Racial Disparity in Diagnostic Evaluation of Uterine Cancer

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Uterine cancer is the most common gynecologic malignancy in the U.S., with a two-fold higher risk of mortality for black women than white women. Early diagnosis is vital for patients’ prognosis as it greatly improves the effectiveness of subsequent treatment. Evidence has shown a significant black-white difference in uterine cancer stage at diagnosis (53% of black women versus 69% of white women are diagnosed at early stage), which explains more of the racial gap in mortality risk than any other factor. However, there has been little research elucidating barriers in the diagnostic pathway that lead to this disparity in early diagnosis, and reasons for the more advanced-stage uterine cancer in black women remain largely unclear, hindering our ability to address this important health inequity. Since many factors in the diagnostic pathway may be modifiable and amenable to interventions, this reflects a lost opportunity of secondary prevention (i.e., early detection and control of the cancerous process). The overarching objective of this project is to reduce racial disparity in the early diagnosis of uterine cancer by systematically examining patients’ diagnostic pathway and identifying barriers to early diagnosis in black women. We will achieve this objective via the following specific aims: 1) to examine racial disparity between black and white women with uterine cancer in the quality of diagnostic evaluation they receive; 2) to compare symptoms and diagnostic evaluation of women who have early versus advanced stage uterine cancer and examine their role in influencing racial disparity in stage at diagnosis; and 3) to conduct a population-based patient experience survey and link to cancer registry data to examine how sociocultural, behavioral and access barriers affect disparity in uterine cancer diagnosis. Aims 1- 2 will draw on three unique large healthcare databases that have patient-level indicators of race/ethnicity and socioeconomic status, contain a complete record of patients’ diagnostic pathway starting from the time when symptoms are reported to a provider, and cover a diverse patient population encompassing the commercially insured, Medicaid enrollees, and Medicare beneficiaries. These databases include the Optum Clinformatics Data Mart, the MarketScan Multi-State Medicaid Database, and the Surveillance, Epidemiology and End Results (SEER)-Medicare database. Aim 3 will exploit the infrastructure of statewide cancer registries and the latest technology of rapid case ascertainment to survey a population-based sample of women newly diagnosed with uterine cancer about their experience. By further linking patient reported survey data to pathology/clinical data in cancer registry, we can uniquely examine how sociocultural, behavior, and patient-perceived barriers affect uterine cancer stage at diagnosis and the potential interplay between tumor characteristics (e.g., histologic type) and patient experience. Findings from this study will provide an essential evidence base about causes of racial disparity in uterine cancer diagnosis. Such information can guide meaningful design of targeted interventions to promote early diagnosis in black women and reduce disparity.