Most women with endometrial cancer survive the disease. The 5-year survival among patients diagnosed and treated at early stages is estimated to be 96%. A large number of studies have demonstrated a high prevalence of cardiovascular death among endometrial cancer survivors. It is possible that obesity and metabolic syndrome, risk factors for cardiovascular disease, may contribute to the high prevalence of cardiovascular death among endometrial cancer survivors. No prior studies have examined causes of death among women with endometrial cancer.
The aim of this retrospective cohort study was to determine the leading causes of death among patients with invasive epithelial endometrial cancer. Data were obtained from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program. Causes of death were stratified by grade and stage.
Of the 44,145 patients with endometrial cancer enrolled in SEER from 1973 to 1988, 33,232 (75.3%) with incident cases had died by 2008 at the time of last follow-up.
Overall, patients with endometrial cancer were most likely to die of cardiovascular disease (35.9%; 95% confidence interval, 35.3%–36.3%) followed by other causes of death, other malignancies, and endometrial cancer. Death due to cardiovascular disease was most likely among patients with low-grade localized cancer and least likely among those with high-grade advanced cancer. Moreover, death due to endometrial cancer was most likely to occur in women with high-grade advanced disease. Among the entire population of women, the risk of death is greatest from endometrial cancer in the first 5 years after diagnosis; risk of death from cardiovascular disease becomes greater in the next 5 years and thereafter.
These findings suggest that higher risk of cardiac death among endometrial cancer patients is a reflection of the likelihood of cure following treatment of low-grade disease and of the high prevalence of cardiac disease and risk factors among survivors. Lifestyle modifications and other interventions that reduce the risk of cardiovascular death are likely to improve overall survival in the women who do not die of endometrial cancer.
Division of Gynecologic Oncology, Department of Reproductive Medicine, Rebecca and John Moores UCSD Cancer Center, La Jolla, CA.