Epidemiology of Ovarian Cancer in African-American Women

描述(申请人提供)：卵巢癌是最致命的妇科恶性肿瘤。尽管非裔美国女性的发病率低于白人女性，但她们的五年存活率也较低。到目前为止，关于非裔美国女性患卵巢癌的研究还很少。1993年，一项涉及110例病例和365名对照的分析是第一份描述非裔美国女性卵巢癌风险因素的报告。这份报告附带的一篇社论呼吁对非裔美国人的卵巢癌进行进一步研究，但在过去15年里，这一领域几乎没有取得什么进展。在国际卵巢癌协会联合会中，来自18个病例对照研究的12 000多个病例中，非洲裔妇女占不到300个，其中包括我们北卡罗来纳州卵巢癌研究的144个病例。在NCOCS中，我们发现有证据表明，非裔美国人和白人在某些卵巢癌风险因素上存在差异，包括雄激素受体(AR)基因的CAG重复和人体测量特征。尽管这些发现很耐人寻味，但我们一直无法证实它们，因为其他研究中缺乏关于非裔美国女性的数据。这项申请的目的是建立一项涉及美国境内九个地理区域的多中心病例对照研究，以研究非裔美国人卵巢癌的病因。具体目标是：1.建立基础设施，招募1000名患有浸润性上皮性卵巢癌的非裔美国女性和同等数量的年龄匹配的对照组。2.确定非裔美国女性患卵巢癌的风险因素与白人女性的既定风险因素有何相似或不同之处。我们将计算人群归因分数，以确定风险因素(例如生殖特征或肥胖)患病率的差异是否可以解释卵巢癌发病率的种族差异。3.评估卵巢癌的遗传危险因素，重点评估结果与大型财团或全基因组关联研究(GWAS)中白人女性卵巢癌相关基因的一致性或不一致性。4.获取有关卵巢癌病例的治疗和结果的信息。我们将分析护理模式，并评估与获得符合推荐治疗标准的治疗相关的因素。我们还将定位于研究非裔美国人卵巢癌患者的生存预测因素。这项拟议的研究将填补非裔美国女性卵巢癌研究的一个重要空白。我们不仅将探索在白人女性中被确定为重要的风险因素和预后特征，我们还将调查与可能特定于非裔美国人的因素的关联。庞大的样本量和不同的人群将为非洲裔美国人和白人女性之间卵巢癌风险因素的异同提供关键的洞察力，并可能有助于更好地理解非裔美国人经历的较差的存活率。 公共卫生相关性：尽管在高加索女性中对卵巢癌的流行病学进行了很好的研究，但对非裔美国人中卵巢癌的危险因素知之甚少。这在很大程度上是因为在现有的流行病学研究中，非洲裔美国人的招生人数很少。这项研究的目的是从美国9个地理区域招募1,000例卵巢癌病例和1,000名非裔美国人对照，以全面评估这一人群中卵巢癌的已知和可疑的流行病学和遗传因素。治疗和后续数据的收集将为解决被诊断为卵巢癌的非裔美国女性与白人相比在卵巢癌存活率方面的差异奠定基础。这项研究将为非裔美国女性卵巢癌的病因和预后提供新的见解。

DESCRIPTION (provided by applicant): Ovarian cancer is the most lethal of gynecologic malignancies. Although African-American women have lower incidence rates than white women, their five-year survival rates are lower. To date, there has been little research on ovarian cancer in African-American women. In 1993, an analysis involving 110 cases and 365 controls was the first published report describing ovarian cancer risk factors in African-American women. An editorial accompanying this report called for further research on ovarian cancer in African-Americans, however there has been little progress in this area in the past fifteen years. In the international Ovarian Cancer Association Consortium, women of African descent comprise fewer than 300 of the more than 12,000 cases from 18 case-control studies, including 144 cases from our North Carolina Ovarian Cancer Study (NCOCS). Within the NCOCS, we have found evidence suggesting differences between African-Americans and whites in certain ovarian cancer risk factors including CAG repeats in the androgen receptor (AR) gene and anthropometric characteristics. Although these findings are intriguing, we have been unable to confirm them because of the paucity of data on African-American women in other studies. The purpose of this application is to establish a multi-center case-control study involving nine geographic regions within the United States to study the etiology of ovarian cancer in African Americans. The specific aims are: 1. To establish the infrastructure to recruit 1000 African-American women with invasive epithelial ovarian cancer and an equal number of age-matched controls. 2. To determine how risk factors for ovarian cancer in African-American women are similar or different to established risk factors for white women. We will calculate population attributable fractions to determine if differences in the prevalence of risk factors (e.g. reproductive characteristics or obesity) can account for racial differences in ovarian cancer incidence. 3. To evaluate genetic risk factors for ovarian cancer, focusing on concordance or discordance of results with genes that have been reported to be associated with ovarian cancer in white women in studies from large consortia or genome-wide association studies (GWAS). 4. To obtain information on treatment and outcome for ovarian cancer cases. We will analyze patterns of care and assess factors associated with obtaining treatment consistent with recommended standards for therapy. We also will be positioning ourselves to study predictors of survival among African-American ovarian cancer patients. The proposed study will fill an important gap in research on ovarian cancer in African-American women. Not only will we explore risk factors and prognostic characteristics that have been established as important in white women, we will investigate associations with factors that may be specific to African Americans. The large sample size and the diverse populations represented will provide critical insight into the similarities and differences in ovarian cancer risk factors between African-American and white women and may contribute to a better understanding of the poorer survival experienced by African Americans. PUBLIC HEALTH RELEVANCE: Although the epidemiology of ovarian cancer has been well-studied among Caucasian women there is very little known about risk factors for ovarian cancer among African-Americans. This is largely due to the sparse enrollment of African Americans in existing epidemiologic studies. The purpose of this study is to enroll 1,000 ovarian cancer cases and 1,000 controls of African American ethnicity from 9 geographic regions in the U.S. to comprehensively evaluate known and suspected epidemiologic and genetic factors for ovarian cancer in this population. The collection of treatment and follow-up data will set the stage to address the disparity in ovarian cancer survival among African-American women diagnosed with ovarian cancer compared to whites. This study will provide new insight into both the etiology and prognosis of ovarian cancer in African-American women.