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Is recurrence increased in black patients who receive estrogen replacement therapy?
Article first published online: 12 AUG 2008
Published © 2008 American Cancer Society
Volume 113, Issue 6, pages 1431–1437, 15 September 2008
How to Cite
Maxwell, G. L., Tian, C., Risinger, J. I., Hamilton, C. A. and Barakat, R. R. (2008), Racial disparities in recurrence among patients with early-stage endometrial cancer. Cancer, 113: 1431–1437. doi: 10.1002/cncr.23717
The following Gynecologic Oncology Group member institutions participated in this study: Roswell Park Cancer Institute, University of Alabama at Birmingham, Duke University Medical Center, Abington Memorial Hospital, Walter Reed Army Medical Center, University of Minnesota Medical School, University of Mississippi Medical Center, Colorado Gynecologic Oncology Group P.C., University of California at Los Angeles, University of Pennsylvania Cancer Center, Milton S. Hershey Medical Center, University of Cincinnati, University of North Carolina School of Medicine, University of Iowa Hospitals and Clinics, University of Texas Southwestern Medical Center at Dallas, Indiana University Medical Center, Wake Forest University School of Medicine, University of California Medical Center at Irvine, Tufts-New England Medical Center, Rush-Presbyterian–St. Luke's Medical Center, State University of New York Downstate Medical Center, University of Kentucky, the Cleveland Clinic Foundation, State University of New York at Stony Brook, Southwest Oncology Group, Washington University School of Medicine, Memorial Sloan-Kettering Cancer Center, Cooper Hospital/University Medical Center, Columbus Cancer Council, Fox Chase Cancer Center, Women's Cancer Center, University of Oklahoma, University of Virginia, University of Chicago, Tacoma General Hospital, Eastern Collaborative Oncology Group, Thomas Jefferson University Hospital, Mayo Clinic, Case Western Reserve University, Tampa Bay Cancer Consortium, Brookview Research Inc., Ellis Fischel Cancer Center, and the University of Texas M. D. Anderson Community Clinical Oncology Program.
The views expressed herein are those of the authors and do not reflect the official policy or opinion of the Department of Defense or the United States Army, Navy, or Air Force.
This article is a US Government work and, as such, is in the public domain in the United States of America.
- Issue published online: 4 SEP 2008
- Article first published online: 12 AUG 2008
- Manuscript Accepted: 23 APR 2008
- Manuscript Revised: 16 MAR 2008
- Manuscript Received: 6 NOV 2007
- National Cancer Institute
- Gynecologic Oncology Group Administrative Office. Grant Number: CA 27469
- Gynecologic Oncology Group Statistical and Data Center. Grant Number: CA 37517
Population-based studies suggest that, because of inequalities in treatment, black women with localized endometrial cancer have shorter survival compared with white women. The objective of the current investigation was to determine whether there is a racial disparity in outcome between black patients and white patients with early-stage endometrial cancer treated similarly in a clinical trial setting.
A retrospective review of 110 black patients and 1049 white patients with stage I and II endometrial cancer (graded according to the International Federation of Gynecology and Obstetrics grading system) was performed using data from a randomized, placebo-controlled trial performed by the Gynecologic Oncology Group that evaluated postoperative estrogen replacement therapy (ERT) and the risk of cancer recurrence. Demographic, pathologic, treatment, and outcome-related data were collected and analyzed using regression and survival analysis.
Estimates of recurrence-free survival suggested that black patients may be more likely to have disease recurrence, particularly those receiving ERT. Within a median follow-up of 3 years, 5 of 56 black patients with endometrial cancer in the ERT group were identified with recurrent disease compared with only 8 of 521 white patients. Adjusted for age, body mass index, and tumor grade, the relative risk of recurrence among blacks in the ERT group was 11.2 (95% confidence interval, 2.86-43.59; P = .0005).
The findings of the current study suggested that recurrence-free survival may be shorter among black women with stage I endometrial cancer, even in a clinical trials setting in which patients receive similar treatment and follow-up. This increased risk of recurrence appeared to be most evident in black women with endometrial cancer who maintained ERT after primary treatment. Cancer 2008. Published 2008 by the American Cancer Society.