Racial Differences in Treatment Modalities for Ovarian Cancer in Florida, 1981–2000

Abstract

Purpose Determine differences in treatment patterns among Non Hispanic White (NHW) and African American (AA) women in Florida, diagnosed with epithelial ovarian cancer. Methods All cases diagnosed with epithelial ovarian cancer, 1981–2000, were identified using the Florida Cancer Data System. Information was obtained on race, tobacco use, marital status, age at diagnosis, and stage. Treatment variables of interest were: surgery, chemotherapy, no treatment, a combination of surgery and chemotherapy and other treatment. Adjusted odds ratio (OR) and 95% confidence intervals were used to determine treatment modalities by stage and race. Results The study population consisted of 16,805 AA and NHW women with epithelial ovarian cancer, of which, 6% were identified as AA and 94% NHW women. AA women were significantly more likely to be diagnosed at a younger age, with 26.5% of AA women diagnosed at age 50 and under compared to 16.4% of NHW women. AA women were also less likely to present with localized disease (12.9 vs. 17.8%) and more likely to present with distant disease (78.0% vs.71.8%). When treatment was considered, AA women were more likely to receive no treatment (20.1% vs. 16.4%) and less likely to receive surgery and chemotherapy (35.4% vs. 39.5%) than NHW women. When evaluated by stage, treatment differences between AA and NHW women remained for local and distant disease. After adjustment for other risk factors the differences for local disease remained. Adjustment for stage, age at diagnosis and other confounding factors, resulted in an overall adjusted odds ratio for no treatment for AA women of OR=1.18 (1.00–1.39) and an adjusted OR=0.84 (0.74–0.96) for surgery and chemotherapy. Conclusion African American women were more likely to be diagnosed with ovarian cancer at a younger age than NHW women. Despite this, AA women are more likely to receive no treatment and less likely to receive surgery and chemotherapy than NHW women. Adjustment for confounding factors, reduced but did not eliminate, all these differences.