The purpose of this study was to examine why black women with endometrial cancer have higher mortality rates than white women. Data were derived from the National Cancer Institute's Black/White Cancer Survival Study. Subjects selected for the current study were black and white women aged 20-79 years who resided in Atlanta, New Orleans, or San Francisco/Oakland and were diagnosed with primary cancer of the uterine corpus during the period from 1985 to 1987.

Black women were diagnosed at a later stage than white women: 25% of blacks versus 10% of whites were stage III or IV at diagnosis. Only 21 women presented with metastatic disease, but the proportion of black to white women with the disease was more than 3 to 1. Black women were two times more likely to have poorly differentiated lesions, and, among the 60% of tumors in both races that were adenocarcinomas, black women were more likely to have serious tumors.

With regard to treatment differences, there were none observed in hormone therapy, or pre- or post-hysterectomy radiation. Surgical treatment did vary by race: 29.5% of blacks versus 4.6% of whites received curettage or less as their surgical treatment; 70.5% of blacks versus 95.4 % of whites received a hysterectomy. This pattern was consistent across disease stages. The authors suggest that these data indicate that closer attention should be paid to whether black women with endometrial cancer are currently receiving optimal surgical care. They further offer that some of the racial difference in surgical treatment may result from a high prevalence of contraindications or high refusal rate among black women.

After adjustment for age, location, stage, tumor characteristics, treatment, hormonal and reproductive health, comorbidities and health behavior, and sociodemographic characteristics, blacks were still 1.6 times more likely to die (all causes) than whites (95% confidence interval = 1.0 to 2.6). The hazard ratio for blacks versus whites that did not adjust for all of these variables was much higher, and a comparison of measures before and after adjusting for these clinical and behavioral factors indicated that they accounted for 80% of the racial difference in survival.