Uterine Cancer To Be Leading Cause of Death Among GYN Cancers

Gynecologic cancer experts at Baptist Health Miami Cancer Institute are concerned by the rise in the number of cases of uterine cancer diagnosed in the U.S., especially among Black and African American women.

According to the American Cancer Society (ACS), uterine cancer is the only cancer type for which survival has fallen in the past four decades. The disease will kill some 13,250 women in the U.S. this year, surpassing ovarian cancer to become the deadliest gynecologic cancer, the group says.

Even more concerning, the ACS notes, is that Hispanic and African American women not only are diagnosed more often than are White non-Hispanic women but also are nearly twice as likely to die from uterine cancer. Such disparities persist even when they are diagnosed at the same stage, an indication that “Black and Hispanic women are less likely to get treatment that matches medical guidelines.”

John Diaz, M.D., chief of gynecologic oncology at Miami Cancer Institute and director of robotic surgery at Baptist Health, says the Institute has seen an increase in the number of patients presenting with uterine cancer, also known as endometrial cancer. More common after menopause, the disease is rising across all age groups including women under 50, for reasons that aren’t yet fully understood, he says.

John Diaz, M.D., chief of gynecologic oncology at Miami Cancer Institute and director of robotic surgery at Baptist Health

With 66,000 new cases a year, roughly 13,000 of which will be fatal, uterine cancer is already the most common gynecologic cancer, according to Dr. Diaz. He says that while ovarian cancer has fewer cases diagnosed per year (22,000), it is a deadlier disease and holds the number one spot – for now.

Increase in uterine cancer concerning

“We think that by 2040, uterine cancer in the U.S. will surpass colorectal cancer as the third leading cancer in women and the fourth leading cause of death among women,” Dr. Diaz says. “It’s a real concern – especially for Black and African American women.”

What’s behind the increase? Rising obesity rates are partly to blame, the ACS says. “Excess weight increases estrogen levels that can fuel uterine cancer. Also, fewer women are getting their uteruses removed to treat abnormal bleeding or noncancerous fibroids, leaving them exposed to the risk cancer develops in the organ as they age.”

The ACS also notes that chemical hair straighteners have been linked to uterine cancer risk. The Food and Drug Administration (FDA) plans in July to propose a ban on formaldehyde in hair straightening or smoothing products, which are used primarily by Black and African American women and could be responsible in part for the increase in uterine cancer.

Dr. Diaz says genetics also play a role. “When it comes to standard of care provided, many times minority patients are not receiving the same quality of care as white patients. But even where they are getting the same quality care, they’re still not doing as well with treatment. Different ethnicities respond differently, based on genetics.”

Two types of uterine cancer

Dr. Diaz says that uterine cancer comes in two forms. The more common one, endometrial cancer, is estrogen-driven and slow-growing. “We tend to see them earlier, which is good because they are more likely to be curable at that stage,” he says.

The other type of uterine cancer – uterine sarcomas, serous and clear cell carcinomas – are non-hormonal and harder to treat. “We’re seeing an increased mortality rate in Blacks and African Americans, in part because we’re also seeing a disproportionately higher rate of these non-endometrial type cancers in those populations.”

These patients tend to present at a more advanced stage and have a worse prognosis, Dr. Diaz adds. “So not only are minority women more at risk for developing uterine cancer, they’re also at risk for developing a more aggressive type of uterine cancer.”

Immunotherapy with chemotherapy improving outcomes

Dr. Diaz says the good news with uterine cancer can be seen in the advances being made in treatment of the disease. In recent years, the FDA has approved two powerful new immunotherapies, pembrolizumab and dostarlimab. These drugs harness a patient’s own immune system and are improving the outlook for some advanced uterine cancer patients.

“Incorporating immunotherapy with chemotherapy has continued to improve outcomes,” says Dr. Diaz, who is principal investigator for Miami Cancer Institute in a national trial studying a new class of drugs – antibody drug conjugates, or ADCs – to treat endometrial cancer uterine cancer. “We’re now looking at a new drug (STRO-002) as part of a Phase 2 trial that is open throughout the U.S. and allows for the enrollment of patients with endometrial uterine cancer.”

Understanding and utilizing all treatment options

Treatment of uterine cancers and all gynecologic cancer has become increasingly sophisticated, Dr. Diaz points out, and requires a dedicated team of specialists focused solely on these particular cancers.

“A gynecologic oncology team at Miami Cancer Institute includes your surgeon, medical oncologist, radiation oncologist, pathologist, geneticist and many others, some of whom you never see,” Dr. Diaz says. “And every one of them is focused on treating gynecologic cancers and delivering the best possible outcomes for our patients.”

Treatment guidelines for uterine cancer have multiple decision trees so there are many different options available for treating this disease, Dr. Diaz adds.

“It takes a great deal of highly specialized knowledge – as well as a clear understanding of each patient’s risk factors for recurrence – to know exactly how to utilize all of the available options,” he explains. “Unless you’re dealing with this disease on a daily basis and are on top of the latest research, you’re not going to know how to tailor that treatment so the patient can have the best possible outcome with the least amount of toxicity.”

When you should see your doctor

Dr. Diaz says one of the most obvious symptoms of uterine cancer is vaginal discharge or abnormal bleeding because of how heavy it is or when it happens and it can also cause pain or pressure in your pelvis.

“Bleeding is never normal after your periods stop,” says Dr. Diaz. “If you have bleeding that is not normal for you – especially if you have already gone through menopause – you should see your doctor right away. These things may be caused by something other than cancer, but the only way to know is to see your doctor.”