Racial health disparities in ovarian cancer: not just black and white

Journal of Ovarian Research, Sep 2017

Ovarian cancer (OC) is the most lethal gynecological malignancy, which disproportionately affects African American (AA) women. Lack of awareness and socioeconomic factors are considered important players in OC racial health disparity, while at the same time, some recent studies have brought focus on the genetic basis of disparity as well. Differential polymorphisms, mutations and expressions of genes have been reported in OC patients of diverse racial and ethnic backgrounds. Combined, it appears that neither genetic nor the socioeconomic factors alone might explain the observed racially disparate health outcomes among OC patients. Rather, a more logical explanation would be the one that takes into consideration the combination and/or the interplay of these factors, perhaps even including some environmental ones. Hence, in this article, we attempt to review the available information on OC racial health disparity, and provide an overview of socioeconomic, environmental and genetic factors, as well as the epigenetic changes that can act as a liaison between the three. A better understanding of these underlying causes will help further research on effective cancer management among diverse patient population and ultimately narrow health disparity gaps.

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Racial health disparities in ovarian cancer: not just black and white

Srivastava et al. Journal of Ovarian Research Racial health disparities in ovarian cancer: not just black and white Sanjeev K. Srivastava 0 1 3 Aamir Ahmad 0 1 Orlandric Miree 1 Girijesh Kumar Patel 1 Seema Singh 1 2 Rodney P. Rocconi Ajay P. Singh 1 2 0 Equal contributors 1 Department of Oncologic Sciences, Mitchell Cancer Institute, University of South Alabama , 1660 Springhill Avenue, Mobile, AL 36604-1405 , USA 2 Department of Biochemistry and Molecular Biology, College of Medicine, University of South Alabama , USA 3 Division of Cell Biology and Genetics , Tatva Biosciences, Coastal Innovation Hub, 600 Clinic Drive, Mobile, AL 36688 , USA Ovarian cancer (OC) is the most lethal gynecological malignancy, which disproportionately affects African American (AA) women. Lack of awareness and socioeconomic factors are considered important players in OC racial health disparity, while at the same time, some recent studies have brought focus on the genetic basis of disparity as well. Differential polymorphisms, mutations and expressions of genes have been reported in OC patients of diverse racial and ethnic backgrounds. Combined, it appears that neither genetic nor the socioeconomic factors alone might explain the observed racially disparate health outcomes among OC patients. Rather, a more logical explanation would be the one that takes into consideration the combination and/or the interplay of these factors, perhaps even including some environmental ones. Hence, in this article, we attempt to review the available information on OC racial health disparity, and provide an overview of socioeconomic, environmental and genetic factors, as well as the epigenetic changes that can act as a liaison between the three. A better understanding of these underlying causes will help further research on effective cancer management among diverse patient population and ultimately narrow health disparity gaps. Ovarian cancer; Racial health disparity; Socioeconomic; Epigenetic Background Ovarian cancer (OC) is the most lethal of all gynecologic malignancies [ 1 ]. Globally, OC is the 7th most commonly diagnosed and the 8th leading cause of cancer-related mortality among women [ 2 ]. According to estimates by the American Cancer Society, 22,440 new OC cases and 14,080 associated deaths will occur in 2017 [ 1 ]. It is a deadly disease with no effective screening [ 3 ]. Approximately 70% of patients with OC are diagnosed at an advanced stage, with associated poor prognosis, even after aggressive and immediate treatments [ 4 ]. Studies over past several years have revealed that besides being highly lethal, OC also disproportionately affects some distinct racial populations, particularly the black women of African American (AA) heritage, as compared to the Caucasian Americans (CA) or white women of European heritage. In fact, even with higher incidence of OC in CA women in the United States, the associated mortality is disproportionately higher in AA women [ 5 ], and such disparities are common worldwide [ 6 ]. Though the exact causes of racial disparities in OC still remain unclear, they are likely to be multifaceted and may include sociocultural factors, acquired co-morbid conditions, increased frequency of modifiable risk factors, access to health care, diet and preventive health factors. Emerging data suggests that several biological factors, such as genetic, epigenetic etc., could be more crucial than thought for health disparities in OC incidence and outcome [ 5, 7, 8 ]. In this review article, we have discussed, in-detail, various biological and non-biological factors in racially disparate clinical outcomes of OC. Disparity in ovarian cancer incidence and mortality While some progress has been made in OC treatment, it has been observed that AA women with OC are not reaping the same benefits of the advances as CA women. Progress in management of OC patients has improved over time but this progress has been relatively slow for AAs [ 9 ]. The all-cause mortality of AA OC patients is 1.3 times higher, as compared to CA OC patients, even when access to care is equal [ 5 ]. According to data from SEER database, between the years 1992 and 2008, the five-year survival rate for CA women rose from 40.7% to 45.0%, while the five-year survival for AA women fell from 47.9% to 40.3%. For the years 2006 through 2012, the reported 5 year survival of AA OC patients is relatively poor, compared to CA OC patients, irrespective of cancer stage at the time of diagnosis [ 1 ] (Table 1). Although the overwhelming majority of all OC patients are diagnosed at an advanced stage, it has been suggested that AA women bear a greater burden in the late diagnosis than CA women. Increased instances of late diagnosis may be attributed to socio-economic factors that will be discussed later in this article. This disparity in survival may also be linked to observed prevalence of comorbidities. Evidence shows that AA women diagnosed wit (...truncated)


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Sanjeev K. Srivastava, Aamir Ahmad, Orlandric Miree, Girijesh Kumar Patel, Seema Singh, Rodney P. Rocconi, Ajay P. Singh. Racial health disparities in ovarian cancer: not just black and white, Journal of Ovarian Research, 2017, pp. 58, Volume 10, Issue 1, DOI: 10.1186/s13048-017-0355-y