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ImportanceDisparities in survival exist between non-Hispanic Black (hereafter, Black) and non-Hispanic White (hereafter, White) patients with uterine cancer.ObjectiveTo investigate factors associated with racial disparities in survival between Black and White patients with uterine cancer.Design, Setting, and PatientsThis cohort study used data from the National Cancer Database on 274 838 Black and White patients who received a diagnosis of uterine cancer from January 1, 2004, to December 31, 2017, with follow-up through December 2020. Statistical analysis was performed in July 2022.Main Outcomes and MeasuresOverall survival by self-reported race and evaluation of explanatory study factors associated with hazard ratio (HR) reduction for Black vs White patients. A propensity scoring approach was applied sequentially to balance racial differences in demographic characteristics, comorbidity score, neighborhood income, insurance status, histologic subtype, disease stage, and treatment.ResultsThe study included 32 230 Black female patients (mean [SD] age at diagnosis, 63.8 [10.0] years) and 242 608 White female patients (mean [SD] age at diagnosis, 63.5 [10.5] years) and had a median follow-up of 74.0 months (range, 43.5-113.8 months). Black patients were more likely than White patients to have low income (44.1% vs 14.0%), be uninsured (5.7% vs 2.6%), present with nonendometrioid histologic characteristics (46.1% vs 21.6%), have an advanced disease stage (34.1% vs 19.8%), receive first-line chemotherapy (33.8% vs 18.2%), and have worse 5-year survival (58.6% vs 78.5%). Among patients who received a diagnosis at younger than 65 years of age, the HR for death for Black vs White patients was 2.43 (95% CI, 2.34-2.52) in a baseline demographic-adjusted model and 1.29 (95% CI, 1.23-1.35) after balancing other factors. Comorbidity score, neighborhood income, insurance status, histologic subtype, disease stage, treatment, and unexplained factors accounted for 0.8%, 7.2%, 11.5%, 53.1%, 5.8%, 1.2%, and 20.4%, respectively, of the excess relative risk (ERR) among the younger Black vs White patients. Among patients 65 years or older, the HR for death for Black vs White patients was 1.87 (95% CI, 1.81-1.93) in the baseline model and 1.14 (95% CI, 1.09-1.19) after balancing other factors. Comorbidity score, neighborhood income, insurance status, histologic subtype, disease stage, treatment, and unexplained factors accounted for 3.0%, 7.5%, 0.0%, 56.2%, 10.6%, 6.9%, and 15.8%, respectively, of the ERR among Black vs White patients aged 65 years or older.Conclusions and RelevanceThis study suggests that histologic subtype was the dominant factor associated with racial survival disparity among patients with uterine cancer, while insurance status represented the main modifiable factor for women younger than 65 years. Additional studies of interactions between biology and social determinants of health are merited.

Introduction In January 2016, the U.S. Department of Defense increased the duration of paid maternity leave for active duty service members from 6 weeks to 12 weeks. Our study aims to determine the impact of maternity leave length on breastfeeding duration and postpartum depression rates in active duty service members. Materials and Methods An institutional review board-approved survey of 9 questions was given to patients at the Brooke Army Medical Center Obstetrics and Gynecology Clinic. Patients were offered voluntary participation if they had delivered a baby while on active duty in the preceding 20 years. The survey included questions about length of maternity leave, duration of breastfeeding, age at delivery, route of delivery, and whether the patient suffered from postpartum depression. Results A total of 214 surveys were collected. Fisher exact test was used to compare rates of breastfeeding and postpartum depression between the 2 groups. A total of 87% of service members initiated breastfeeding. Among women who had 6 weeks versus 12 weeks of maternity leave, 51.64% versus 56.96% breastfed up to 6 months, p = 0.45. The overall rate of postpartum depression was 13.5%. Among women who had 6 weeks versus 12 weeks of maternity leave, 16.1% versus 9.5% reported postpartum depression, p = 0.11. Conclusion The ideal maternity leave duration is unknown. With recent changes to the Department of Defense maternity leave policy, we aimed to evaluate the effect this had on breastfeeding and postpartum depression rates. No statistically significant difference was seen when we compared rates of breastfeeding in women who had 6 weeks versus 12 weeks of maternity leave. Further research is required to determine the ideal maternity leave duration and best practices to promote breastfeeding. When looking at postpartum depression, our study shows that postpartum depression was noted in 16% of patients who took 6 weeks versus 9% of those who took 12 weeks of maternity leave. No statistically significant difference was seen; however, this was likely because of the small sample size. Only 29 out of 214 women suffered from depression regardless of length of maternity leave. More research is needed to determine if maternity leave length does indeed impact postpartum depression rates.

Highlights • Ovarian germ cell tumors can produce hCG and be confused with ectopic pregnancy. • Ovarian germ cell tumors can present with subacute pelvic pain. • Ectopic pregnancy should be the primary differential diagnosis due to its acuity.