Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico.
BMC Cancer. 2010 Feb 3;10:31. doi: 10.1186/1471-2407-10-31.
Endometrial cancer is the most common gynecologic malignancy in Puerto Rico and the United States (US).
We compare the age-specific and age-adjusted incidence and mortality rates and the survival of endometrial cancer in Puerto Rico with that of non-Hispanic whites (NHW), non-Hispanic blacks (NHB) and Hispanics in the US. Data from the Puerto Rico Central Cancer Registry and the Surveillance, Epidemiology, and End Results program were analyzed from 1992-2003.
Age-standardized incidence rates of endometrial cancer increased significantly (p < 0.05) in Puerto Rico (APC = 2.8%) and among NHB (APC = 1.9%) and remained constant (p > 0.05) for NHW (APC = -0.1%) and Hispanics in the US (APC = 0.4%). Mortality trends remained constant in all racial/ethnic groups (p > 0.05). For 1999-2003, women in Puerto Rico had similar incidence of endometrial cancer as Hispanics (Standardized rate ratio [SRR] = 0.94, 95% CI = 0.87-1.01), although their risk was lower than that of NHW (SRR = 0.56, 95% CI = 0.53-0.59) and NHB (SRR = 0.91, 95% CI = 0.84-0.98). Meanwhile, women in Puerto Rico had 15% higher risk of death than Hispanic women (SRR = 1.15, 95% CI = 1.03-1.30) similar risk than NHW (SRR = 0.93, 95% CI = 0.83-1.03), and lower risk than NHB (SRR = 0.51, 95% CI = 0.46-0.57). Puerto Rico (63.1%) and NHB (56.8%) had a lower 5-year survival than NHW (78.4%) and Hispanics (79.5%). An age-adjusted Cox proportional hazards model showed that compared with women in Puerto Rico, Hispanic women in the United States had 37% lower mortality risk (HR = 0.63, 95% CI = 0.56-0.71) and NHW had 53% lower mortality risk (HR = 0.47, 95% CI = 0.43-0.52) after 5 years of diagnosis; NHB women had 22% higher mortality risk than women in Puerto Rico (HR = 1.22, 95% CI = 1.09-1.36).
The lower burden of endometrial cancer in Puerto Rico suggests the presence of protective factors or lower exposure to risk factors in this population, although increases in incidence suggest changes in the occurrence of lifestyles and environmental risk factors. Meanwhile, the lower five-year survival from endometrial cancer among Puerto Ricans suggests a health disparity for this group in areas such as quality of care and/or differences in terms of stage at diagnosis and associated comorbidities. Assessment of disease risk factors and characteristics, and access and response to treatment is required to further understand these results.
子宫内膜癌是波多黎各和美国（US）最常见的妇科恶性肿瘤。
我们比较了波多黎各与非西班牙裔白人（NHW）、非西班牙裔黑人（NHB）和美国西班牙裔人群的子宫内膜癌的年龄特异性和年龄调整发病率和死亡率以及生存率。1992-2003 年期间，分析了来自波多黎各中央癌症登记处和监测、流行病学和最终结果计划的数据。
子宫内膜癌的年龄标准化发病率在波多黎各（APC=2.8%）和 NHB（APC=1.9%）中显著增加（p<0.05），而 NHW（APC=-0.1%）和美国西班牙裔人群中保持不变（p>0.05）（APC=0.4%）。所有种族/族裔群体的死亡率趋势均保持不变（p>0.05）。对于 1999-2003 年，波多黎各的女性患子宫内膜癌的发病率与西班牙裔女性相似（标准化率比 [SRR]=0.94，95%CI=0.87-1.01），尽管她们的风险低于 NHW（SRR=0.56，95%CI=0.53-0.59）和 NHB（SRR=0.91，95%CI=0.84-0.98）。同时，波多黎各的女性死于子宫内膜癌的风险比西班牙裔女性高 15%（SRR=1.15，95%CI=1.03-1.30），与 NHW 的风险相似（SRR=0.93，95%CI=0.83-1.03），并且低于 NHB（SRR=0.51，95%CI=0.46-0.57）。波多黎各（63.1%）和 NHB（56.8%）的 5 年生存率低于 NHW（78.4%）和西班牙裔（79.5%）。年龄调整的 Cox 比例风险模型显示，与波多黎各的女性相比，美国的西班牙裔女性的死亡率风险降低了 37%（HR=0.63，95%CI=0.56-0.71），NHW 的死亡率风险降低了 53%（HR=0.47，95%CI=0.43-0.52）；诊断后 5 年；与波多黎各的女性相比，NHB 女性的死亡率风险高 22%（HR=1.22，95%CI=1.09-1.36）。
波多黎各子宫内膜癌的负担较低表明该人群存在保护因素或较低的风险因素暴露，尽管发病率的增加表明生活方式和环境风险因素的发生发生了变化。同时，波多黎各女性的子宫内膜癌五年生存率较低表明该人群在护理质量等方面存在健康差异，以及在诊断时的分期和相关合并症方面存在差异。需要评估疾病风险因素和特征以及获得和对治疗的反应，以进一步了解这些结果。
