Racial disparities in epithelial ovarian cancer survival: An examination of contributing factors in the Ovarian Cancer in Women of African Ancestry (OCWAA) consortium

• Type of Material: Article
• Authors: Holly R. Harris, University of Washington, Seattle; Kristin A. Guertin, University of Connecticut, Farmington; Tareq F. Camacho, University of Virginia, Charlottesville; Courtney Elizabeth Johnson, Emory University; Anna H. Wu, University of Southern California; Patricia G. Moorman, Duke University; Evan Myers, Duke University; Traci N. Bethea, Georgetown University; Eliza V. Bandera, Rutgers Cancer Institute of New Jersey; Charlotte E. Joslin, University of Illinois, Chicago; Heather M. Ochs-Balcom, University at Buffalo; lauren C. Peres, H. Lee Moffitt Cancer Center and Research Institute; Will T. Rosenow, University of Virginia, Charlottesville; Veronica W. Setiawan, University of Southern California; Alicia Beeghly-Fadiel, Vanderbilt University; Lauren Dempsey, Emory University; Lynn Rosenberg, Boston University; Joellen Martha Schildkraut, Emory University
• Language: English
• Date: 2022-07-30
• Publisher: John Wiley and Sons
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 UICC.
• Final Published Version (URL): https://doi.org/10.1002/ijc.34141
• Title of Journal or Parent Work: International Journal of Cancer
• Volume: 151
• Issue: 8
• Start Page: 1228
• End Page: 1239
• Grant/Funding Information: This study is supported by the National Institutes of Health (R01-CA207260 to Schildkraut and Rosenberg and K01-CA212056 to Bethea). AACES was funded by NCI (R01-CA142081 to Schildkraut); BWHS is funded by NIH (R01-CA058420,UM1-CA164974, and U01-CA164974 to Rosenberg); CCCCS was funded by NIH/NCI (R01-CA61093 to Rosenblatt); LACOCS was funded by NCI (R01-CA17054 to Pike, R01-CA58598 to Goodman and Wu, and Cancer Center Core Grant P30-CA014089 to Henderson and Wu) and by the California Cancer Research Program (2II0200 to A. Wu); MEC is funded by NCI (U01-CA164973 to Le Marchand, Haiman, and Wilkens); and NCOCS was funded by NCI (R01-CA076016 to Schildkraut). The WHI program is funded by the National Heart, Lung, and Blood Institute through contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C and HHSN268201600004C. Additional grants to support WHI inclusion in OCWAA include UM1-CA173642-05 (to Anderson), NHLBI-CSB-WH-2016-01-CM and NHLBI-75N92021D00002.
• Keywords: disparities; Ovarian cancer; survival
• Research Categories: Health Sciences, Oncology; Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

Black women diagnosed with epithelial ovarian cancer have poorer survival compared to White women. Factors that contribute to this disparity, aside from socioeconomic status and guideline-adherent treatment, have not yet been clearly identified. We examined data from the Ovarian Cancer in Women of African Ancestry (OCWAA) consortium which harmonized data on 1,074 Black women and 3,263 White women with ovarian cancer from seven U.S. studies. We selected potential mediators and confounders by examining associations between each variable with race and survival. We then conducted a sequential mediation analysis using an imputation method to estimate total, direct, and indirect effects of race on ovarian cancer survival. Black women had worse survival than White women (HR=1.30; 95%CI=1.16–1.47) during study follow-up; 67.9% of Black women and 69.8% of White women died. In our final model, mediators of this disparity include college education, nulliparity, smoking status, body mass index, diabetes, diabetes/race interaction, postmenopausal hormone (PMH) therapy duration, PMH duration/race interaction, PMH duration/age interaction, histotype, and stage. These mediators explained 48.8%(SE=12.1%) of the overall disparity; histotype/stage and PMH duration accounted for the largest fraction. In summary, nearly half of the disparity in ovarian cancer survival between Black and White women in the OCWAA consortium is explained by education, lifestyle factors, diabetes, PMH use, and tumor characteristics. Our findings suggest that several potentially modifiable factors play a role. Further research to uncover additional mediators, incorporate data on social determinants of health, and identify potential avenues of intervention to reduce this disparity is urgently needed.