The survival rates for cervical and uterine cancer have been stagnant for years, even as the number of deaths from cancer in the United States dropped overall. This week, the American Cancer Society announced the largest reduction in cancer deaths ever reported in a single year, dropping by 2.2 percent in 2017. But while treatments have improved dramatically for many forms of cancer, these particular cancers are left behind for a number of reasons, including gaps in treatment and limited research funding for the diseases.
“I hope this data demonstrates that there needs to be more attention given to these diseases,” says Sarah Temkin, a gynecologic oncologist at Anne Arundel Medical Center in Maryland. “At every level, gynecological malignancies are given a little less attention. Hopefully, this starts to be a bit of a wake up call that women with these diseases deserve as much attention and research as any other cancer patient.”
New treatments for lung cancer and melanoma, like immunotherapy, helped drive the overall reduction in cancer deaths. There haven’t been similar advances in treatments for cervical and uterine (also called endometrial) cancers, especially for recurring and metastatic forms of the disease.
Around 66,000 new cases of endometrial cancer are diagnosed in the United States each year, and the need for good, accessible treatments is growing. Rates of aggressive endometrial cancers, which don’t have good treatment options, are going up. The increase in these types of cancer is likely due to the aging of the population, not obesity like some other forms of cancer.
Patients with these cancers sometimes struggle to get appropriate treatment. “We know for both endometrial and cervical cancers, access to treatment is a huge problem,” Temkin says. Racial disparities around treatment and survival are especially high for these diseases, for example. Black women are less likely to have vaginal bleeding evaluated than white women, which leads to later diagnoses for endometrial cancer and far lower survival rates.
Those disparities only get worse when it comes to new or novel treatments, like immunotherapy, which tend to be expensive and might not be offered in as many places. “Immunotherapy has not really been used as effectively in most endometrial and a lot of cervical cancers, even though it’s indicated in some cases,” Temkin says.
Even as the need to treat these cancers grows, systemic problems plague research funding. “These are really underfunded compared to other diseases that have similar mortality rates,” Temkin says. Federal funding for all cancer research was restructured in 2014 when the National Cancer Institute formed the National Clinical Trials Network to coordinate clinical trials for cancer treatments. Gynecologic oncology was grouped with radiation, breast cancer, and colon cancer research. “The cooperative group became much bigger. The overall funding didn’t really change that much,” says Matt Carlson, assistant professor in the division of gynecologic oncology at UT Southwestern Medical Center.
While there were good reasons for the change and it improved the efficiency of clinical trials, it also caused an abrupt decline in the number of clinical trials for gynecologic cancer, Temkin says. “The number of trials open and available plummeted,” she says. “We were more affected because we’re such a small speciality.” That left researchers more dependent on pharmaceutical companies to conduct trials, and their priorities may not be in line with those in the gynecologic oncology community.
Despite those challenges, Carlson says he’s optimistic that mortality rates for cervical and endometrial cancers will start to go down. The Society for Gynecologic Oncology, of which both Carlson and Temkin are members, has been lobbying legislators for more funding. “We’ve had incremental success each time,” Carlson says. In September, the Food and Drug Administration also approved a new treatment for patients with aggressive endometrial cancer or whose cancer had returned after their first round of treatment. “We haven’t had a lot of new drugs, and if we were having this conversation a year ago, I’d be more melancholy,” he says. “But it’s an exciting time, and we have some other trials in the works.”
The barriers blocking better treatment and improved survival rates for cervical and endometrial cancers aren’t insurmountable, Temkin says. “We have the opportunity to fix this.”