Original Article

Racial/Ethnic Disparities in the Incidence of Epithelial Ovarian Cancer in Florida by Histology, 2001–2015: Analysis of Trends

Authors: Ashly Westrick, PhD, Matthew Schlumbrecht, MD, Paulo Pinheiro, MD, PhD, WayWay Hlaing, PhD, Erin Kobetz, PhD, Daniel Feaster, PhD, Raymond Balise, PhD


Objectives: Because the population in Florida is 25.6% Hispanic, it is possible to evaluate the influence of race and ethnicity within clinically relevant subgroups of women with epithelial ovarian cancer (EOC), including histology and tumor grade. This study explores racial/ethnic disparities in the incidence of EOC in Florida by histology and tumor grade.

Methods: This study is an analysis of the Florida Cancer Database System. All incidence EOC cases from 2001 through 2015 were identified. Age-adjusted incidences were calculated and trends modeled by race/ethnicity and histology using Joinpoint and Poisson regression.

Results: In total, 80% of the 21,731 women with EOC were White, followed by Hispanic (13.1%) and non-Hispanic Black (7.9%). All races/ethnicities had statistically significant declines in incidence, with non-Hispanic White and non-Hispanic Black women having the steepest declines (annual percentage change −2.5, 95% confidence interval [CI] −5.9 to −2.1 and annual percentage change −2.8, 95% CI −4.8 to −1.5, respectively). A decreased incidence trend across the time period was seen for all subgroups (relative risk 0.97 [95% CI 0.96–0.98], 0.96 [95% CI 0.96–0.99], and 0.98 [95% CI 0.96–0.99] for non-Hispanic White, non-Hispanic Black, and Hispanic). High-grade EOC incidence for all groups did not change with time.

Conclusions: We found significant declines in the incidence of EOC for all races/ethnicities, but not for high-grade EOC. The observed incidence decline in Hispanic women differs from previous research. More research is needed to understand women the causes of overall racial/ethnic differences and the decline in EOC.
Posted in: Ovarian Disorders And Female Reproductive Health2 Ovarian Disorders2

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1. Torre LA, Trabert B, DeSantis CE, et al. Ovarian cancer statistics, 2018. CA Cancer J Clin 2018;68:284–296.
2. National Cancer Institute. Cancer stat facts: ovarian cancer. https://seer.cancer.gov/statfacts/html/ovary.html. Published 2018. Accessed May 7, 2021.
3. Park HK, Ruterbusch JJ, Cote ML. Recent trends in ovarian cancer incidence and relative survival in the United States by race/ethnicity and histologic subtypes. Cancer Epidemiol Biomarkers Prev 2017;26:1511–151.
4. Wu J, Sun H, Yang L, et al. Improved survival in ovarian cancer, with widening survival gaps of races and socioeconomic status: a period analysis, 1983-2012. J Cancer 2018;9:3548–3556.
5. Ibeanu OA, Diaz-Montes TP. Outcomes in ovarian cancer among Hispanic women living in the United States: a population-based analysis. Pathol Res Int 2013;2013:672–710.
6. Morris CR, Rodriguez AO, Epstein J, et al. Declining trends of epithelial ovarian cancer in California. Gynecol Oncol 2008;108:207–213.
7. Reid BM, Permuth JB, Sellers TA. Epidemiology of ovarian cancer: a review. Cancer Biol Med 2017;14:9–32.
8. Gockley A, Melamed A, Bregar AJ, et al. Outcomes of women with high-grade and low-grade advanced-stage serous epithelial ovarian cancer. Obstet Gynecol 2017;129:439–447.
9. Bowtell DD, Bohm S, Ahmed AA, et al. Rethinking ovarian cancer II: reducing mortality from high-grade serous ovarian cancer. Nat Rev Cancer 2015;15:668–679.
10. Mahal AS, Rhoads KF, Elliott CS, et al. Inappropriate oophorectomy at time of benign premenopausal hysterectomy. Menopause 2017;24:947–953.
11. Sopik V, Iqbal J, Rosen B, et al. Why have ovarian cancer mortality rates declined? Part I. Incidence. Gynecol Oncol 2015;138:741–749.
12. US Census Bureau. QuickFacts Florida. https://www.census.gov/quickfacts/FL. Published 2017. Accessed March 1, 2019.
13. Integrated Public Use Microdata Series: version 5.0 [macine-readable database]. https://usa.ipums.org/usa/. Published 2010. Accessed October 2015.
14. Woodward M. Epidemiology: Study Design and Data Analysis. Boca Raton, FL: CRC Press; 2014.
15. Kim HJ, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med 2000;19:335–351.
16. Chen VW, Ruiz B, Killeen JL, et al. Pathology and classification of ovarian tumors. Cancer 2003;97(10 suppl):2631–2642.
17. Ruhl J, Hofferkamp J, Ward E. Grade coding instructions and tables. Effective with cases diagnosed 1/1/2018 and forward. https://www.naaccr.org/SSDI/Grade-Manual.pdf?v=1605552799f. Published August 2019. Accessed November 2020.
18. National Cancer Institute. Joinpoint trend analysis software. Version https://surveillance.cancer.gov/joinpoint/. Published 2021. Accessed May 7, 2021.
19. R Core Development Team. R: A language and environment for statistical computing. https://www.r-project.org. Published 2018. Accessed May 7, 2021.
20. Wickham H. tidyverse: easily install and load the ‘Tidyverse’. R package version 1.3.1. https://CRAN.R-project.org/package=tidyverse. Published 2021. Accessed May 7, 2021.
21. Howlader N, Noone A, Krapcho M, et al. Previous version: SEER cancer statistics review, 1975-2013. https://seer.cancer.gov/archive/csr/1975_2013. Published 2016. Accessed February 16, 2019.
22. Mink PJ, Sherman ME, Devesa SS. Incidence patterns of invasive and borderline ovarian tumors among white women and black women in the United States. Results from the SEER Program, 1978-1998. Cancer 2002;95:2380–2389.
23. Hernandez MN, Sussman DA, Lee DJ, et al. Trends in colorectal cancer among Hispanics by stage and subsite location: 1989-2006. Clin Transl Gastroenterol 2012;3:e21.
24. Rosen DG, Yang G, Liu G, et al. Ovarian cancer: pathology, biology, and disease models. Front Biosci 2009;14:2089–2102.
25. Blustein J. The reliability of racial classifications in hospital discharge abstract data. Am J Public Health 1994;84:1018–1021.
26. Stewart SL, Swallen KC, Glaser SL, et al. Comparison of methods for classifying Hispanic ethnicity in a population-based cancer registry. Am J Epidemiol 1999;149:1063–1071.
27. Pinheiro PS, Sherman R, Fleming LE, et al. Validation of ethnicity in cancer data: which Hispanics are we misclassifying? J Registry Manag 2009;36:42–46.