Trends in Endometrial Cancer Incidence Among Premenopausal and Postmenopausal Women in the United States Between 2001 and 2021.

Background: Endometrial cancer incidence has been rising in the United States. We assessed trends in endometrial cancer incidence among both premenopausal and postmenopausal women in the US from 2001 to 2021. We also compared the incidence during 2019-2021 to assess the impact of the COVID-19 pandemic.

Methods: We used data from the United States Cancer Statistics 2001-2021 database to assess the incidence trends among adult females. Endometrial cancer incidence was corrected for hysterectomy prevalence and age, adjusted to the 2000 US standard population.

Results: From 2001 to 2021, the incidence of endometrial cancer rose from 86.8 cases to 113.8 cases per 1,000,000 persons among women aged 20-49 years (APC 1.5, 95% CI 1.2-1.8), while in women 70 and older, it increased from 1326.4 cases to 1339.4 cases per 1,000,000 persons (APC 0.3, 95% CI 0.1-0.6). The incidence has recently decreased among women aged 50-69 years (APC from 2001 to 2016 0.3, 95% CI 0.1-0.9; APC from 2016 to 2021 -1.3, 95% CI -2.2--0.3). Endometrial cancer incidence sharply increased from 2001 to 2021 among non-Hispanic Blacks, non-Hispanic Asians or Pacific Islanders, and women in the South. Endometrial cancer incidence sharply decreased from 2019 to 2020, and the proportion of metastatic cancer at diagnosis increased across all age groups. In 2021, the incidence returned to 2019 levels.

Conclusions: Endometrial cancer incidence rates are rising, particularly among premenopausal women. During the beginning of the COVID-19 pandemic, the incidence rates decreased, but the proportion of metastatic cancer increased.