Twenty-Year Temporal Patterns of Endometrial Cancer Burden: Race/Ethnicity and Age-Specific Incidence-Mortality Trends Among U.S. Women (Aged ≥20 Years), 2000-2019

Twenty-Year Temporal Patterns of Endometrial Cancer Burden: Race/Ethnicity and Age-Specific Incidence-Mortality Trends Among U.S. Women (Aged ≥20 Years), 2000-2019 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Twenty-Year Temporal Patterns of Endometrial Cancer Burden: Race/Ethnicity and Age-Specific Incidence-Mortality Trends Among U.S. Women (Aged ≥20 Years), 2000-2019 Xianying Cheng, Ping Wang, Li Cheng, Feng Zhao, Jiangang Liu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6138249/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Endometrial cancer is one of the most prevalent gynecologic malignancies. Over the past three decades, its incidence has increased significantly, while mortality has decreased. These trends vary by age and race/ethnicity. Methods We obtained endometrial cancer incidence and mortality data from the Surveillance, Epidemiology, and End Results (SEER) program registry. Trends were quantified by average annual percent change and annual percentage changes through Joinpoint Regression modeling. Results In total, 217,228 endometrial cancer patients were included in the incidence analysis, and 45,812 deaths were included in the mortality analysis. The overall age-standardized incidence rate was 32.76 cases per 100,000 person-years, and the incidence-based mortality was 20.57 deaths per 100,000 person-years. From 2000 to 2019, the overall incidence rate increased by 0.95% annually, while the mortality rate increased by 0.29% per year from 2005 to 2019. Between 2000–2019, all racial/ethnic groups experienced accelerating incidence trends, with non-Hispanic White women showing a distinct pattern: a 1.2% annual increase confined to 2003–2016. The incidence among young and middle-aged women increased rapidly, while that among elderly women decreased significantly (AAPC = -1.28%). Similarly, the mortality rates of endometrial cancer in young and middle-aged women were rising significantly. Conclusions The incidence and mortality of endometrial cancer vary significantly by age group and race/ethnicity. Trends indicate that the incidence and mortality of young and middle-aged women increased rapidly from 2000 to 2019. Although non-Hispanic whites represented the vast majority of cases, their trend was relatively stable compared to other ethnic groups. These findings may offer evidence for future research on endometrial cancer risk factors and for uncovering health disparities among women. Endometrial Cancer Age group Race/Ethnicity Incidence Mortality Figures Figure 1 Figure 2 Figure 3 Figure 4 What does this study add to the clinical work This study provided specific data on endometrial cancer incidence and mortality from 2000-2019. Trends in morbidity and mortality were also quantified for different age groups and racial/ethnic groups, with particular reference to the rapid upward trend in young and middle-aged women and the downward trend in older women. It also revealed significant differences in trends between non-Hispanic white females and other racial/ethnic groups. 1. Introduction In the past 30 years, the number of newly diagnosed endometrial cancer (EC) cases worldwide has increased by 1.32 times ( 1 ), with low-grade endometrioid adenocarcinoma accounting for the majority of new cases. This rise can be partially attributed to advancements in medical infrastructure and enhanced cancer surveillance capabilities. Alarmingly, projections suggest the U.S. incidence rate may exceed 40 cases per 100,000 women by 2030. Emerging evidence now confirms a true rise in endometrial cancer incidence ( 2 ). In the past, an estimated 49,560 cases and 8,190 deaths of uterine cancer were recorded. By 2018, these numbers had risen to 63,230 cases and 11,350 deaths ( 3 , 4 ). Notably, the incidence of early-stage, low-grade EC has been increasing among younger women ( 5 ). Thus, the increasing incidence of EC in young women suggests that targeted prevention strategies and fertility-sparing treatments are necessary ( 5 , 6 ). These epidemiological patterns parallel well-established risk factor distributions. Non-genetic risk factors associated with EC include obesity, aging population, excess exogenous estrogen, insulin resistance ( 7 ), and tamoxifen use ( 8 – 10 ). Over the last four decades, there has been a rising trend in overweight among children and adolescents, especially in developed countries ( 11 ). Globally, endometrial cancer (EC) incidence and mortality rates exhibit significant disparities across nations ( 1 ). The most significant increase in incidence has occurred in high-income countries ( 12 ). Racial differences also contribute to the varying incidence of EC ( 13 ). Although the global incidence of EC has increased, mortality rates have decreased, despite the higher number of endometrial cancer-related deaths ( 1 ). Given the increasing incidence of EC in young women and the differences among different races, we analyzed Surveillance, Epidemiology, and End Results (SEER) program data (2000–2019), stratifying incidence and mortality trends by age groups and race/ethnicity. 2. Methods Data Sources The analysis included EC cases diagnosed between 2000–2019 from the SEER-17 program ( 14 ). This population-based registry comprises 17 high-quality cancer registries across the United States, representing approximately 26% of the national population. Demographic variables and tumor characteristics were retrieved from individual patient records within the database. Mortality data were obtained from patients’ death certificates. Age-adjusted incidence rates were calculated by the SEER-17 incidence file. Incidence-based mortality rates were provided by the SEER-8 incidence-based mortality file ( 15 ). Mortality analyses were restricted to deaths occurring during 2000–2019, with diagnostic years extended to 1975–2019 to optimize case ascertainment and minimize temporal bias. Demographic Characteristics Demographic variables included race/ethnicity, age at diagnosis, annual household income, and rural-urban distribution. These data were abstracted from standardized medical records and official death certificates. Age stratification followed 20-year cohorts: 20–39, 40–59, 60–79 and 80 + years old. Annual household income was divided into low- and high-income groups based on $ 75,000. Tumor Characteristics Endometrial cancer cases were identified using the International Classification of Diseases for Oncology, Third Edition (ICD-O-3), with topography codes C54 and C55. Only patients with malignant behavior (ICD-O-3 behavior code: /3) and microscopically confirmed were selected. Summary stage 2000 (1998–2017) and Combined Summary Stage (2004+) classified cancer as localized, regional, distant and unknown. FIGO staging corresponded to the American Joint Committee on Cancer staging system (AJCC stage 3rd for 1988–2003; AJCC stage group 6th for 2004–2015; AJCC stage group 7th for 2016–2017; AJCC stage group 8th for 2018+). Beginning in 1983, patients' tumor size was recorded in SEER database according to 4 different codes (Extent of Disease 4-digit [EOD-4; 1983–1987], EOD 10-digit [EOD-10; 1988–2003], Collaborative Stage [CS; 2004–2015], Tumor Size Summary [2016+]). Statistical Analysis SEER*Stat 8.4.0.1 was used to calculate incidence and mortality rates. These rates were expressed as per 100,000 person-years. All rates were adjusted to 2000 US Std Population. Patients whose cancers were identified solely by autopsy or death certificates were excluded. Trends were quantified using annual percentage changes (APC) and average annual percent change (AAPC). This quantification was carried out by the Joinpoint program, version 4.9.0.1. A two-side P < 0.05 was considered statistically significant. 3. Results Between 2000 and 2019, the SEER-17 database recorded 217,228 patients diagnosed with EC. The overall incidence rate was 32.76 cases per 100,000 person-years (Table 1). Among these, EC was the predominant histological type, accounting for 172,305 cases with an incidence rate of 26.04 per 100,000 person-years. By race/ethnicity, non-Hispanic whites constituted the largest group (152,307 cases) and exhibited the highest incidence rate at 34.62 per 100,000 person-years. The 60–79 age group had the highest incidence (89.51 cases per 100,000 person-years), followed by those over 80 years old (58.78 cases per 100,000 person-years). During the same period, the SEER-8 database documented 45,812 EC-related deaths. The incidence-based mortality rate was 20.57 deaths per 100,000 person-years. Endometrioid carcinoma was also the leading histological type in mortality, with 37,217 deaths and a rate of 16.50 per 100,000 person-years. Whites and the elderly represented the majority of deaths. Notably, individuals over 80 years old had a significantly higher mortality rate (228.05 deaths per 100,000 person-years) compared to other age groups. Racial/ethnic differences in EC incidence by histologic type were presented in Fig. 1. Endometrioid carcinoma incidence was highest among non-Hispanic whites (age-adjusted incidence rate [AIR] = 28.45; 95% CI, 28.29–28.62) and lowest among non-Hispanic blacks (AIR = 18.10; 95% CI, 17.77–18.43), with the latter group’s incidence being 63.6% of that in non-Hispanic whites (Fig. 1A). Serous carcinoma incidence was highest in non-Hispanic blacks (AIR = 4.89; 95% CI, 4.71–5.07), more than double the rate observed in other racial/ethnic groups (Fig. 1B). Similarly, carcinosarcoma incidence was highest in non-Hispanic blacks (AIR = 4.08; 95% CI, 3.92–4.24), significantly exceeding rates in other groups (Fig. 1C). In contrast, clear cell carcinoma incidence was lowest in non-Hispanic whites (AIR = 0.41; 95% CI, 0.39–0.43) and highest in non-Hispanic blacks (AIR = 0.78; 95% CI, 0.71–0.86), with the latter group’s incidence being 1.89 times higher (Fig. 1D). Finally, mixed carcinoma incidence was highest in non-Hispanic whites (AIR = 1.76; 95% CI, 1.73–1.80) and lowest in American Indians or Alaska Natives (AIR = 1.09; 95% CI, 0.81–1.44), representing 61.9% of the incidence in non-Hispanic whites (Fig. 1E). We analyzed SEER-17 data from 2000 to 2019 to investigate trends in EC incidence among aged 20 years and above, stratified by race/ethnicity and age groups (Table 2 and Fig. 2). A modest annual increase in EC incidence was observed from 2000 to 2019, with an average annual percent change (AAPC) of 0.95%. Overall, EC incidence remained stable from 2000 to 2003 but increased at an average annual rate of 1.4% from 2003 to 2019. From 2000 to 2019, EC incidence among non-Hispanic white women remained stable, although it increased at an average annual rate of 1.2% from 2003 to 2016. Among other racial/ethnic groups, EC incidence showed consistent and rapid annual increases from 2000 to 2019 (Fig. 2A). Among women under 60 years, EC incidence rose at an average annual rate of 3.49% from 2000 to 2019 for those aged 20–39 years and 1.16% for those aged 40–59 years. For women aged 60–79 years, EC incidence decreased at an average annual rate of 2.15% from 2000 to 2004, followed by an increase of 2.42% per year from 2004 to 2012 and 1.09% per year from 2012 to 2019. Among women aged 80 years and older, EC incidence declined at an average annual rate of 2.80% from 2000 to 2006 and continued to decrease at a rate of 0.57% per year from 2006 to 2019 (Fig. 2B). We utilized SEER-8 incidence-based mortality data to analyze trends in EC mortality among women aged 20 years and older, stratified by race and age groups (Table 2 and Fig. 3). The overall mortality rate remained stable from 2000 to 2019, with an AAPC of 0.30. However, the APC showed a significant increase of 0.29% from 2005 to 2019. Mortality rates increased significantly across all racial groups, with the smallest increase observed among white women (APC = 0.17%) (Fig. 3A). Among different age groups, significant increases in mortality were observed among young women (aged 20–39 years) and middle-aged women (aged 40–59 years). Additionally, mortality increased at an average annual rate of 0.78% from 2006 to 2019 for women aged 60–79 years, while it decreased at a rate of 0.37% per year from 2002 to 2019 for women aged 80 years and older (Fig. 3B). Figure 4 presents the AAPC in the incidence of EC among women aged 20 years and older, stratified by race/ethnicity and age group. Among women aged 20–39 years, the incidence among Hispanic women increased at an average annual rate of 5.05%, which was the largest increase among all age groups and race/ethnicities. In the same age group, non-Hispanic White and non-Hispanic Black women also had an increased incidence. For women aged 40–59 and 60–79 years, the incidence remained stable among non-Hispanic White women. However, it increased for other race/ethnic groups. Among women aged 80 years and older, the incidence among all race/ethnic groups was stable. 4. Discussion This study examines EC incidence and mortality trends over a 20-year period, revealing significant variations by age and race/ethnicity. Incidence rates were calculated using data from approximately 26% of the US population, while mortality rates were derived from about 9% of the US population. The findings indicate that EC incidence among women aged 20 years and older increased from 2000 to 2019. Incidence rates increased rapidly among young and middle-aged women but declined among elderly women. Among women aged 20–39 years, Hispanic women experienced the fastest increase in incidence, whereas among women aged 40–59 years, non-Hispanic American Indian or Alaska Native women showed the highest increase. Additionally, EC mortality increased from 2005 to 2019, with the highest increases observed among young and middle-aged women. A prior SEER study reported similar findings: between 1992 and 2012, the incidence rate among women under 50 years old increased by 2% per year ( 16 ). A global epidemiological survey on EC revealed a 1.32-fold increase in overall incidence over the past 30 years, with rising rates observed in 160 countries or regions worldwide. However, EC mortality showed a significant decline during this period, with an APC of -0.85% (95% CI: -0.93% to -0.76%) ( 1 ). Another study found that while EC incidence increased across all age groups, the rate of increase doubled among women under 40 years of age, accounting for 4.2% of low-grade endometrial cancer cases ( 5 ). In the United States, Black women exhibit more aggressive EC and worse progression-free survival compared to White women ( 13 ). The observed variations in EC incidence and outcomes by age and race/ethnicity warrant further investigation. Obesity is recognized as one of the primary risk factors for EC. Approximately 50% of newly diagnosed EC cases are attributed solely to obesity ( 17 ). Obese women face a 2.4 to 4.5 times higher risk of EC compared to women with normal weight ( 18 ). The primary mechanism through which obesity promotes EC development involves the conversion of androgens to estrogens by adipocytes, stimulating endometrial hyperplasia and ultimately leading to cancer ( 19 , 20 ). Additionally, obesity-related hyperglycemia and insulin resistance can activate the IGF-1 and mTOR signaling pathways, resulting in increased cell proliferation. Inflammation, oxidative stress, and physiological changes in cytokines, steroid hormones, and adipokines further contribute to the development of EC in obese women ( 21 , 22 ). Over the past four decades, the prevalence of overweight and obesity has steadily increased among adults and children, becoming a global epidemic ( 11 ). This trend may explain the rapid rise in EC incidence among young and middle-aged individuals. Improved lifestyle habits and intentional weight loss have been strongly associated with a reduced risk of EC ( 23 ). The risk factors of EC also include advanced age, certain ethnic groups, estrogen exposure, tamoxifen use, and metabolic syndrome. Studies indicated that EC incidence and mortality were influenced by socioeconomic status (SES) and race/ethnicity. A Swedish study, using income, social class, and education as measures, found that women with higher SES were less likely to develop advanced EC and had better access to care and improved outcomes compared to those with lower SES ( 24 ). Compared to white women, black women showed no advantages in EC diagnosis, access to care, or prognosis ( 25 , 26 ). The primary causes of racial disparities in EC include cultural barriers, limited access to treatment, comorbidities, inequities in treatment, and tumor biology ( 27 , 28 ). Despite over a decade of increased awareness and initiatives to address racial disparities, black women continue to face a higher risk of death from EC ( 29 ). As demonstrated in our findings, the increase in EC mortality was significantly higher among black women compared to white women. Several limitations of this study should be noted. Due to the descriptive nature of this study, the reliability and accuracy of the findings depend on the quality and completeness of the SEER database. Second, a limitation of this study was that while the incidence database includes Hispanic categories, the mortality database does not, restricting racial classifications to White, Black, and Other. As shown in Table 1, although many variables related to EC were included, the SEER database lacks individual-level risk factors, lifestyle-related factors, and EC screening methods. Consequently, accurately assessing the impact of these risk factors on EC incidence and mortality was challenging, and our analysis was limited to providing potential explanations. 5. Conclusions Endometrial cancer incidence and mortality varied significantly across age groups and race/ethnicity. Trends revealed a rapid increase in EC incidence and mortality among young and middle-aged women from 2000 to 2019. Although non-Hispanic white women represented the majority of cases, their trends remained relatively stable compared to other racial/ethnic groups. These findings may inform future research on endometrial cancer risk factors and highlight health disparities among women. Declarations Ethical Statement: Not applicable. Acknowledgments : None Conflicts of Interest: The authors declare that they have no competing interests. Funding: None Author Contribution The conception or design of the work: JGL and XYC; analysis or interpretation of data for the work: XYC, PW and LC; drafting the work: XYC, FZ and LC; provide approval for publication of the content: all authors; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: JGL. References Gu B, Shang X, Yan M, Li X, Wang W, Wang Q, et al. Variations in incidence and mortality rates of endometrial cancer at the global, regional, and national levels, 1990–2019. Gynecol Oncol. 2021;161(2):573–80. Brooks RA, Fleming GF, Lastra RR, Lee NK, Moroney JW, Son CH, et al. Current recommendations and recent progress in endometrial cancer. CA Cancer J Clin. 2019;69(4):258–79. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. 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Yap OW, Matthews RP. Racial and ethnic disparities in cancers of the uterine corpus. J Natl Med Assoc. 2006;98(12):1930–3. Huang AB, Huang Y, Hur C, Tergas AI, Khoury-Collado F, Melamed A, et al. Impact of quality of care on racial disparities in survival for endometrial cancer. Am J Obstet Gynecol. 2020;223(3):396 e1- e13. Tables Table 1 and 2 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Tables.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6138249","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":423763168,"identity":"dd14b99b-a705-4c66-9167-869ea7ccee1b","order_by":0,"name":"Xianying Cheng","email":"","orcid":"","institution":"Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College","correspondingAuthor":false,"prefix":"","firstName":"Xianying","middleName":"","lastName":"Cheng","suffix":""},{"id":423763169,"identity":"34d6cb00-bcce-4bc0-b719-0ccc3fd045d4","order_by":1,"name":"Ping Wang","email":"","orcid":"","institution":"Zouping People's Hospital, Binzhou, Shandong, China","correspondingAuthor":false,"prefix":"","firstName":"Ping","middleName":"","lastName":"Wang","suffix":""},{"id":423763170,"identity":"99611706-8cf8-4c15-b03c-21486cb767d7","order_by":2,"name":"Li Cheng","email":"","orcid":"","institution":"Affiliated Hangzhou Xixi Hospital Zhejiang University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Cheng","suffix":""},{"id":423763171,"identity":"c6b4b6c7-f96d-4235-a63f-d917af6166f1","order_by":3,"name":"Feng Zhao","email":"","orcid":"","institution":"Zouping People's Hospital, Binzhou, Shandong, China","correspondingAuthor":false,"prefix":"","firstName":"Feng","middleName":"","lastName":"Zhao","suffix":""},{"id":423763172,"identity":"e766d4e7-a4ac-40fc-894e-8430dcf24695","order_by":4,"name":"Jiangang Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAw0lEQVRIiWNgGAWjYFCCA2BSjo29/QBpWoz5eM4kkGZX4jwJBwPilMo3njF+8XNHbXqbBEMCw4+KbYS1MDacMbPsPXM8t0268QBjz5nbhLUwM5wxM+BtO5bbJnMggZmxjQgtbEAthn/bjqWzSSQYEKeFh+GM8WPetpoE4rVIMBwrY5ZtO2DYBgzkg0T5RX7G4c0f37bVycu3tx988KOCCC0MEgfYJBgYDoPZB4hQDwT8DcwfGBjqiFM8CkbBKBgFIxMAAM1hPn1F7J0EAAAAAElFTkSuQmCC","orcid":"","institution":"Puren Hospital Affiliated to Wuhan University of Science and Technology","correspondingAuthor":true,"prefix":"","firstName":"Jiangang","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2025-03-02 08:38:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6138249/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6138249/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":78251673,"identity":"85d2c59b-ce79-4edb-8c3c-c37adfd048d4","added_by":"auto","created_at":"2025-03-11 10:02:29","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":442451,"visible":true,"origin":"","legend":"\u003cp\u003eAverage Annual Age-Adjusted Incidence Rates and 95% Confidence Intervals for Selected Endometrial Cancer Histology by Race or Ethnicity and Incidence Rate Ratios (IRR) Compared with Non-Hispanic Whites. NHW, Non-Hispanic Whites; HW, Hispanic white; AIAN, American Indian or Alaska Native; API, Asian or Pacific Islander.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6138249/v1/a0ca516bbcdb02cc93fc6403.jpeg"},{"id":78249165,"identity":"9c29e0d8-1ab7-46a6-962d-b41626c663dc","added_by":"auto","created_at":"2025-03-11 09:46:29","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":330282,"visible":true,"origin":"","legend":"\u003cp\u003eTrends in Annual Endometrial Cancer Incidence Rates. (A) Trends in Incidence according to Race/Ethnicity; (B) Trends in Incidence according to Age Group.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6138249/v1/fd1a72f2f3aae160a7d19606.jpeg"},{"id":78249172,"identity":"4ce77231-0da6-4ab8-aa1a-d7ed50479013","added_by":"auto","created_at":"2025-03-11 09:46:29","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":263611,"visible":true,"origin":"","legend":"\u003cp\u003eTrends in Annual Endometrial Cancer Mortality Rates. (A) Trends in Mortality according to Race/Ethnicity; (B) Trends in Mortality according to Age Group.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6138249/v1/2b13340d2159e2cf69048267.jpeg"},{"id":78249167,"identity":"49a5157f-b6fa-4e1e-aac1-cc6f18bccc48","added_by":"auto","created_at":"2025-03-11 09:46:29","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":293481,"visible":true,"origin":"","legend":"\u003cp\u003eAverage Annual Percent Change in Endometrial Cancer Incidence among Women Aged ≥20 Years by Race/Ethnicity and Age Group.\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6138249/v1/c49b9cd0559be1833079d12d.jpeg"},{"id":78532041,"identity":"82bb7ecb-091d-4061-bdc4-8e9ec7909698","added_by":"auto","created_at":"2025-03-14 14:08:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1742706,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6138249/v1/a084f2c0-7ba4-4860-9b9b-bfa556e75284.pdf"},{"id":78249163,"identity":"0b1ef014-fe42-4da7-8e8f-7d6989b50ac3","added_by":"auto","created_at":"2025-03-11 09:46:28","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":26570,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-6138249/v1/cefbfb25412b9b96834336ea.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Twenty-Year Temporal Patterns of Endometrial Cancer Burden: Race/Ethnicity and Age-Specific Incidence-Mortality Trends Among U.S. Women (Aged ≥20 Years), 2000-2019","fulltext":[{"header":"What does this study add to the clinical work","content":"\u003cp\u003eThis study provided specific data on endometrial cancer incidence and mortality from 2000-2019. Trends in morbidity and mortality were also quantified for different age groups and racial/ethnic groups, with particular reference to the rapid upward trend in young and middle-aged women and the downward trend in older women. It also revealed significant differences in trends between non-Hispanic white females and other racial/ethnic groups.\u003c/p\u003e"},{"header":"1. Introduction","content":"\u003cp\u003eIn the past 30 years, the number of newly diagnosed endometrial cancer (EC) cases worldwide has increased by 1.32 times (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), with low-grade endometrioid adenocarcinoma accounting for the majority of new cases. This rise can be partially attributed to advancements in medical infrastructure and enhanced cancer surveillance capabilities. Alarmingly, projections suggest the U.S. incidence rate may exceed 40 cases per 100,000 women by 2030.\u003c/p\u003e \u003cp\u003eEmerging evidence now confirms a true rise in endometrial cancer incidence (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In the past, an estimated 49,560 cases and 8,190 deaths of uterine cancer were recorded. By 2018, these numbers had risen to 63,230 cases and 11,350 deaths (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Notably, the incidence of early-stage, low-grade EC has been increasing among younger women (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Thus, the increasing incidence of EC in young women suggests that targeted prevention strategies and fertility-sparing treatments are necessary (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). These epidemiological patterns parallel well-established risk factor distributions. Non-genetic risk factors associated with EC include obesity, aging population, excess exogenous estrogen, insulin resistance (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), and tamoxifen use (\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Over the last four decades, there has been a rising trend in overweight among children and adolescents, especially in developed countries (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGlobally, endometrial cancer (EC) incidence and mortality rates exhibit significant disparities across nations (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The most significant increase in incidence has occurred in high-income countries (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Racial differences also contribute to the varying incidence of EC (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Although the global incidence of EC has increased, mortality rates have decreased, despite the higher number of endometrial cancer-related deaths (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven the increasing incidence of EC in young women and the differences among different races, we analyzed Surveillance, Epidemiology, and End Results (SEER) program data (2000\u0026ndash;2019), stratifying incidence and mortality trends by age groups and race/ethnicity.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eData Sources\u003c/p\u003e \u003cp\u003eThe analysis included EC cases diagnosed between 2000\u0026ndash;2019 from the SEER-17 program (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). This population-based registry comprises 17 high-quality cancer registries across the United States, representing approximately 26% of the national population. Demographic variables and tumor characteristics were retrieved from individual patient records within the database. Mortality data were obtained from patients\u0026rsquo; death certificates. Age-adjusted incidence rates were calculated by the SEER-17 incidence file. Incidence-based mortality rates were provided by the SEER-8 incidence-based mortality file (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Mortality analyses were restricted to deaths occurring during 2000\u0026ndash;2019, with diagnostic years extended to 1975\u0026ndash;2019 to optimize case ascertainment and minimize temporal bias.\u003c/p\u003e \u003cp\u003eDemographic Characteristics\u003c/p\u003e \u003cp\u003eDemographic variables included race/ethnicity, age at diagnosis, annual household income, and rural-urban distribution. These data were abstracted from standardized medical records and official death certificates. Age stratification followed 20-year cohorts: 20\u0026ndash;39, 40\u0026ndash;59, 60\u0026ndash;79 and 80\u0026thinsp;+\u0026thinsp;years old. Annual household income was divided into low- and high-income groups based on \u003cspan\u003e$\u003c/span\u003e75,000.\u003c/p\u003e \u003cp\u003eTumor Characteristics\u003c/p\u003e \u003cp\u003eEndometrial cancer cases were identified using the International Classification of Diseases for Oncology, Third Edition (ICD-O-3), with topography codes C54 and C55. Only patients with malignant behavior (ICD-O-3 behavior code: /3) and microscopically confirmed were selected. Summary stage 2000 (1998\u0026ndash;2017) and Combined Summary Stage (2004+) classified cancer as localized, regional, distant and unknown. FIGO staging corresponded to the American Joint Committee on Cancer staging system (AJCC stage 3rd for 1988\u0026ndash;2003; AJCC stage group 6th for 2004\u0026ndash;2015; AJCC stage group 7th for 2016\u0026ndash;2017; AJCC stage group 8th for 2018+). Beginning in 1983, patients' tumor size was recorded in SEER database according to 4 different codes (Extent of Disease 4-digit [EOD-4; 1983\u0026ndash;1987], EOD 10-digit [EOD-10; 1988\u0026ndash;2003], Collaborative Stage [CS; 2004\u0026ndash;2015], Tumor Size Summary [2016+]).\u003c/p\u003e \u003cp\u003eStatistical Analysis\u003c/p\u003e \u003cp\u003eSEER*Stat 8.4.0.1 was used to calculate incidence and mortality rates. These rates were expressed as per 100,000 person-years. All rates were adjusted to 2000 US Std Population. Patients whose cancers were identified solely by autopsy or death certificates were excluded. Trends were quantified using annual percentage changes (APC) and average annual percent change (AAPC). This quantification was carried out by the Joinpoint program, version 4.9.0.1. A two-side P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eBetween 2000 and 2019, the SEER-17 database recorded 217,228 patients diagnosed with EC. The overall incidence rate was 32.76 cases per 100,000 person-years (Table\u0026nbsp;1). Among these, EC was the predominant histological type, accounting for 172,305 cases with an incidence rate of 26.04 per 100,000 person-years. By race/ethnicity, non-Hispanic whites constituted the largest group (152,307 cases) and exhibited the highest incidence rate at 34.62 per 100,000 person-years. The 60\u0026ndash;79 age group had the highest incidence (89.51 cases per 100,000 person-years), followed by those over 80 years old (58.78 cases per 100,000 person-years). During the same period, the SEER-8 database documented 45,812 EC-related deaths. The incidence-based mortality rate was 20.57 deaths per 100,000 person-years. Endometrioid carcinoma was also the leading histological type in mortality, with 37,217 deaths and a rate of 16.50 per 100,000 person-years. Whites and the elderly represented the majority of deaths. Notably, individuals over 80 years old had a significantly higher mortality rate (228.05 deaths per 100,000 person-years) compared to other age groups.\u003c/p\u003e\n\u003cp\u003eRacial/ethnic differences in EC incidence by histologic type were presented in Fig. 1. Endometrioid carcinoma incidence was highest among non-Hispanic whites (age-adjusted incidence rate [AIR]\u0026thinsp;=\u0026thinsp;28.45; 95% CI, 28.29\u0026ndash;28.62) and lowest among non-Hispanic blacks (AIR\u0026thinsp;=\u0026thinsp;18.10; 95% CI, 17.77\u0026ndash;18.43), with the latter group\u0026rsquo;s incidence being 63.6% of that in non-Hispanic whites (Fig. 1A). Serous carcinoma incidence was highest in non-Hispanic blacks (AIR\u0026thinsp;=\u0026thinsp;4.89; 95% CI, 4.71\u0026ndash;5.07), more than double the rate observed in other racial/ethnic groups (Fig. 1B). Similarly, carcinosarcoma incidence was highest in non-Hispanic blacks (AIR\u0026thinsp;=\u0026thinsp;4.08; 95% CI, 3.92\u0026ndash;4.24), significantly exceeding rates in other groups (Fig. 1C). In contrast, clear cell carcinoma incidence was lowest in non-Hispanic whites (AIR\u0026thinsp;=\u0026thinsp;0.41; 95% CI, 0.39\u0026ndash;0.43) and highest in non-Hispanic blacks (AIR\u0026thinsp;=\u0026thinsp;0.78; 95% CI, 0.71\u0026ndash;0.86), with the latter group\u0026rsquo;s incidence being 1.89 times higher (Fig. 1D). Finally, mixed carcinoma incidence was highest in non-Hispanic whites (AIR\u0026thinsp;=\u0026thinsp;1.76; 95% CI, 1.73\u0026ndash;1.80) and lowest in American Indians or Alaska Natives (AIR\u0026thinsp;=\u0026thinsp;1.09; 95% CI, 0.81\u0026ndash;1.44), representing 61.9% of the incidence in non-Hispanic whites (Fig. 1E).\u003c/p\u003e\n\u003cp\u003eWe analyzed SEER-17 data from 2000 to 2019 to investigate trends in EC incidence among aged 20 years and above, stratified by race/ethnicity and age groups (Table\u0026nbsp;2 and Fig.\u0026nbsp;2). A modest annual increase in EC incidence was observed from 2000 to 2019, with an average annual percent change (AAPC) of 0.95%. Overall, EC incidence remained stable from 2000 to 2003 but increased at an average annual rate of 1.4% from 2003 to 2019. From 2000 to 2019, EC incidence among non-Hispanic white women remained stable, although it increased at an average annual rate of 1.2% from 2003 to 2016. Among other racial/ethnic groups, EC incidence showed consistent and rapid annual increases from 2000 to 2019 (Fig.\u0026nbsp;2A). Among women under 60 years, EC incidence rose at an average annual rate of 3.49% from 2000 to 2019 for those aged 20\u0026ndash;39 years and 1.16% for those aged 40\u0026ndash;59 years. For women aged 60\u0026ndash;79 years, EC incidence decreased at an average annual rate of 2.15% from 2000 to 2004, followed by an increase of 2.42% per year from 2004 to 2012 and 1.09% per year from 2012 to 2019. Among women aged 80 years and older, EC incidence declined at an average annual rate of 2.80% from 2000 to 2006 and continued to decrease at a rate of 0.57% per year from 2006 to 2019 (Fig.\u0026nbsp;2B).\u003c/p\u003e\n\u003cp\u003eWe utilized SEER-8 incidence-based mortality data to analyze trends in EC mortality among women aged 20 years and older, stratified by race and age groups (Table 2 and Fig. 3). The overall mortality rate remained stable from 2000 to 2019, with an AAPC of 0.30. However, the APC showed a significant increase of 0.29% from 2005 to 2019. Mortality rates increased significantly across all racial groups, with the smallest increase observed among white women (APC\u0026thinsp;=\u0026thinsp;0.17%) (Fig. 3A). Among different age groups, significant increases in mortality were observed among young women (aged 20\u0026ndash;39 years) and middle-aged women (aged 40\u0026ndash;59 years). Additionally, mortality increased at an average annual rate of 0.78% from 2006 to 2019 for women aged 60\u0026ndash;79 years, while it decreased at a rate of 0.37% per year from 2002 to 2019 for women aged 80 years and older (Fig. 3B).\u003c/p\u003e\n\u003cp\u003eFigure 4 presents the AAPC in the incidence of EC among women aged 20 years and older, stratified by race/ethnicity and age group. Among women aged 20\u0026ndash;39 years, the incidence among Hispanic women increased at an average annual rate of 5.05%, which was the largest increase among all age groups and race/ethnicities. In the same age group, non-Hispanic White and non-Hispanic Black women also had an increased incidence. For women aged 40\u0026ndash;59 and 60\u0026ndash;79 years, the incidence remained stable among non-Hispanic White women. However, it increased for other race/ethnic groups. Among women aged 80 years and older, the incidence among all race/ethnic groups was stable.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study examines EC incidence and mortality trends over a 20-year period, revealing significant variations by age and race/ethnicity. Incidence rates were calculated using data from approximately 26% of the US population, while mortality rates were derived from about 9% of the US population. The findings indicate that EC incidence among women aged 20 years and older increased from 2000 to 2019. Incidence rates increased rapidly among young and middle-aged women but declined among elderly women. Among women aged 20\u0026ndash;39 years, Hispanic women experienced the fastest increase in incidence, whereas among women aged 40\u0026ndash;59 years, non-Hispanic American Indian or Alaska Native women showed the highest increase. Additionally, EC mortality increased from 2005 to 2019, with the highest increases observed among young and middle-aged women.\u003c/p\u003e \u003cp\u003eA prior SEER study reported similar findings: between 1992 and 2012, the incidence rate among women under 50 years old increased by 2% per year (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). A global epidemiological survey on EC revealed a 1.32-fold increase in overall incidence over the past 30 years, with rising rates observed in 160 countries or regions worldwide. However, EC mortality showed a significant decline during this period, with an APC of -0.85% (95% CI: -0.93% to -0.76%) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Another study found that while EC incidence increased across all age groups, the rate of increase doubled among women under 40 years of age, accounting for 4.2% of low-grade endometrial cancer cases (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In the United States, Black women exhibit more aggressive EC and worse progression-free survival compared to White women (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The observed variations in EC incidence and outcomes by age and race/ethnicity warrant further investigation.\u003c/p\u003e \u003cp\u003eObesity is recognized as one of the primary risk factors for EC. Approximately 50% of newly diagnosed EC cases are attributed solely to obesity (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Obese women face a 2.4 to 4.5 times higher risk of EC compared to women with normal weight (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The primary mechanism through which obesity promotes EC development involves the conversion of androgens to estrogens by adipocytes, stimulating endometrial hyperplasia and ultimately leading to cancer (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Additionally, obesity-related hyperglycemia and insulin resistance can activate the IGF-1 and mTOR signaling pathways, resulting in increased cell proliferation. Inflammation, oxidative stress, and physiological changes in cytokines, steroid hormones, and adipokines further contribute to the development of EC in obese women (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Over the past four decades, the prevalence of overweight and obesity has steadily increased among adults and children, becoming a global epidemic (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). This trend may explain the rapid rise in EC incidence among young and middle-aged individuals. Improved lifestyle habits and intentional weight loss have been strongly associated with a reduced risk of EC (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The risk factors of EC also include advanced age, certain ethnic groups, estrogen exposure, tamoxifen use, and metabolic syndrome.\u003c/p\u003e \u003cp\u003eStudies indicated that EC incidence and mortality were influenced by socioeconomic status (SES) and race/ethnicity. A Swedish study, using income, social class, and education as measures, found that women with higher SES were less likely to develop advanced EC and had better access to care and improved outcomes compared to those with lower SES (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Compared to white women, black women showed no advantages in EC diagnosis, access to care, or prognosis (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). The primary causes of racial disparities in EC include cultural barriers, limited access to treatment, comorbidities, inequities in treatment, and tumor biology (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Despite over a decade of increased awareness and initiatives to address racial disparities, black women continue to face a higher risk of death from EC (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). As demonstrated in our findings, the increase in EC mortality was significantly higher among black women compared to white women.\u003c/p\u003e \u003cp\u003eSeveral limitations of this study should be noted. Due to the descriptive nature of this study, the reliability and accuracy of the findings depend on the quality and completeness of the SEER database. Second, a limitation of this study was that while the incidence database includes Hispanic categories, the mortality database does not, restricting racial classifications to White, Black, and Other. As shown in Table\u0026nbsp;1, although many variables related to EC were included, the SEER database lacks individual-level risk factors, lifestyle-related factors, and EC screening methods. Consequently, accurately assessing the impact of these risk factors on EC incidence and mortality was challenging, and our analysis was limited to providing potential explanations.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eEndometrial cancer incidence and mortality varied significantly across age groups and race/ethnicity. Trends revealed a rapid increase in EC incidence and mortality among young and middle-aged women from 2000 to 2019. Although non-Hispanic white women represented the majority of cases, their trends remained relatively stable compared to other racial/ethnic groups. These findings may inform future research on endometrial cancer risk factors and highlight health disparities among women.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Statement:\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e: None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe conception or design of the work: JGL and XYC; analysis or interpretation of data for the work: XYC, PW and LC; drafting the work: XYC, FZ and LC; provide approval for publication of the content: all authors; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: JGL.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGu B, Shang X, Yan M, Li X, Wang W, Wang Q, et al. 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Cancer Epidemiol Biomarkers Prev. 2002;11(12):1531\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCalle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348(17):1625\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCollaboration NCDRF. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet. 2017;390(10113):2627\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrosbie EJ, Kitson SJ, McAlpine JN, Mukhopadhyay A, Powell ME, Singh N. Endometrial cancer. Lancet. 2022;399(10333):1412\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDubil EA, Tian C, Wang G, Tarney CM, Bateman NW, Levine DA, et al. 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Am J Obstet Gynecol. 2020;223(3):396 e1- e13.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 and 2 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Endometrial Cancer, Age group, Race/Ethnicity, Incidence, Mortality","lastPublishedDoi":"10.21203/rs.3.rs-6138249/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6138249/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEndometrial cancer is one of the most prevalent gynecologic malignancies. Over the past three decades, its incidence has increased significantly, while mortality has decreased. These trends vary by age and race/ethnicity.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe obtained endometrial cancer incidence and mortality data from the Surveillance, Epidemiology, and End Results (SEER) program registry. Trends were quantified by average annual percent change and annual percentage changes through Joinpoint Regression modeling.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn total, 217,228 endometrial cancer patients were included in the incidence analysis, and 45,812 deaths were included in the mortality analysis. The overall age-standardized incidence rate was 32.76 cases per 100,000 person-years, and the incidence-based mortality was 20.57 deaths per 100,000 person-years. From 2000 to 2019, the overall incidence rate increased by 0.95% annually, while the mortality rate increased by 0.29% per year from 2005 to 2019. Between 2000\u0026ndash;2019, all racial/ethnic groups experienced accelerating incidence trends, with non-Hispanic White women showing a distinct pattern: a 1.2% annual increase confined to 2003\u0026ndash;2016. The incidence among young and middle-aged women increased rapidly, while that among elderly women decreased significantly (AAPC = -1.28%). Similarly, the mortality rates of endometrial cancer in young and middle-aged women were rising significantly.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe incidence and mortality of endometrial cancer vary significantly by age group and race/ethnicity. Trends indicate that the incidence and mortality of young and middle-aged women increased rapidly from 2000 to 2019. Although non-Hispanic whites represented the vast majority of cases, their trend was relatively stable compared to other ethnic groups. These findings may offer evidence for future research on endometrial cancer risk factors and for uncovering health disparities among women.\u003c/p\u003e","manuscriptTitle":"Twenty-Year Temporal Patterns of Endometrial Cancer Burden: Race/Ethnicity and Age-Specific Incidence-Mortality Trends Among U.S. Women (Aged ≥20 Years), 2000-2019","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-11 09:46:24","doi":"10.21203/rs.3.rs-6138249/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6b47ce2f-0ea8-4824-aba3-4c383a828954","owner":[],"postedDate":"March 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-14T14:08:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-11 09:46:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6138249","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6138249","identity":"rs-6138249","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}