RACIAL-DIFFERENCES IN TUMOR GRADE AMONG WOMEN WITH ENDOMETRIAL CANCER

Black women with endometrial cancer have more advanced disease and les s favorable tumor grade than do white women. This study evaluated whet her racial differences in tumor grade could be explained by hormone-re lated factors and other putative determinants of grade. Subjects inclu ded 207 white and 81 black postmenopausal women diagnosed with primary cancer of the uterine corpus between 1985 and 1987. Blacks had poorer tumor grade than whites (odds ratio for FIGO grade 2 versus grade 1 i s 1.8; odds ratio for grade 3 versus grade 1 is 2.8). Over 75% of the excess of poorly differentiated tumors versus well-differentiated tumo rs among blacks could be explained by racial differences in use of rep lacement estrogens, age at first pregnancy, history of oophorectomy, p overty, stage of disease, use of screening, and access to health care. The most prominent factor was estrogen therapy, which was associated with favorable tumor grade and was used much less frequently by blacks . Although not statistically significant, a moderate racial difference in tumor grade remained after control of the potential explanatory va riables. This may reflect true biologic variation between blacks and w hites and may explain, in part, the observation that blacks with endom etrial cancer have a worse prognosis. (C) 1995 Academic Press, Inc.