UCI study finds racial, economic disparities in ovarian cancer care, survival

Poor women and African Americans with ovarian cancer are less likely to receive the highest standards of care, leading to worse outcomes than among white and affluent patients, according to a study of 50,000 women presented by UC Irvine’s Dr. Robert Bristow at the Society of Gynecologic Oncology’s annual meeting March 27.

“Not all women are benefiting equally from improvements in ovarian cancer care,” said Bristow, UC Irvine’s director of gynecologic oncology services. “The reasons behind these disparities are not entirely clear, which is why we need additional research.”

The study’s goal was to examine differences related to race and socioeconomic status among women being treated for epithelial ovarian carcinomas – cancer that forms on the surface of an ovary. It also aimed to determine whether their care adhered to National Comprehensive Cancer Network treatment guidelines.

Bristow and colleagues found that five-year survival rates varied significantly. (Improvement in ovarian cancer care is measured in length of survival after diagnosis rather than a “cure” rate.)

Among those whose care met NCCN standards, the rate for white women was 41.4 percent, compared with 33.3 percent for African American women. Among those whose care did not meet NCCN standards, the rate for white women was 37.8 percent, compared with 22.5 percent for African American women.

Ovarian cancer is the fifth most common cancer among women, and it causes more deaths than any other type of female reproductive cancer.
The cause is unknown.

The risk for developing ovarian cancer appears to be affected by several factors. The more children a woman has and the earlier in life she gives birth, the lower her risk for ovarian cancer. Certain genes defects (BRCA1 and BRCA2) are responsible for a small number of ovarian cancer cases. Women with a personal history of breast cancer or a family history of breast or ovarian cancer have an increased risk for ovarian cancer.

Women who take estrogen replacement only (not with progesterone) for 5 years or more seem to have a higher risk of ovarian cancer. Birth control pills, however, decrease the risk of ovarian cancer.

Studies suggest that fertility drugs do not increase the risk for ovarian cancer.

Older women are at highest risk for developing ovarian cancer. Most deaths from ovarian cancer occur in women age 55 and older.

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team.

Ovarian cancer is treated with one or a combination of treatments, including surgery, chemotherapy, and radiation therapy. Each treatment option is described below, followed by an outline of the treatments based on the stage of the disease. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, the patient’s preferences and overall health, and personal considerations, such as the woman’s age and if she is planning to have children. Women with ovarian cancer may have concerns about if or how their treatment may affect their sexual function and fertility, and these topics should be discussed with the health care team before treatment begins.

Bristow said that women on Medicaid or those with no insurance had a 30 percent increased risk of death. Poor women – defined as having an annual household income of less than $35,000 – had worse survival rates regardless of race.

He said it’s likely that the effects of race and socioeconomic status are cumulative and that some combination of other medical conditions, poverty, culture and social injustice accounts for the majority of observed disparities.

Ovarian cancer is the deadliest gynecologic cancer, accounting for more than 15,000 deaths a year, according to the National Cancer Institute.

Ovarian cancer Prevention
There are no standard recommendations for screening for ovarian cancer. Screening women with pelvic ultrasound or blood tests, such as the Ca-125 has not been found to be effective and is not recommended.
BRCA testing may be done in women at high risk for ovarian cancer.

Removal of the ovaries and tubes in women who have a mutation in the BRCA1 and BRCA2 genes may reduce the risk of developing ovarian cancer, although ovarian cancer may still develop in other areas of the pelvis.

“Under the best circumstances, treating ovarian cancer is challenging, because there’s no screening tool available to detect the disease in its early stages,” Bristow said.

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