Disparities in Endometrial Cancer Mortality: Will Increasing Use of Targeted Therapies Widen the Gap?

Importance: Incidence and mortality in endometrial cancer (EC) have been steadily increasing in the United States over the past two decades, with Black women experiencing disproportionately higher rates of advanced disease and cancer mortality. Recent treatment advances show promising improvements in EC survival, but as seen in other malignancies, access to and clinical benefits of these novel therapies are often not equitably shared.

Observations: In some gynecologic malignancies such as ovarian cancer, Black women are less likely than White women to receive targeted therapies for treatment of their disease. The reasons for this are multifactorial and include higher medication costs, decreased rates of insurance coverage, lower median income, lower rates of clinical trial enrollment, and lack of social support among Black patients. Several studies have examined racial differences in molecular tumor classification in EC, and these have shown that Black women are at least equally eligible for use of immunotherapy on the basis of tumor classification alone.

Conclusion and relevance: Immunotherapy is a recent addition to treatment of some advanced and recurrent ECs. On the basis of these findings alone, use of immunotherapy should be increased among Black patients given their higher rates of advanced disease at diagnosis. Yet trends in treatment of other malignancies raise concerns that Black patients may not have adequate access to targeted and immunotherapy agents for treatment of EC in the coming years.