UC Irvine

Endometrial cancer is the most common gynecologic cancer and the fourth most common cancer among women in the United States. To date, the majority of research on endometrial cancer treatment and survival has focused solely on investigations between Black and white populations due to the consistent and concerning disparities in mortality and survival between these two groups. However, this leaves gaps in our knowledge regarding disparities in endometrial cancer treatment and survival for additional minoritized racial/ethnic groups. Importantly, American Indian/Alaska Native, Asian or Pacific Islander, and Hispanic/Latina women experience risk factors related to social determinants of health and barriers to receiving quality cancer care compared to white women. Therefore, utilizing a systemic racism lens, this dissertation focuses on examining how racially minoritized women are impacted by endometrial cancer and how the healthcare system shapes treatment and survival outcomes for women of color utilizing data from national and state population-based cancer registries. Findings from Chapter 2 exhibit the importance of shifting our conceptualization and understanding of endometrial cancer as one that is increasingly burdening women of color, particularly younger women of color. Findings from Chapter 3 demonstrate that women of color with both type I and type II endometrial cancer experience a greater burden of surgical treatment delays compared to white women. Additionally, findings from Chapter 3 show that among type I and type II endometrial cancers, there is no association between time to surgical treatment and endometrial cancer survival. Findings from Chapter 4 indicate an association between guideline non-concordant care and worse endometrial cancer survival for both type I and type II endometrial cancers. Further, findings from Chapter 4 demonstrate that for type II endometrial cancers, the association between receipt of guideline non-concordant care and endometrial cancer survival among women with type I and type II endometrial cancers differed between racial/ethnic groups. Moreover, findings from Chapter 4 indicate that across racial/ethnic groups, receipt of guideline non-concordant care accounted for a proportion of endometrial cancer-specific deaths for women with type I and type II endometrial cancers; for type I endometrial cancers, guideline non-concordant care was only a risk factor for endometrial cancer-specific deaths among white women; whereas for type II endometrial cancers, guideline non-concordant care was a risk factor across all racial/ethnic groups. Findings of this dissertation underscore the systemic racial/ethnic disparities in healthcare access and outcomes for women of color to which future research and practice interventions should work towards mitigating and eliminating.