Ovarian cancer causes more deaths per year than all other female reproductive cancers. Ethnicity, parity, oral contraception use, and breast feeding are all predictive factors for development of ovarian cancer. Factors that predict poor prognosis include higher disease stage and older age. Other studies have also shown that African-Americans with ovarian cancer have higher mortality rates than Caucasians with ovarian cancer. While ethnicity is a risk factor, little is known about the differences in prognostic factors between Caucasians and African-Americans with ovarian cancer that could effect survival. In a retrospective study of over 13,000 women with ovarian cancer, Barnholtz-Sloan et al analyzed data for differences in prognostic factors between Caucasians and African-Americans and the effect of these differences on ovarian cancer survival.
Data from 12,285 Caucasian women and 798 African-American women diagnosed with primary, malignant ovarian carcinoma was analyzed from the Surveillance, Epidemiology, and End Results (SEER) Program. SEER is a population-based national cancer surveillance database with demographic, clinical, treatment and survival information on men and women diagnosed with cancer. Factors included the database and analyzed in this study include marital status, age at diagnosis, tumor stage, tumor histology and grade, lymph node involvement, site-specific surgical treatment, and death from any cause.
Analysis of demographic and clinical data showed significant differences between Caucasian and African-American women. The mean age at diagnosis was 61 years and 63 years for African-American and Caucasian women, respectively. African-American women were also 2.4 times more likely to be unmarried compared to Caucasian women. African-American women were 50% more likely to have Stage IV disease and more likely to have lymph node involvement and distant metastases than Caucasian women. African-American women were 40% more likely not to undergo surgery. However, microscopic grade did not differ by ethnicity.
Median survival was 22 months and 32 months for African-American and Caucasian women, respectively. Single variable analysis accounting for only ethnicity showed that compared to Caucasian women, African-American women had a 30% increased risk of death from any cause. After adjusting for the observed ethnic differences in prognostic factors, African-American women were still at a 30% increased risk of death from any cause compared to Caucasian women.
The authors conclude, "compared with Caucasian women, African-American women are at a 30% increased risk of death from any cause after they are diagnosed with ovarian carcinoma, after adjustment for all variables that differ significantly between these two ethnic groups." The authors add, "additional variables should be investigated that are not available in the SEER database, such as socioeconomic status, course of treatment, and accessibility to care, to help explain the ethnic difference in survival."
"Ethnic Differences in Survival Among Women with Ovarian Carcinoma," Jill S. Barnholtz-Sloan, Michael A. Tainsky, Judith Abrams, Richard K. Severson, Faisal Qureshi, Suzanne M. Jacques, Nancy Levin, Ann G. Schwartz, CANCER* 2002; 94:6; pp. 1886-1893.
For a full copy of the article, please contact David Greenberg at dgreenbe@wiley.com
Journal
Cancer