Improved survival of baby boomer women with early-stage uterine cancer: A Surveillance, Epidemiology and End Results (SEER) Study.

Aim: To study the prognostic impact of baby boomer (BB) generation on survival end-points of patients with early-stage endometrial carcinoma (EC). Patients and Methods: Data were obtained from the SEER registry between 1988-2009. Inclusion criteria included women who underwent hysterectomy for stage I-II EC. Patients were divided into two birth cohorts: BB (women born between 1946 and 1964) and pre-boomers (PB) (born between 1926 and 1945). Results: A total of 30,956 patients were analyzed. Considering that women in the PB group were older than those of the BB generation, the statistical analysis was limited to women 50-59 years of age at the time of diagnosis (n=11,473). Baby boomers had a significantly higher percentage of endometrioid histology (p<0.0001), higher percentage of African American women (p<0.0001), lower tumor grade (p<0.0001), higher number of dissected lymph nodes (LN) (p<0.0001), and less utilization of adjuvant radiation therapy (p=0.0003). Overall survival was improved in women in the BB generation compared to the PB generation (p=0.0003) with a trend for improved uterine cancer-specific survival (p=0.0752). On multivariate analysis, birth cohort (BB vs. PB) was not a significant predictor of survival end-points. Factors predictive of survival included: tumor grade, FIGO stage, African- American race, and increased number of dissected LN. Conclusion: Our study suggests that the survival of BB women between 50-60 years of age is better compared to women in the PB generation. As more BB patients are diagnosed with EC, further research is warranted. Endometrial cancer (EC) is the most common gynecological malignancy in the United States with an estimated 49,560 women diagnosed with the disease and 8,190 deaths in 2013 (1). The baby boomer (BB) generation is distinguished by an increase in birth rates following World War II, and is one of the largest generations in US history. The BB includes people born between 1946 and 1964 (2). The incidence of obesity, a major risk factor for many diseases including uterine carcinoma (3-7), is increasing in the BB generation. Several investigators suggested that women in the BB generation are relatively more obese compared to earlier generations (8-10). A recently published single- institution study showed that women with uterine endometrioid carcinoma who were born between 1946 and 1964 were more obese compared to pre-boomer (PB) patients born between 1926 and 1964. However, there were no differences in overall survival between BB and PB patients (11). There is a paucity of population-based studies in the literature evaluating the outcome of BB women with EC. The National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) provides a database to examine this issue. Considering that more than 85% of patients with endometrial carcinoma present with International Federation of Gynecology and Obstetrics (FIGO) stage I-II carcinoma (12), the purpose of the present study was to describe patient demographics, tumor characteristics and survival in BB women and compare it to PB women who underwent hysterectomy for early-stage EC.