Researchers predict that the uterine cancer incidence and mortality rates will increase substantially in the United States over the next 25 years, with Black women disproportionately affected compared with White women.

“Uterine cancer is one of the few cancers for which incidence rates and mortality rates are both increasing,” said the study’s senior author Elena Elkin, PhD, a health policy expert at Columbia University Mailman School of Public Health. “There are also profound and growing racial disparities in uterine cancer incidence and mortality.”

Jason Wright, MD, who is the lead author of the study and chief of the Division of Gynecologic Oncology at Columbia University added that “understanding future trends will help inform the development of robust strategies to reduce the burden and improve outcomes.”

As part of the National Cancer Institute’s Cancer Intervention and Surveillance Modeling Network, Wright and team built the Columbia University Uterine Cancer Model (UTMO), which simulates trajectories for uterine cancer incidence and mortality. It is based on characteristics from a sample population, considering factors such as age, race, birth cohort, cancer stage, and histologic subtype. Survival estimates are based on currently available treatments and do not account for potential advances in therapeutics.

To validate the model, the researchers used UTMO to predict the median age of diagnosis, survival rate, and distribution of diagnosis by stage for uterine cancer in 2018, and found those projections were comparable to the actual incidence data from that year.

They then looked at predicted incidence up to 2050 and found that uterine cancer diagnosis rates in White women are expected to increase substantially from 57.7 cases per 100,000 in 2018 to 74.2 cases per 100,000 in 2050. In Black women the rates could rise from 56.8 cases per 100,000 in 2018 to 86.9 per 100,000 in 2050.

Furthermore, uterine cancer incidence-based mortality rates could double by 2050, with rates going from 6.1 per 100,000 in 2018 to 11.2 per 100,000 in 2050 among White women, and from 14.1 per 100,000 to 27.9 per 100,000 among Black women.

“There are likely a number of factors that are associated with the increased burden of uterine cancer in Black women,” Wright said. “They more commonly have aggressive types of uterine cancer, face delayed diagnosis resulting in later-stage disease at diagnosis, and there are often delays in their treatment.”

In terms of cancer histology, the incidence of endometroid tumors is expected to increase considerably in both White (from 49.2 to 63.4 per 100,000) and Black women (from 34.2 per to 50.5 per 100,000), but White women will experience only a slight increase in the more aggressive nonendometrioid tumors (from 8.5 to 10.8 per 100,000) compared with a substantial increase in Black women (from 22.5 to 36.3 per 100,000).

Elkin said she was not surprised by the findings given past trends, but is “certainly concerned,” noting that the model “projects quite a substantial burden of disease if current trends persist.”

The researchers also looked at the impact of changing hysterectomy and obesity rates. Obesity is a known risk factor for uterine cancer, and while an increase in the use of obesity treatments like glucagon-like peptide-1 inhibitors could cause obesity rates to decline, Wright explained it is hard to predict if that will be the case. Hysterectomy is known to reduce the risk of uterine cancer, but due to the availability of nonsurgical treatments for gynecologic disease, hysterectomy rates are projected to decline 25.7% from 2020 to 2035.

The model indicated that should hysterectomy rates continue to decrease, and obesity rates continue to increase, the incidence and mortality rates for uterine cancer would increase at a faster rate for both White and Black women. For White women, incidence could reach 92.9 cases per 100,000 by 2050, and for Black women the rate is projected to rise to 102.0 cases per 100,000. Mortality predictions were a corresponding 12.9 and 31.4 per 100,000.

“An obvious target for slowing uterine cancer incidence is addressing rising rates of overweight and obesity in the U.S.,” Elkin told Inside Precision Medicine. “If improving access to the current generation of weight-loss medications, along with healthy diet and physical activity can slow the obesity epidemic, then we may see a slowing or reversal of the trend in uterine cancer incidence.”

However, tackling mortality will require improvements in diagnosis and treatment. Elkin noted that there are several available and emerging therapies, including immunotherapy and biomarker-based treatment strategies that hold promise for improving survival.

The development and adoption of an effective screening test for uterine cancer could also slow or even reverse current trends in mortality. When hypothetical screening and intervention methods that could detect uterine cancer and precancerous changes prior to clinical diagnosis were incorporated into the model and introduced at age 55 years, the researchers found that there was a decline in cancer incidence that lasted up to 15 years in White women and up to 16 years in Black women.

“This suggests that if there was an effective screening test, we may be able to substantially reduce the burden of disease,” Wright said. “While there is presently no screening or prevention that is routinely used for uterine cancer, we are currently examining the potential impact of integrating screening for this cancer into practice.”

Elkin believes the UTMO could be used to benefit precision medicine strategies for uterine cancer by using it to evaluate the impact of targeted, biomarker-based treatment strategies. “We can also study whether targeted screening and prevention strategies, for women at high risk of developing uterine cancer, may have a reasonable balance of benefit and harm, and identify risk thresholds for recommending these interventions,” she said.

The study findings are published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.