Abstract B138: Receipt of NCCN-guideline concordant endometrial cancer care in the Carolina Endometrial Cancer Study: Disparities by race and histology

Abstract

Endometrial cancer survivors comprise the second largest cancer survivorship group among U.S. women after breast cancer survivors. Endometrial cancer survivorship is marked by stark racial disparities in outcomes with 5-year relative survival of 63% for Black women compared to 85% for White women. Survival disparities are multi-factorial; previous work has highlighted a higher proportion of advanced disease and worse-prognosis non-endometrioid histologies, and more prevalent barriers to high quality care, among Black women. We assessed the association between race and receipt of National Comprehensive Cancer Network (NCCN)-guideline concordant care (GCC) in the Carolina Endometrial Cancer Study (CECS). CECS is an ongoing, prospective cohort of recently diagnosed endometrial cancer survivors across North Carolina. Since 2021, >1,000 participants have been enrolled. As part of enrollment activities, participants are asked for consent to obtain and abstract treatment details from medical records. This analysis uses data from the first 714 participants (241 Black, 429 White) with abstracted medical record information. Year-specific NCCN Guidelines were used to categorize cancer treatments as guideline concordant (yes/no) based on surgical approach, radiation modality, and chemo- or immunotherapy agents received. Multivariable Poisson regression with robust standard error was used to calculate prevalence ratios (PR) and 95% confidence intervals (CIs) for the association between race and GCC. The majority of participants were diagnosed with stage I (79.3% overall, 72.6% Black, 82.5% White) and endometrioid (82.1% overall, 64.3% Black, 91.1% White) disease. Overall, 17.9% of participants had non-endometrioid histologies (by race: 35.7% Black, 8.9% White). In our sample, 83.8% of participants received NCCN GCC (by race: 87.2% White, 76.8% Black; by histology: 89.8% endometrioid, 56.3% non-endometrioid). In univariate models, Black women had an estimated 12% lower prevalence of GCC (PR=0.88; CI: 0.81, 0.95) that varied only slightly with adjustment for factors including education, marital status, income, insurance coverage type, and body mass index (PR= 0.90; CI: 0.82, 0.98). In univariate analyses restricted to endometrioid histology (N=586), race was not associated with GCC (PR=1.02; CI: 0.96, 1.08). Sample sizes were more limited for non-endometrioid histologies (N=135); in this group, Black women had an estimated lower prevalence of GCC compared to White women (PR=0.81; CI: 0.59, 1.11). Our analyses suggest disparities in receipt of endometrial cancer NCCN GCC by race and histology in North Carolina. Patients with non-endometrioid histologies are more often recommended to receive adjuvant radiation or systemic therapies. Future analyses will examine the extent to which GCC disparities are driven by these treatment modalities. Taylor D. Ellington, Mu Jin, Marc Peterson, Chelsea Anderson, Victoria Bae-Jump, Jamie L. Hunter, Lisa Spees, Russell Broaddus, Kemi Doll, Andrew Olshan, Hazel Nichols. Receipt of NCCN-guideline concordant endometrial cancer care in the Carolina Endometrial Cancer Study: Disparities by race and histology [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr B138.