The effect of time on racial differences in epithelial ovarian cancer (OVCA) diagnosis stage, overall and by histologic subtypes: a study of the National Cancer Database

Abstract

PURPOSE Previous studies assessing racial and ethnic differences in ovarian cancer (OVCA) diagnosis stage fail to present subtype-specific results and provide historic data on cases diagnosed between ten and twenty years ago. The purpose of this analysis is to assess non-Hispanic Black (NHB) and non-Hispanic White (NHW) differences in late stage diagnosis including; 1) factors associated with late-stage diagnosis of invasive epithelial OVCA overall and by histologic subtypes 2) potential changes across time, and, 3) current patterns of trends in a national cancer registry in the US and Puerto Rico between 1998 and 2011. METHODS NHB and NHW OVCA cases were derived from the National Cancer Database (NCDB). Diagnosis stage was analyzed as a dichotomous and a four-level category variable, respectively; early (stages I and II; localized) versus late (stages III and IV; regional and distant) and stages I, II, III and IV. Diagnosis period was trichotomized (1998–2002, 2003–2007, 2008–2011). Racial differences in stage were tested using Chi-square statistics. Odds ratios (OR) and 95% confidence intervals (95%CI) were estimated using multivariable binomial and generalized ordered logistic regressions. Interactions between race and diagnosis period were evaluated. RESULTS Between 1998 and 2011, 11,562 (7.8%) NHB and 137,106 (92.2%) NHW were diagnosed with OVCA. In adjusted models, NHB were significantly more likely diagnosed with late-stage OVCA than NHW (ORadj=1.26; 95%CI 1.19–1.33). Interaction between race and diagnosis period was marginally significant (pvalue=0.09), with racial differences in stage decreasing over time (1998–2002: ORadj= 1.36, 95%CI= 1.23–1.49; 2003–2007: ORadj= 1.27, 95%CI= 1.15–1.39; 2008–2011; ORadj =1.15, 95%CI= 1.05–1.27). NHB were also more likely to be diagnosed with stage 4 high grade serous (ORadj=1.46; 95%CI 1.22–1.74), clear cell (ORadj=2.71; 95%CI 1.94 – 3.79) and mucinous (ORadj=2.78; 95%CI 2.24 – 3.46) carcinomas than NHW. CONCLUSIONS Racial differences in late-stage OVCA diagnosis exist; however, these differences are decreasing with time. Within NCDB, NHB are significantly more likely diagnosed with late-stage OVCA and more specifically high-grade serous, clear cell and mucinous carcinomas than NHW.

Histopathological Pattern and Age Distribution, of Malignant Ovarian Tumor among Sudanese Ladies

“…Studies demonstrated that white women had the highest risk of developing ovarian cancer, followed by Hispanic, Asian, black, and American Indian women [ 10 ]. The variation in the incidence of ovarian cancer between nations may be due to other factors such as sample size in each study, biosocial differences of the population, and genetic and other environmental factors.…”

Racial health disparities in ovarian cancer: not just black and white

“…Racial disparity has been noted in the diagnosis of OC [ 22 ] with AA women being frequently diagnosed with advanced stage OC. However, interestingly, in one study, no race-based differences in clinical outcome were reported in patients with advanced stage epithelial OC, provided they received similar treatment [ 23 ].…”

Recent Advances in Integrative Multi-Omics Research in Breast and Ovarian Cancer

“…Ovarian tumors are classified into four major classes: high (70%) and low (4.1%) grade serous, endometrioid (8.3%), clear cell (9.5%) and mucinous (3.2%) carcinoma [ 37 , 38 , 39 ]. Of note, a study by Beckmeyer-Borowko and colleagues showed that non-Hispanic Black ovarian cancer patients were more likely to be diagnosed with stage four HGSOC, clear cell or mucinous carcinomas when compared to non-Hispanic White patients [ 40 ]. Beyond these classifications, ovarian epithelial tumors have been divided into Type I and Type II tumors [ 41 , 42 , 43 , 44 ].…”