While uterine cancer quietly became the sixth most common cancer in women worldwide, claiming over 400,000 new diagnoses in 2020, understanding its global footprint and the factors driving its rise is the first step toward reversing this trend.
Key Takeaways
- In 2023, an estimated 66,470 new cases of uterine corpus cancer will be diagnosed in the United States, accounting for 3.0% of all new female cancer cases
- Globally, uterine cancer was the 6th most common cancer in women in 2020 with 417,367 new cases, representing 3.1% of all female cancers
- In the US, the age-adjusted incidence rate for uterine corpus cancer was 27.5 per 100,000 women per year based on 2017–2021 rates
- Obesity increases endometrial cancer risk by 2-4 times, with risk rising exponentially with BMI over 25
- Type 2 diabetes mellitus is associated with a 2.0-3.0 fold increased risk of endometrial cancer
- Nulliparity (never having given birth) raises endometrial cancer risk by 1.8-3.0 times compared to women with 3+ births
- The most common symptom of uterine cancer is abnormal vaginal bleeding, occurring in 90% of postmenopausal cases
- Transvaginal ultrasound detects endometrial thickness >4mm in postmenopausal women with bleeding, sensitivity 96% for cancer
- Endometrial biopsy has a sensitivity of 90-99% for detecting endometrial cancer in women with bleeding
- Total hysterectomy with salpingo-oophorectomy is standard for Stage I, performed in 80% of cases
- Adjuvant radiation therapy reduces local recurrence by 50% in intermediate-risk Stage I
- Chemotherapy with carboplatin-paclitaxel standard for advanced disease, response rate 40-60%
- 5-year overall survival for all stages uterine cancer in US is 84%
- Stage I endometrial cancer 5-year survival is 93-95%
- US uterine cancer mortality rate 2021-2025 projected 5,200 deaths
Uterine cancer is a common female cancer with varying global incidence and strong survival when caught early.
Epidemiology
- In 2023, an estimated 66,470 new cases of uterine corpus cancer will be diagnosed in the United States, accounting for 3.0% of all new female cancer cases
- Globally, uterine cancer was the 6th most common cancer in women in 2020 with 417,367 new cases, representing 3.1% of all female cancers
- In the US, the age-adjusted incidence rate for uterine corpus cancer was 27.5 per 100,000 women per year based on 2017–2021 rates
- Uterine cancer incidence rates in the US increased by 0.6% annually from 2012 to 2021, with a sharper rise of 1.9% per year among Black women
- In Europe, the age-standardized incidence rate of uterine cancer was 13.7 per 100,000 women in 2020, varying from 5.4 in Eastern Europe to 18.2 in Northern Europe
- Among Hispanic women in the US, uterine cancer incidence rose by 2.7% annually between 2007 and 2016
- In 2022, approximately 65,950 women in the US were diagnosed with endometrial cancer
- The lifetime risk of developing uterine cancer for US women is about 3.1% (1 in 32)
- In the UK, there were 10,253 new uterine cancer cases in 2020, making it the 4th most common female cancer
- Uterine cancer prevalence in the US reached 873,436 cases in 2022
- In Japan, uterine corpus cancer incidence is 24.7 per 100,000 women, lower than Western countries due to lower obesity rates
- Among US Asian/Pacific Islander women, uterine cancer incidence is 14.5 per 100,000
- In Australia, 2,313 new uterine cancer cases were diagnosed in 2021, with an ASR of 20.5 per 100,000
- Uterine cancer incidence in non-Hispanic white US women is 28.2 per 100,000
- In India, uterine cancer accounts for 4.4% of female cancers with 21,115 cases in 2020
- US uterine cancer diagnoses peaked at ages 70-74 with rates of 142 per 100,000
- In Brazil, 2020 saw 13,881 new uterine cancer cases, ASR 12.3 per 100,000 women
- Among US Black women, uterine cancer incidence is 24.4 per 100,000, higher mortality despite lower incidence
- In Canada, 7,300 new uterine cancer cases expected in 2023
- Global uterine cancer cases projected to reach 1.5 million by 2050 due to aging and obesity
- In Sweden, uterine cancer incidence rate is 30.4 per 100,000 women (2020)
- US uterine cancer 5-year limited duration prevalence is 4.7% of female cancer survivors
- In China, 148,557 new uterine cancer cases in 2022, ASR 15.4 per 100,000
- Among postmenopausal US women, 90% of uterine cancers occur post-menopause
- In the Netherlands, uterine cancer incidence rose 2.3% annually from 1989-2019
- US American Indian/Alaska Native women have uterine cancer incidence of 15.8 per 100,000
- In France, 9,582 new uterine cancer cases in 2020
- Global variation shows highest uterine cancer ASRs in North America (30.7 per 100,000)
- In 2021, US SEER data showed 42,530 invasive uterine corpus cancers diagnosed
Epidemiology Interpretation
While these numbers may seem like a dry constellation of statistics, they tell a sobering and expanding story: uterine cancer is a pervasive global health issue whose rising incidence, particularly among Black and Hispanic women in the US, is a silent alarm demanding our attention beyond the 3% of female cancers it represents.
Prognosis and Mortality
- 5-year overall survival for all stages uterine cancer in US is 84%
- Stage I endometrial cancer 5-year survival is 93-95%
- US uterine cancer mortality rate 2021-2025 projected 5,200 deaths
- Black women have 37% higher uterine cancer mortality than white women
- 10-year survival for localized uterine cancer is 89%
- Global uterine cancer deaths in 2020: 97,370, ASR 2.3 per 100,000
- Stage IV 5-year survival 17-20%
- Mortality rates increased 2.0% annually 2007-2016 for Black women
- Grade 1 endometrioid tumors 5-year OS 90-95%
- Uterine serous carcinoma 5-year survival 45-50% despite early stage
- Distant stage 5-year survival 18%
- In UK, 5-year net survival for uterine cancer 77% (2016-2020)
- Recurrence rate for Stage I high-intermediate risk 20-25% without adjuvant RT
- MMR-deficient tumors have better prognosis, 5-year OS 75% vs 60%
- Age >60 years halves 5-year survival to 50%
- Lymphovascular space invasion increases recurrence risk 3-fold
- 15-year relative survival for localized disease 81%
- Clear cell carcinoma 5-year survival 40%, poorest among subtypes
- Australia 5-year survival 83% for uterine cancer (2016-2020)
- Deep myometrial invasion (>50%) drops Stage I survival to 80%
- Positive peritoneal cytology worsens prognosis by 10-15% OS reduction
- Canada uterine cancer 5-year survival 74%
- Median survival for recurrent disease 12-24 months with treatment
- p53 abnormal tumors have 40% 5-year survival vs 80% wild-type
- Stage III 5-year survival 50-60%
- Obesity paradoxically improves surgical prognosis but worsens cancer-specific
- Japan 5-year survival 82% for endometrial cancer
Prognosis and Mortality Interpretation
While we have made impressive progress, boasting survival rates as high as 95% for some, the cold truth is that these statistics betray a profound inequality, where a black woman's diagnosis or a rarer, more aggressive tumor type can drastically rewrite her odds in a system that hasn't protected everyone equally.
Risk Factors
- Obesity increases endometrial cancer risk by 2-4 times, with risk rising exponentially with BMI over 25
- Type 2 diabetes mellitus is associated with a 2.0-3.0 fold increased risk of endometrial cancer
- Nulliparity (never having given birth) raises endometrial cancer risk by 1.8-3.0 times compared to women with 3+ births
- Postmenopausal hormone therapy with estrogen alone (without progestin) increases risk by 2-10 times depending on duration
- Polycystic ovary syndrome (PCOS) is linked to a 2.5-3.0 fold higher risk of endometrial cancer due to chronic anovulation
- Late menopause (after age 52) increases risk by 1.5-2.0 times due to prolonged estrogen exposure
- Early menarche (before age 12) associated with 1.5-fold increased endometrial cancer risk
- Hereditary nonpolyposis colorectal cancer (HNPCC/Lynch syndrome) confers 40-60% lifetime risk of endometrial cancer
- Tamoxifen use for breast cancer treatment increases endometrial cancer risk by 2-7 times
- Hypertension is associated with 1.4-1.7 fold increased risk of endometrial cancer
- Family history of endometrial or colorectal cancer doubles the risk
- Smoking reduces endometrial cancer risk by 20-30% in postmenopausal women
- Physical inactivity increases risk by 20-40%, with sedentary lifestyle OR of 1.3-1.5
- Breastfeeding reduces risk by 10-20% per year of breastfeeding
- Oral contraceptive use decreases risk by 30-50% with 5+ years use, effect lasting 20+ years post-use
- Metabolic syndrome components (obesity, diabetes, hypertension) synergistically increase risk up to 4-fold
- BRCA1 mutation carriers have 2-3 fold higher endometrial cancer risk compared to non-carriers
- High glycemic load diet associated with 1.5-2.0 fold risk increase
- Estrogen-producing ovarian tumors increase risk dramatically, up to 20-fold
- Alcohol consumption shows inverse association, reducing risk by 10-20% in moderate drinkers
- Prior pelvic radiation therapy increases risk by 2-4 times
- Coffee consumption (4+ cups/day) linked to 20-25% risk reduction
- Vitamin D deficiency associated with 1.5-fold increased risk
- Endometrial hyperplasia without atypia progresses to cancer in 1-3% of cases
- Atypical endometrial hyperplasia has 20-30% progression rate to endometrial cancer
- Obesity BMI >40 increases risk 7-fold compared to normal weight
Risk Factors Interpretation
It seems the uterus keeps a meticulous, often ironic ledger: while life blesses us with childbirth and coffee as modest shields, it cruelly multiplies the bill through obesity, diabetes, and estrogen's unopposed reign, reminding us that our most profound reproductive risks are often woven from the very threads of modern living.
Symptoms and Diagnosis
- The most common symptom of uterine cancer is abnormal vaginal bleeding, occurring in 90% of postmenopausal cases
- Transvaginal ultrasound detects endometrial thickness >4mm in postmenopausal women with bleeding, sensitivity 96% for cancer
- Endometrial biopsy has a sensitivity of 90-99% for detecting endometrial cancer in women with bleeding
- Pelvic pain occurs in 20-30% of advanced uterine cancer cases
- CA-125 tumor marker is elevated in 25-50% of women with advanced endometrial cancer
- Hysteroscopy allows direct visualization and biopsy, with 90-95% sensitivity for endometrial pathology
- Watery or bloody discharge occurs in 10-15% of premenopausal uterine cancer patients
- MRI staging accuracy for deep myometrial invasion is 85-95%, superior to CT
- Postmenopausal bleeding prompts 90% of endometrial cancer diagnoses
- PET-CT has 90% sensitivity for detecting lymph node metastases in high-risk cases
- Lower abdominal pain reported in 25% of symptomatic uterine cancer patients
- Endometrial sampling false-negative rate is 5-10% due to sampling error
- Unintentional weight loss occurs in 10-20% of advanced cases
- Saline infusion sonography improves detection of focal lesions, sensitivity 92%
- Fatigue and anemia from bleeding seen in 15% of diagnosed patients
- FIGO staging system used in 95% of cases, with Stage I comprising 75% of diagnoses
- Dysuria or hematuria in 5-10% due to bladder involvement
- Office endometrial biopsy success rate 87-97% in postmenopausal women
- CT scan detects extrauterine disease with 70-80% accuracy
- Vaginal bleeding in premenopausal women abnormal if heavy or intermenstrual in 75% suspicious cases
- Sentinel lymph node biopsy mapping success 80-90% in early-stage disease
- Pelvic mass palpable in only 5% of early-stage uterine cancers
- HE4 biomarker elevated in 70% of Type II endometrial cancers
- Dilation and curettage diagnostic yield 99% when biopsy inconclusive
- Leg swelling from lymphatic obstruction in 10% advanced cases
Symptoms and Diagnosis Interpretation
If your body starts writing checks your hormones can't cash—like any postmenopausal bleeding or wildly irregular premenopausal flow—consider it a serious memo to investigate, because while the diagnostic tools are impressively sharp, from ultrasound's watchful eye to biopsy's precise verdict, catching this early, when it's often stage one and highly treatable, is what turns a staggering statistic into a survivable story.
Treatment
- Total hysterectomy with salpingo-oophorectomy is standard for Stage I, performed in 80% of cases
- Adjuvant radiation therapy reduces local recurrence by 50% in intermediate-risk Stage I
- Chemotherapy with carboplatin-paclitaxel standard for advanced disease, response rate 40-60%
- Vaginal brachytherapy for high-intermediate risk Stage I, recurrence risk reduced to 4%
- Hormone therapy with progestins effective in 20-30% of low-grade advanced cases
- Minimally invasive laparoscopic hysterectomy feasible in 70% of cases, with shorter hospital stay
- Pembrolizumab immunotherapy shows 48% response in MSI-high/dMMR tumors
- External beam radiation for Stage II-III, pelvic control 85-90%
- Lenvatinib + pembrolizumab ORR 38% in advanced endometrial cancer
- Neoadjuvant chemotherapy response 30-40% in high-risk operable cases
- Robotic-assisted surgery reduces complications to 10% vs 20% open surgery
- Dostarlimab achieves 42.3% response in dMMR recurrent cases
- Lymphadenectomy in low-risk omitted in 60% per PORTEC-4a trial
- Trastuzumab for HER2-positive uterine serous carcinoma, response 50%
- Megestrol acetate for stage IV low-grade, stable disease in 25%
- IMRT reduces bowel toxicity by 40% compared to conventional RT
- Bevacizumab added to chemo improves PFS to 14.7 months vs 10.2
- Fertility-sparing progestin therapy success 75% in stage IA grade 1 young women
- PARP inhibitors like olaparib for BRCA-mutated, response 20-30%
- Whole pelvic RT + brachytherapy for stage III, 5-year DFS 60%
- Hysteroscopic resection for early lesions, complete response 80% in select cases
- Atezolizumab + chemo PFS benefit 1.7 months in MMR-proficient
- Sentinel node biopsy reduces lymphedema to 5% vs 20% full lymphadenectomy
- Everolimus + letrozole PFS 8.5 months in advanced disease
- Adjuvant chemo for serous/clear cell histology, OS benefit 10-15%
- Proton therapy for recurrent pelvic disease, local control 80%
- Hormonal intrauterine device (Mirena) prevents hyperplasia recurrence 90%
Treatment Interpretation
We have evolved from one brutal cure to an arsenal of elegant, targeted strategies, trading blanket removal for precision strikes that turn our own defenses against the disease while preserving everything from fertility to bowel function.
Sources & References
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