Ovarian Cancer Survival in African-American Women

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ABSTRACT Although epithelial ovarian cancer (EOC) is the fifth-leading cause of cancer death in women in the U.S.—with worse survival in African-American (AA) women than European-American (EA) women—little is known about factors affecting survival among AAs. The causes for this disparity are likely multifactorial and need to be examined from multiple levels, including factors affecting the neighborhood social environment and individual- level factors. We posit that inflammatory exposures may explain some of the disparity in EOC survival among AA women due to important role of inflammation on carcinogenesis and prognosis and the higher levels of inflammatory biomarkers present among AA women. The African American Cancer Epidemiology Study (AACES) is a multi-site epidemiologic study of AA women in diverse geographic regions. Due to comprehensive data collection, pathology assessment and length of follow-up, AACES is uniquely positioned to evaluate factors influencing the survival of EOC in AA women. AACES has enrolled an unprecedented number of AA participants during a previous funding period, making AACES the largest study of ovarian cancer in AA women to date: 595 AA women with invasive EOC and 752 controls. Prior to AACES, no epidemiologic study of ovarian cancer had enrolled more than 150 AA cases and 150 AA controls. The overarching goal of this proposal is to assemble the first cohort study of AA EOC survivors by expanding recruitment to reach a sample size of ~944 cases and continuing follow-up of existing AACES cases. We propose a novel multi-level approach to evaluate the impact of neighborhood, lifestyle factors and biomarkers on survival. We propose the following aims that build on our current infrastructure and accomplishments: 1) investigate the effects of the neighborhood social and physical environment on EOC survival; 2) evaluate the association between individual characteristics and EOC survival; 3) characterize inflammatory tumor markers that may be key treatment targets; and 4) use multi-leveling modeling to integrate the impact of the Aim 1-3 variables. Our multi- disciplinary investigative team has extensive experience in all facets of ovarian cancer research, which ensures comprehensive, synergistic approaches to understanding factors that affect survival in AA women diagnosed with invasive EOC. The critical deficit of information on the epidemiologic and prognostic factors for ovarian cancer survival among AA women is addressed comprehensively in the proposed study. Our study will inform strategies to reduce mortality in AA women with EOC.