Trends in uterine cancer among premenopausal and postmenopausal women in the United States, 2001–2020
Introduction
Uterine cancer, primarily originating in the endometrium, is the most common gynecologic malignancy in the United States. Despite being traditionally considered a disease of postmenopausal women, recent studies have indicated a rising incidence among premenopausal women as well. We assessed the current trends in uterine cancer and endometrial cancer incidence in both premenopausal and postmenopausal women in the U.S. from 2001 to 2020.
Methods
We used data on U.S. adult women from U.S. Cancer Statistics 2001–2020 database. This database covered essentially all adult female population between 2001 and 2020 in the U.S. (Puerto Rico not included). Uterine cancer cases were defined as microscopically confirmed cancers of the corpus uteri (ICD-O-3 site codes C54.0, C54.1, C54.2, C54.3, C54.8, C54.9, and C55.9). Endometrial cancer cases were defined as uterine cancer cases with the following histologic types classified by ICD-O-3 histology codes: endometrioid carcinomas (8380) and other carcinomas (8000–8379, 8381–8790, 8981, 9700–9701). We only included malignant cases. Incidence was age adjusted to the 2020 U.S. standard population. Joinpoint regression models were fitted based on age-adjusted annual incidence data of 2001–2019 using the National Cancer Institute’s Joinpoint Regression Analysis program, version 5.0.2. When analyzing the trends, we excluded the data from 2020 because the COVID pandemic affected the public’s ability and desire to use health care services. This resulted in postponed and decreased cancer screenings and diagnoses, causing a significant temporary decrease in incidence rates.
Results
Incidence rate of uterine cancer and endometrial cancer sharply decreased from 2019 to 2020 in all age groups (20–54 years, 55–79 years, 80+ years) and the proportion of metastatic cancer increased across all age groups. From 2001 to 2019, both the incidence of uterine cancer and endometrial cancer increased in 20–54 years old and 55–79 years old, but decreased in 80+ years old. Joinpoint analyses revealed that there were 1 joinpoint for the trends in incidence rate of endometrial cancer incidence among 20–54 years old (annual percentage change (APC) from 2001 to 2012 0.9, 95% confidence interval (CI) -0.2 - 1.3, APC from 2012 to 2019 1.9, 95% CI 1.2–3.0), 0 joinpoints among 55-79 years old (APC from 2001 to 2019 1.3, 95% CI 1.1–1.5), and 1 joinpoints among 80+ years old (APC from 2001 to 2014 -1.6, 95% confidence interval (CI) -2.2 – -1.3, APC from 2014 to 2019 0.8, 95% CI -0.5 – 2.1). Similar patterns were observed for uterine cancer.
Conclusion
Our findings indicate increasing trends in uterine cancer and endometrial cancer among both premenopausal and postmenopausal women, while rates decreased among individuals aged 80 and older. Notably, the COVID-19 pandemic had a substantial impact on cancer diagnosis, leading to decreased incidence rates but an increased proportion of metastatic cases. These observations highlight the need for continued monitoring and targeted interventions to address the rising incidence of uterine cancer among women under 80 years old and the potential consequences of delayed diagnoses due to external factors like the pandemic.