Are we doing enough to address ethnic disparities in endometrial cancer mortality? The study titled “Trends and Ethnic Disparity in Endometrial Cancer Mortality in South Africa (1999–2018): A Population-Based Age-Period-Cohort and Join Point Regression Analyses” examines the trends and ethnic disparities in endometrial cancer mortality in South Africa over two decades. It finds that endometrial cancer mortality nearly doubled from 1999 to 2018, highlighting significant ethnic disparities. The study employs age-period-cohort and join point regression models to analyse the data, revealing strong age and cohort effects alongside minimal period effects.
Analysing Mortality Trends and Ethnic Disparities
-
Rising Mortality Rates Across Ethnic Groups: The age-standardised mortality rate (ASMR) of endometrial cancer rose from 0.76 deaths per 100,000 women in 1999 to 1.5 in 2018, with an average annual increase of 3.6%. Notable ethnic disparities exist, with higher ASMRs among Indian/Asians, Blacks, and Coloreds compared to Whites. Indian/Asians maintained stable rates, while other groups saw increases.
-
Influence of Age and Birth Cohorts:Â Mortality risk increased with age and successive birth cohorts from 1924 to 1963, followed by a decline. Significant period effects were noted only among Blacks.
-
Age at Death Variations:Â The mean age at death from endometrial cancer increased from 64 years in 1999 to 67 years in 2018, with variations across ethnicities. Significant local drifts were noted among older women, especially within Black and White populations.
The Global and Local Impact of Endometrial Cancer
Endometrial cancer is the sixth leading cause of cancer deaths among women worldwide, with about 97,000 deaths in 2020. Addressing endometrial cancer mortality is crucial in global public health. Key risk factors include obesity, low parity, early menarche, late menopause, and hormone replacement therapy. Protective factors involve the use of exogenous progesterone, combined oral contraceptives, and tobacco smoking.
Disparities in healthcare access and quality significantly influence cancer outcomes. Although access to reproductive health services in South Africa has improved since 1994, ethnic disparities continue to impact the effectiveness of interventions related to endometrial cancer mortality.
Addressing Rising Mortality and Health Disparities
The rising mortality rate, especially among certain ethnic groups, signals the need for targeted interventions. Addressing modifiable risk factors, like obesity and low fertility rates, could be facilitated through public health campaigns, better access to reproductive health services, and improved cancer screening and treatment programs.
This study emphasises the importance of early detection and treatment. Policies aimed at reducing health disparities, expanding oncological services, and enhancing health-seeking behaviors are essential for improving survival rates.
Recommendations: Strategic Approaches for Policy and Practice
Further investigation into ethnic disparities in endometrial cancer trends is necessary to inform effective policies. Integrating endometrial cancer into existing cancer control programs, such as the breast and cervical cancer control initiative launched in 2017, could provide substantial benefits.
The findings indicate the need for resource allocation tailored to high-risk groups. Initiatives could include education programs, screening efforts, and ensuring equitable access to healthcare services. These measures can help reverse unfavorable trends among non-White populations and improve overall survival rates.
