Every 5 minutes, a woman in the United States receives a uterine cancer diagnosis, a stark reality reflected in the over 66,000 new cases estimated for 2023 that underscores the critical need for awareness and understanding of this increasingly common disease.
Key Takeaways
- In 2023, approximately 66,470 new cases of uterine corpus cancer were estimated to be diagnosed among women in the United States
- The lifetime risk of developing uterine corpus cancer for a woman in the US is about 3.1% or 1 in 32
- Uterine cancer accounts for about 6% of all new cancer cases in US women, ranking as the fourth most common cancer
- Obesity increases endometrial cancer risk by 2-4 times compared to normal weight women
- Type 2 diabetes mellitus is associated with a 2.8-fold increased risk of endometrial cancer
- Postmenopausal estrogen-only hormone therapy raises risk by 2-10 times depending on duration
- Vaginal abnormal bleeding is the presenting symptom in 90% of postmenopausal endometrial cancer cases
- Endometrial biopsy detects 90-95% of endometrial cancers
- Transvaginal ultrasound sensitivity for detecting endometrial cancer is 96% when endometrial thickness >4mm in postmenopausal women
- Hysterectomy is the primary treatment for 95% of stage I-II uterine cancers
- 5-year survival for localized uterine corpus cancer is 94.7% in the US
- Adjuvant radiation reduces locoregional recurrence by 50% in intermediate-risk stage I
- In 2023, uterine corpus cancer caused 12,160 deaths in the US
- Mortality rate for uterine corpus cancer is 4.9 per 100,000 women per year (2015-2019)
- Black women face 2.1 times higher mortality rate (11.6 vs 5.5 per 100,000)
Uterine cancer cases are rising globally, especially in Black women who face significantly higher risks.
Epidemiology
- In 2023, approximately 66,470 new cases of uterine corpus cancer were estimated to be diagnosed among women in the United States
- The lifetime risk of developing uterine corpus cancer for a woman in the US is about 3.1% or 1 in 32
- Uterine cancer accounts for about 6% of all new cancer cases in US women, ranking as the fourth most common cancer
- From 2015–2019, the incidence rate of uterine corpus cancer was 28.7 per 100,000 women per year based on 62,339 cases
- Uterine corpus cancer incidence rates have been rising by 0.6% annually over the past decade in the US
- Black women have a 63% higher incidence rate of uterine corpus cancer compared to White women (32.9 vs 20.2 per 100,000)
- Globally, there were an estimated 417,367 new cases of uterine cancer in 2020
- Uterine cancer is the 6th most common female cancer worldwide, with higher rates in high-income countries
- In Europe, the age-standardized incidence rate for uterine corpus cancer is 20.3 per 100,000 women
- Among US women aged 45-54, uterine cancer incidence has increased by 2.2% per year from 2007-2016
- Prevalence of uterine cancer survivors in the US is about 873,649 as of 2022
- In China, uterine corpus cancer incidence rose from 6.8 to 12.6 per 100,000 between 2008-2016
- Hispanic women in the US have seen a 2.5% annual increase in uterine cancer rates over the last decade
- Uterine cancer represents 3.4% of all new cancer cases in Canada in 2022
- In Australia, 2,313 new cases of uterine cancer were diagnosed in 2022
- Age-specific incidence peaks at 70-74 years for uterine corpus cancer in the US at 192.6 per 100,000
- In Japan, uterine corpus cancer cases increased by 4.2% annually from 1993-2015
- UK incidence rate for uterine cancer is 27 per 100,000 women
- In low-income countries, uterine cancer incidence is lower at 5.9 per 100,000 vs 24.3 in high-income
- US women under 50 now account for 14% of new uterine cancer cases, up from previous decades
- In India, age-adjusted incidence of uterine cancer is 2.4 per 100,000 women
- Brazilian national incidence of uterine cancer was 10.6 per 100,000 in 2018
- In South Korea, uterine corpus cancer incidence reached 17.7 per 100,000 in 2017
- French women have an incidence rate of 21.8 per 100,000 for uterine cancer
- In the US, endometrioid type accounts for 80-90% of uterine corpus cancers histologically
- Global prevalence of uterine cancer is estimated at 1.9 million women living with the disease in 2020
- Italian incidence rate for uterine cancer is 18.5 per 100,000 women
- In Sweden, uterine cancer incidence is 31 per 100,000, one of the highest in Europe
- US Asian/Pacific Islander women have the lowest incidence at 15.3 per 100,000
- In 2022, projected 65,950 new US cases of endometrial cancer specifically
Epidemiology Interpretation
Uterine cancer is a stealthy, rising foe—now the fourth most common cancer in American women—that disproportionately strikes Black women and increasingly targets younger women, while the disease's global shadow shows that wealthier nations paradoxically bear the heaviest burden.
Mortality and Prognosis
- In 2023, uterine corpus cancer caused 12,160 deaths in the US
- Mortality rate for uterine corpus cancer is 4.9 per 100,000 women per year (2015-2019)
- Black women face 2.1 times higher mortality rate (11.6 vs 5.5 per 100,000)
- Globally, 97,370 deaths from uterine cancer occurred in 2020
- Mortality rates have increased 1.2% annually since 2009 in the US
- Serous and clear cell histologies have 5-year survival <50% vs 90% endometrioid
- Stage IV disease mortality approaches 80% within 5 years
- Recurrence rate for stage I high-risk is 15-20% within 3 years
- Median overall survival for recurrent disease is 12-24 months
- Lymphovascular invasion increases mortality risk by 3-fold in early stage
- Distant metastasis 5-year survival is 18.7%
- Age >60 at diagnosis halves 5-year survival odds
- High-grade tumors (grade 3) have 50% increased mortality hazard
- Positive peritoneal cytology worsens prognosis with 20% lower survival
- p53 mutation status predicts poor prognosis with HR 2.5 for recurrence
- MSI-high status improves prognosis with 20% better survival in stage II-III
- Deep myometrial invasion (>50%) doubles mortality risk in stage I
- 30-day postoperative mortality after hysterectomy is 0.5-1%
- Cervix involvement increases recurrence risk by 2-fold
- Obesity BMI>40 raises postoperative mortality by 2.5 times
- Adnexal involvement portends 40% 5-year mortality in early stage
- POLE ultramutated subtype has excellent prognosis >95% 5-year survival
- Global age-standardized mortality rate is 2.1 per 100,000 women
- Comorbidity index >2 increases 5-year mortality by 30%
- Vaginal recurrence mortality is 50% if untreated
- TCGA classification: serous-like poorest prognosis with median OS 23 months
Mortality and Prognosis Interpretation
While the average odds are grim, this disease plays a cruelly biased game, disproportionately claiming Black women and those with aggressive subtypes, yet it also holds surprising cards, where molecular quirks can offer a reprieve or seal a fate.
Risk Factors
- Obesity increases endometrial cancer risk by 2-4 times compared to normal weight women
- Type 2 diabetes mellitus is associated with a 2.8-fold increased risk of endometrial cancer
- Postmenopausal estrogen-only hormone therapy raises risk by 2-10 times depending on duration
- Nulliparity (never giving birth) confers a 2-fold higher risk of endometrial cancer
- Each 5-unit increase in BMI above 25 increases endometrial cancer risk by 60%
- Polycystic ovary syndrome (PCOS) is linked to a 3.11 relative risk for endometrial cancer
- Late menopause (after age 52) increases risk by 1.5-2 times
- Tamoxifen use for breast cancer raises endometrial cancer risk by 2-7 fold
- Hereditary nonpolyposis colorectal cancer (HNPCC/Lynch syndrome) carries 40-60% lifetime risk of endometrial cancer
- First-degree family history of endometrial cancer doubles the risk
- Unopposed estrogen exposure for 10+ years increases risk 10-fold
- Smoking reduces endometrial cancer risk by 20-30% in postmenopausal women
- Physical activity reduces risk by 20-40% with high vs low activity levels
- Oral contraceptive use for 5+ years lowers risk by 50%
- Hypertension is associated with 1.5-fold increased risk of endometrial cancer
- BRCA1 mutation carriers have a 19-66% lifetime risk of endometrial cancer in some studies
- Early age at menarche (<12 years) increases risk by 1.5 times
- Coffee consumption of 4+ cups/day reduces risk by 25%
- Statin use is linked to 20-30% risk reduction in meta-analyses
- Endometrial hyperplasia without atypia progresses to cancer in 1-3% of cases
- Atypical endometrial hyperplasia has 25-40% progression rate to endometrial cancer
- Aspirin use reduces endometrial cancer risk by 17% in regular users
- Metabolic syndrome components increase risk synergistically up to 3-fold
- Multiparity (3+ births) reduces risk by 30-50%
- Vitamin D deficiency is associated with 2-fold higher risk in some cohorts
- 80% of endometrial cancers are linked to excess estrogen exposure
- Breastfeeding reduces risk by 10-20% per year of duration
- Alcohol consumption shows inverse association, reducing risk by 10-15%
Risk Factors Interpretation
A woman’s risk for endometrial cancer appears to be a grim accounting of her life, where the protective credits of pregnancy, exercise, and coffee can seldom fully offset the heavy debits of obesity, unopposed estrogen, and family history.
Symptoms and Diagnosis
- Vaginal abnormal bleeding is the presenting symptom in 90% of postmenopausal endometrial cancer cases
- Endometrial biopsy detects 90-95% of endometrial cancers
- Transvaginal ultrasound sensitivity for detecting endometrial cancer is 96% when endometrial thickness >4mm in postmenopausal women
- 75-80% of uterine cancers are diagnosed at stage I
- Pelvic pain occurs in 20-25% of advanced uterine cancer cases
- CA-125 is elevated in 25% of early-stage and 80% of advanced endometrial cancers
- Hysteroscopy allows visualization and biopsy with 98% sensitivity for focal lesions
- Postmenopausal bleeding prompts evaluation in 10% of cases leading to cancer diagnosis
- MRI staging accuracy for deep myometrial invasion is 85-92%
- Weight loss occurs in 10-15% of symptomatic endometrial cancer patients
- Pipelle endometrial sampling has 91-99% sensitivity for detecting cancer
- PET/CT detects lymph node metastases with 82% sensitivity in high-risk cases
- Discharge or spotting reported in 15-20% pre-diagnosis
- Endometrial thickness >5mm in premenopausal women warrants biopsy in 20% abnormal cases
- CT scan detects extrauterine disease in 70-80% accuracy for staging
- Fatigue present in 30% of newly diagnosed uterine cancer patients
- HE4 biomarker outperforms CA-125 in early detection with AUC 0.93
- 5% of premenopausal abnormal bleeding leads to endometrial cancer finding
- Sentinel lymph node mapping detects metastases with 90% accuracy in early stage
- Pelvic ultrasound first-line for postmenopausal bleeding with 96% NPV if thin stripe
- Lower abdominal pain in 5-10% early stage, rising to 40% in advanced
- Dilation and curettage diagnostic yield 60% for malignancy in high suspicion
- ROMA index predicts recurrence with 75% sensitivity post-treatment
- Urinary symptoms like hematuria in 5% due to advanced local invasion
- 90% of stage I cancers diagnosed via office biopsy without anesthesia
- Chest X-ray abnormal in 15% of stage IV uterine cancer at diagnosis
- Mean age at diagnosis for endometrioid type is 63 years
- 70% of uterine cancers are low-grade endometrioid at diagnosis
Symptoms and Diagnosis Interpretation
While the numbers paint a hopeful picture of early detection through simple measures like investigating postmenopausal bleeding, they soberly remind us that when symptoms like pelvic pain or weight loss join the party, the disease has often already made itself far too comfortable.
Treatment and Survival
- Hysterectomy is the primary treatment for 95% of stage I-II uterine cancers
- 5-year survival for localized uterine corpus cancer is 94.7% in the US
- Adjuvant radiation reduces locoregional recurrence by 50% in intermediate-risk stage I
- Overall 5-year relative survival for uterine corpus cancer is 84.5%
- Chemotherapy with carboplatin-paclitaxel improves PFS by 10 months in advanced disease
- Stage III 5-year survival is 73.7%, dropping to 20.1% for stage IV
- Minimally invasive surgery (laparoscopic) has 10% lower complication rate vs open
- Hormone therapy effective in 20-30% low-grade advanced endometrioid cancers
- PORTEC-2 trial showed vaginal brachytherapy equivalent to pelvic RT with less toxicity
- Immunotherapy with pembrolizumab yields 48% response rate in MSI-high tumors
- GOG-249 trial: 3-year RFS 84% with brachytherapy vs 77% pelvic RT
- Robotic hysterectomy shortens hospital stay by 2-3 days vs abdominal
- PARP inhibitors show promise in 20% HRD-positive uterine cancers
- Lymphadenectomy in low-risk stage I does not improve survival per GOG-99
- 10-year survival for grade 1 stage IA is 98%
- Trastuzumab effective in 30% HER2-positive uterine serous carcinomas
- Dose-dense paclitaxel boosts OS by 12 months in high-risk advanced disease
- Observation alone safe for low-risk stage I with 95% 5-year RFS
- Bevacizumab adds 4 months PFS in recurrent disease per GOG-218
- Sentinel node biopsy reduces lymphedema risk by 70% vs full lymphadenectomy
- 90% of stage I patients cured with surgery alone
- Lenvatinib + pembrolizumab ORR 38% in non-MSI-high advanced disease
- Adjuvant chemotherapy improves 5-year OS by 10-15% in stage III
- Vaginal brachytherapy reduces vaginal recurrence to 2% vs 6% no RT
- Median survival for stage IVB is 31 months with modern chemo-immuno
- Black women have 40% lower 5-year survival (63.3% vs 84.9%) despite similar stage
- 15-year survival for low-risk early stage exceeds 90%
- Dostarlimab achieves 42% response in dMMR recurrent endometrial cancer
- Combined chemo-RT improves OS by 15% in high-intermediate risk stage I-II
Treatment and Survival Interpretation
The story here is one of remarkable success when we catch it early, but a stark and urgent reminder that our best tools become far less effective if we wait too long, and tragically, not everyone gets equal access to the fight.
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