary evidence from the Epidemiology of Endometrial Cancer Consortium (E2C2) suggests that oral contraceptive use, parity, and older age at first and last birth are not as protective against endometrial cancer in black women as they are in white women. We propose to assess the influence of anthropometric, reproductive, hormonal, and metabolic factors on incident endometrial cancer diagnosed over 18 years of follow-up (1995-2013) in the Black Women's Health Study (BWHS), a large prospective cohort study of U.S. black women. We then propose to perform a meta-analysis of results from the BWHS, the Case-Control Surveillance Study (CCS), and 10 additional studies from the E2C2 that include black women to investigate predictors of incidence and histology (types I, II, and II). Type II and II tumors are more aggressive than type I tumors, and they are also more prevalent in black women. Little is known about risk factors for type II and III tumors. Our assessment of different histologic types for endometrial cancer has the potential to address important questions about the black-white discrepancy in mortality. The meta-analysis will involve more than 800 black cases of endometrial cancer. We will compute a relative risk (RR) for each study, evaluate heterogeneity in the RRs, and then estimate a RR for all studies combined and according to study design (e.g., cohort vs. case-control). In addition, we will perform separate analyses of histologic type to assess whether the environmental factors of interest predict types II and III cancer, which are more prevalent in black women. Black women are understudied with regard to endometrial cancer etiology. Many of the putative risk factors that we propose to study are of particular relevance to black women; for example, U.S. black women have significantly higher rates of obesity, type 2 diabetes, and uterine fibroids, and give birth at earlier ages and have more children than white women. New data about modifiable risk factors has the potential to influence primary prevention of disease. The proposed study of an underserved minority population at increasing risk of death from endometrial cancer will address gaps in research, as almost all data on determinants of endometrial cancer come from studies of white women. The proposed study can be carried out at modest cost because data collection and infrastructure are supported by other grants.