Survival of epithelial ovarian cancer in Black women: a society to cell approach in the African American cancer epidemiology study (AACES)

Abstract

Purpose The causes for the survival disparity among Black women with epithelial ovarian cancer (EOC) are likely multi-factorial. Here we describe the African American Cancer Epidemiology Study (AACES), the largest cohort of Black women with EOC. Methods AACES phase 2 (enrolled 2020 onward) is a multi-site, population-based study focused on overall survival (OS) of EOC. Rapid case ascertainment is used in ongoing patient recruitment in eight U.S. states, both northern and southern. Data collection is composed of a survey, biospecimens, and medical record abstraction. Results characterizing the survival experience of the phase 1 study population (enrolled 2010–2015) are presented. Results Thus far, ~ 650 patients with EOC have been enrolled in the AACES. The five-year OS of AACES participants approximates those of Black women in the Surveillance Epidemiology and End Results (SEER) registry who survive at least 10-month past diagnosis and is worse compared to white women in SEER, 49 vs. 60%, respectively. A high proportion of women in AACES have low levels of household income (45% < $25,000 annually), education (51% ≤ high school education), and insurance coverage (32% uninsured or Medicaid). Those followed annually differ from those without follow-up with higher levels of localized disease (28 vs 24%) and higher levels of optimal debulking status (73 vs 67%). Conclusion AACES is well positioned to evaluate the contribution of social determinants of health to the poor survival of Black women with EOC and advance understanding of the multi-factorial causes of the ovarian cancer survival disparity in Black women.

Molecular subtypes of high-grade serous ovarian cancer across racial groups and gene expression platforms

“…However, it is also possible that variations in study design across the six study populations contributed to the different subtype distributions that we observed. For example, case-control studies like the AACES and NCOCS are unable to enroll cases with rapidly fatal HGSC (Schildkraut et al, 2023). This could have skewed the observed subtype distribution for Black cases toward a greater proportion of less aggressive, immunoreactive tumors, and artificially inflated estimates of overall survival in the SchildkrautB study population ( Supplemental Figure 11 ), as has been posited previously (Schildkraut et al, 2023).…”

“…We included epithelial ovarian cancer cases enrolled in one of two population-based case-control studies, the North Carolina Ovarian Cancer Study (NCOCS, diagnosis dates 1999-2005) (Moorman et al, 2002), and the African American Cancer Epidemiology Study (AACES, diagnosis dates 2010-2015) (Schildkraut et al, 2013, 2023). Both of these studies enrolled epithelial ovarian cancer cases covering a range of histotypes, grades, and stages, though some of the most aggressive epithelial ovarian cancer cases were missed because they were not feeling well enough or were already deceased by the time they were invited to participate in research (Schildkraut et al, 2023). Written informed consent was obtained for NCOCS participants, while AACES participants provided verbal consent and signed medical record and pathology release forms to allow for access to tumor tissue.…”

“…were not feeling well enough or were already deceased by the time they were invited to participate in research (Schildkraut et al, 2023). Written informed consent was obtained for NCOCS participants, while AACES participants provided verbal consent and signed medical record and pathology release forms to allow for access to tumor tissue.…”

“…We included epithelial ovarian cancer cases enrolled in one of two population-based case-control studies, the North Carolina Ovarian Cancer Study (NCOCS, diagnosis dates 1999(NCOCS, diagnosis dates -2005 (Moorman et al, 2002), and the African American Cancer Epidemiology Study (AACES, diagnosis dates 2010-2015) (Schildkraut et al, 2013(Schildkraut et al, , 2023. Both of these studies enrolled epithelial ovarian cancer cases covering a range of histotypes, grades, and stages, though some of the most aggressive epithelial ovarian cancer cases were missed because they…”

“…Here, we leverage RNA-sequencing (RNA-seq) data to characterize HGSC gene expression subtypes among a more racially diverse study population, including a population of >300 self-identified Black individuals. Prior studies have noted that Black individuals have poorer overall ovarian cancer survival (Siegel et al, 2022), and poorer three-year and six-year HGSC survival when compared to White individuals (Peres et al, 2020; Schildkraut et al, 2023), so inclusion of Black individuals in the derivation of HGSC molecular subtypes is especially important.…”