Racial, Ethnic, and Socioeconomic Gaps Persist in US Female-Specific Cancer Burden

Significant sociodemographic disparities and unfavorable trends continue to affect the incidence and mortality of all 6 major female-specific cancers (FSCs), according to a study published in PLoS One, underscoring the need for targeted prevention and intervention strategies.1

Unequal Burden of FSCs Across Populations

FSCs, including breast, cervical, uterine, ovarian, vaginal, and vulvar cancers, account for 44% of all cancer cases in women. In 2024, an estimated 427,650 new FSC cases and 76,100 related deaths were expected in the US, representing about 44% of all new cancer cases and 26% of cancer deaths among women.2 Persistent racial and ethnic disparities in FSC burden remain strongly linked to social determinants of health (SDOH), such as racial and ethnic minorities, low-income groups, and individuals with limited health care access, which disproportionately affect disadvantaged populations.3

Persistent racial, ethnic, and socioeconomic disparities affect the incidence and mortality of major female-specific cancers in the US. | Image Credit: Andreas Prott - stock.adobe.com

The researchers noted that most prior studies have focused on individual FSC types rather than the overall burden of all FSCs.1 They also highlighted a lack of recent systematic analyses of temporal trends in FSC incidence and mortality, particularly across racial and ethnic groups and in relation to SDOH. To address these gaps, the researchers examined sociodemographic disparities, trends in incidence and mortality, and associated risk factors for breast, cervical, uterine, ovarian, vaginal, and vulvar cancers in the US.

They obtained incidence data from the Surveillance, Epidemiology, and End Results (SEER) 22-registry database, which encompasses 47.9% of the US population, to analyze cross-sectional incidence rates from 2017 to 2021 and long-term trends (2000-2021). Mortality data spanning 2000 to 2022 were obtained from the SEER mortality database, which covers nearly the entire US population.

To evaluate FSC risk factors, the researchers used data from the Global Burden of Disease (GBD) 2021 database, which included data on breast, cervical, uterine, and ovarian cancers. Data on vaginal and vulvar cancers were unavailable.

Trends in Incidence, Mortality, and Risk Factors Across FSCs

Between 2017 and 2021, breast cancer had the highest incidence rate across all racial and ethnic groups (129.4 per 100,000; 95% CI, 129.1-129.8), while vaginal cancer had the lowest (0.7 per 100,000; 95% CI, 0.6-0.7). Incidence was highest among non-Hispanic White patients for breast cancer (139.0 per 100,000; 95% CI, 138.5-139.4) and among Hispanic patients for cervical cancer (9.8 per 100,000; 95% CI, 9.6-10.0).

Black patients had the highest incidences of uterine (30.2 per 100,000; 95% CI, 29.7-30.6 per 100,000) and vaginal (0.9 per 100,000; 95% CI, 0.8-1.0) cancers. American Indian and Alaska Native patients had the highest ovarian cancer incidence (11.6 per 100,000; 95% CI, 9.9-13.5), comparable with White patients (rate ratio [RR], 1.12; 95% CI, 0.95-1.30). Vulvar cancer incidence was highest among White patients (3.1 per 100,000; 95% CI, 3.0-3.1) and was similar among American Indian and Alaska Native patients (3.0 per 100,000; 95% CI, 2.1-4.0).

From 2018 to 2022, Black patients had the highest mortality rates for breast (26.8 per 100,000; 95% CI, 26.5-27.1), cervical (3.2 per 100,000; 95% CI, 3.1-3.3), and uterine (9.5 per 100,000; 95% CI, 9.4-9.7) cancers. White patients had the highest mortality rates for ovarian (6.3 per 100,000; 95% CI, 6.3-6.4) and vulvar (0.7 per 100,000; 95% CI, 0.7-0.7) cancers. Vaginal cancer mortality was comparable among White, Black, and Hispanic patients.

Long-term analyses showed that breast cancer incidence increased across all racial and ethnic groups from 2000 to 2021 (average annual percentage change [AAPC], 1.4; 95% CI, 0.7-2.5), especially among non-Hispanic American Indian, Alaska Native, Asian American, and Pacific Islander patients. Although breast cancer mortality declined overall (AAPC, –1.5; 95% CI, –2.0 to –1.3), Black patients continued to have the highest mortality despite showing the most significant decline (AAPC, –1.4; 95% CI, –1.5 to –1.3).

Uterine cancer incidence rose across all groups except White patients, whose rates fell between 2000 and 2004 and again between 2016 and 2021. Despite these fluctuations, uterine cancer mortality increased for all groups. Both ovarian and vaginal cancer incidence and mortality declined, whereas vulvar cancer rates increased across racial and ethnic groups.

According to the GBD data, dietary risks contributing to breast cancer deaths decreased by 26.8%, followed by reductions linked to high body mass index (BMI), fasting plasma glucose, alcohol use, tobacco use, and low physical activity. For cervical cancer, deaths attributed to unsafe sex and tobacco use declined by 19.8% and 31.5%, respectively. Similarly, for ovarian cancer, deaths linked to high BMI and occupational risks decreased by 17.7% and 30.3%, respectively. In contrast, uterine cancer deaths attributable to high BMI increased by 38.5%

Implications for Prevention and Research

The researchers acknowledged several study limitations, including potential racial and ethnic misclassification in records that may have led to underestimation of rates among groups other than non-Hispanic White and Black patients. The absence of data on vaginal and vulvar cancers in the GBD database also limited exploration of risk factors for those types. Still, the researchers expressed confidence in their findings and emphasized their relevance in guiding prevention and research efforts.

“Further efforts to prevent FSCs should focus on the management of risk factors and intervention measures, including expanding HPV vaccination in underserved communities, implementing Medicaid coverage expansion to improve treatment access, and developing targeted obesity prevention initiatives in high-risk regions,” the authors concluded. “Further research should elucidate these patterns and mitigate disparities…”

References

1. Zhang Z, Li Y, Huang H, et al. Disparities and trends of the incidence and mortality of female-specific cancers in the United States. PLoS One. 2025;20(10):e0334128. Published online October 14, 2025. doi:10.1371/journal.pone.0334128
2. Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin. 2024;74(1):12-49. doi:10.3322/caac.21820
3. Korn AR, Walsh-Bailey C, Correa-Mendez M, et al. Social determinants of health and US cancer screening interventions: a systematic review. CA Cancer J Clin. 2023;73(5):461-479. doi:10.3322/caac.21801