Published online Oct 24, 2019. doi: 10.5306/wjco.v10.i10.340
Peer-review started: May 14, 2019
First decision: August 16, 2019
Revised: August 22, 2019
Accepted: September 20, 2019
Article in press: September 20, 2019
Published online: October 24, 2019
Black women are known to have a higher risk of aggressive endometrial cancers. Little data exist about the role of nativity as a determinant of survival outcomes in women with this disease.
Our objective was to evaluate a population of Haitian immigrants with endometrial cancer in an urban setting using the Florida Cancer Data System (FCDS).
A search of FCDS identified 107 women born in Haiti and who received treatment for invasive endometrial cancer in Miami-Dade County between 1989 and 2013. Clinicopathologic data were extracted to describe the cohort and assess associations with overall survival. Statistical analyses were performed using Cox proportional hazards models, the log-rank test, and the Kaplan-Meier method, with significance set at P ≤ 0.05.
Median age at diagnosis was 65 years. 63.9% of the patients had a type II, high-grade, histology, and 52.6% presented with extrauterine metastatic disease. Nearly three quarters had health insurance. Within the entire cohort, only presence of extrauterine disease was associated with worse overall survival [Hazard ratio (HR) = 2.70, 95% confidence interval (CI): 1.31-5.57, P = 0.007]. However, after stratification by histologic grade, both age (HR = 0.88, 95%CI: 0.81-0.96, P = 0.002) and extrauterine disease (HR = 2.49, 95%CI: 1.01-6.21, P = 0.049) were independently associated with worse survival, but only in women with type II malignancies.
Urban Haitian women with endometrial cancer have a high burden of aggressive histologies. Additional investigation to explain the etiology of these findings is needed.
Core tip: Black women of Haitian nativity have a higher prevalence of type II endometrial cancers than previously reported in other large, population-based studies performed in the United States. Further investigation into the genetic, epigenetic, and behavioral determinations of this observed health outcome is necessary.