Endometrial carcinoma in the baby boomer generation. Tumor characteristics and clinical outcome.

Background: Baby boomers (BB) entering retirement represent a significant burden on medical resources. The unique lifestyle characteristics engendered by the BB may lead to different endometrial cancer characteristics that bear understanding. We sought to characterize BB with endometrioid carcinoma after hysterectomy and compare the results to those of prior to the baby boomers (PB). Patients and Methods: After reviewing our prospectively maintained database of 1,450 patients with endometrial cancer, we identified 595 patients who underwent hysterectomy for 1988 International Federation of Gynecologic Oncology (FIGO) stage I-II uterine endometrioid carcinomas, who were born between 1926 and 1964. Their medical records were reviewed in this Institutional review board (IRB)-approved study. Patients with non-endometrioid carcinoma and those who received preoperative therapy were excluded. Patients were defined as BB (born 1946-1964) or PB (born in 1926-1945). The two groups were compared regarding patients' demographics, tumor characteristics and survival. Following a univariate analysis, multivariable modeling was carried out using Cox regression analysis. Results: All patients underwent hysterectomy with a minimum of two years' follow-up. There were 234 patients (39%) in the BB group and 361 patients (61%) in the PB group. Median follow-up for the study cohort was 56 months. BB had higher body mass index (p=0.027), lower tumor grade (p=0.002), earlier FIGO stage (p=0.023), higher number of dissected lymph nodes (p=0.008), less lymphvascular space involvement (p=<0.034), less utilization of adjuvant therapy (p=<0.001), and younger age at diagnosis (p=0.002). However, there was no significant difference found between the BB and PB in regards to local control, disease- specific survival and overall survival. For the study cohort, FIGO stage and tumor grade were independent predictors of recurrence-free and disease-specific survival. There was a trend towards shorter overall survival for the PB women (p=0.063). Conclusion: Although tumor characteristics were more favorable in the BB group of women, local control and survival end-points were not statistically different compared to those of the PB group. As more BB are diagnosed with endometrial carcinoma, further research is warranted to further elucidate the characteristic differences in endometrial carcinoma, if any, in this generation. Endometrial cancer is the most common gynecological malignancy in the United States and ranks second in gynecological cancer mortality following ovarian cancer (1). The baby boomer (BB) generation is distinguished by a dramatic increase in birth rates following World War II, and is one of the largest generations in the US history. The BB includes people born between 1946 and 1964 (2). The aging of BB will result in profound changes in the demographics in the US, with a likely increase in the prevalence of uterine carcinoma. Some investigators suggested that women in the BB generation are relatively more obese and became so at younger ages than did their predecessors (3, 4). Obesity and increased body mass index (BMI) are well-known etiological factors for uterine carcinoma (5-9). Considering that more than 84% of patients with endometrial carcinoma present with (FIGO) stage I-II endometrioid carcinoma (10), the purpose of the present study was to describe patients' demographics, tumor characteristics and treatment outcome in BB women and compare it to pre- boomer (PB) women with early-stage endometrial carcinoma who underwent hysterectomy for their endometrial carcinoma.