Disparities In Ovarian Cancer Research Articles

Healthcare Access Domains and Treatment as Mediators of Ovarian Cancer Racial Disparities in Survival: A Structural Equation Modeling Analysis in SEER-Medicare.

Racial differences in healthcare access (HCA) may contribute to disparities in ovarian cancer (OC) survival. We used structural equation models (SEM) to examine associations between race and HCA domains (affordability, availability, accessibility) in relation to overall and OC-specific mortality. Non-Hispanic (NH)-Black and non-Black (Hispanic, NH-White) women diagnosed with OC in 2008-2015 were identified from SEER-Medicare. Cox proportional hazards regression was used to conduct mediation analysis for associations between race and HCA domains with overall and OC-specific mortality. SEM models adjusting for demographic and clinical covariates were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). A total of 4,629 eligible OC patients were identified, including 255 (5.5%) patients who were NH-Black. In SEM adjusting for demographic, clinical, and HCA latent variables, there was a total effect of NH-Black race on overall (HR: 1.11, 95% CI: 1.03,1.19) and OC-specific mortality (HR: 1.16, 95% CI: 1.08, 1.24), which was primarily driven by a direct effect. There was a modest indirect association between NH-Black race and mortality through decreased treatment receipt, though not through HCA. There is a need for studies investigating additional social and biological mechanisms that contribute to worse cancer survival among NH-Black patients.

The effect of formal education on ovarian cancer, clinical trial access, and clinical trial awareness among Black and Latino US women.

e18667 Background: Ovarian Cancer (OC) is ranked as one of the deadliest women’s cancers in the US. Due to non-specific symptoms, it is often misdiagnosed and detected late. The mortality rate is higher and increasing among Black women. In addition, Black women have poor participation in clinical trials. We conducted a survey study among Black and Latino US women to understand the factors influencing their understanding of genetic risks of OC, clinical trial awareness and ability to access a clinical trial. Methods: MiOra health educators administered an electronic survey to 226 women in their communities in Houston, TX, Atlanta, GA, and Los Angeles, CA. The data was analyzed using two-sided Fisher’s Exact Test. Results: Out of the 226 respondents 63.4% were 30 years of age or younger and 22.9% had high school education or less (low education). Out of 109 respondents, 93 (85.3%) self-identified as Black or Latino. Age did not influence self-reported awareness of genetic risk for OC, clinical trials or how to locate a clinical trial (Table 1). Low education women were significantly less likely to report being knowledgeable about genetic risk factors of OC, clinical trials or locating clinical trials. Thirty out of 48, 62.5% responding low education women and 118 out of 173, 68.2% high education women reported to have an annual provider visit (p > 0.05). The self-reported awareness on how to locate a trial was low in both the low (3 out of 48, 6.2%) and high education groups (34 out of 171, 19.9%, p < 0.05). Only 8 out of 44 (18.1%) respondents who knew someone with OC knew how to locate clinical trials. Conclusions: These results suggest that the level of education influences Black and Latino women’s awareness of OC genetic risk factors, clinical trials and clinical trial access. However, even among college educated Black and Latino women, only a small portion reported to know how to locate a clinical trial. Both high and low education Black and Latino women reported to comply with annual provider visits. These visits may be an opportunity to close the health-literacy disparities in OC and clinical trials for Black and Latino women. [Table: see text]

Health-care access dimensions and ovarian cancer survival: SEER-Medicare analysis of the ORCHiD study.

Racial and ethnic disparities in ovarian cancer (OC) survival are well-documented. However, few studies have investigated how health-care access (HCA) contributes to these disparities. To evaluate the influence of HCA on OC mortality, we analyzed 2008-2015 Surveillance, Epidemiology, and End Results-Medicare data. Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between HCA dimensions (affordability, availability, accessibility) and OC-specific and all-cause mortality, adjusting for patient characteristics and treatment receipt. The study cohort included 7590 OC patients: 454 (6.0%) Hispanic, 501 (6.6%) Non-Hispanic (NH) Black, and 6635 (87.4%) NH White. Higher affordability (HR = 0.90, 95% CI = 0.87 to 0.94), availability (HR = 0.95, 95% CI = 0.92 to 0.99), and accessibility scores (HR = 0.93, 95% CI = 0.87 to 0.99) were associated with lower risk of OC mortality after adjusting for demographic and clinical factors. Racial disparities were observed after additional adjustment for these HCA dimensions: NH Black patients experienced a 26% higher risk of OC mortality compared with NH White patients (HR = 1.26, 95% CI = 1.11 to 1.43) and a 45% higher risk among patients who survived at least 12 months (HR = 1.45, 95% CI = 1.16 to 1.81). HCA dimensions are statistically significantly associated with mortality after OC and explain some, but not all, of the observed racial disparity in survival of patients with OC. Although equalizing access to quality health care remains critical, research on other HCA dimensions is needed to determine additional factors contributing to disparate OC outcomes by race and ethnicity and advance the field toward health equity.

Factor Analysis of Health Care Access With Ovarian Cancer Surgery and Gynecologic Oncologist Consultation

Poor health care access (HCA) is associated with racial and ethnic disparities in ovarian cancer (OC) survival. To generate composite scores representing health care affordability, availability, and accessibility via factor analysis and to evaluate the association between each score and key indicators of guideline-adherent care. This retrospective cohort study used data from patients with OC diagnosed between 2008 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) Medicare database. The SEER Medicare database uses cancer registry data and linked Medicare claims from 12 US states. Included patients were Hispanic, non-Hispanic Black, and non-Hispanic White individuals aged 65 years or older diagnosed from 2008 to 2015 with first or second primary OC of any histologic type (International Classification of Diseases for Oncology, 3rd Edition [ICD-O-3] code C569). Data were analyzed from June 2020 to June 2022. The SEER-Medicare data set was linked with publicly available data sets to obtain 35 variables representing health care affordability, availability, and accessibility. A composite score was created for each dimension using confirmatory factor analysis followed by a promax (oblique) rotation on multiple component variables. The main outcomes were consultation with a gynecologic oncologist for OC and receipt of OC-related surgery in the 2 months prior to or 6 months after diagnosis. The cohort included 8987 patients, with a mean (SD) age of 76.8 (7.3) years and 612 Black patients (6.8%), 553 Hispanic patients (6.2%), and 7822 White patients (87.0%). Black patients (adjusted odds ratio [aOR], 0.75; 95% CI, 0.62-0.91) and Hispanic patients (aOR, 0.81; 95% CI, 0.67-0.99) were less likely to consult a gynecologic oncologist compared with White patients, and Black patients were less likely to receive surgery after adjusting for demographic and clinical characteristics (aOR, 0.76; 95% CI, 0.62-0.94). HCA availability and affordability were each associated with gynecologic oncologist consultation (availability: aOR, 1.16; 95% CI, 1.09-1.24; affordability: aOR, 1.13; 95% CI, 1.07-1.20), while affordability was associated with receipt of OC surgery (aOR, 1.08; 95% CI, 1.01-1.15). In models mutually adjusted for availability, affordability, and accessibility, Black patients remained less likely to consult a gynecologic oncologist (aOR, 0.80; 95% CI, 0.66-0.97) and receive surgery (aOR, 0.80; 95% CI, 0.65-0.99). In this cohort study of Hispanic, non-Hispanic Black, and non-Hispanic White patients with OC, HCA affordability and availability were significantly associated with receiving surgery and consulting a gynecologic oncologist. However, these dimensions did not fully explain racial and ethnic disparities.

35P Racial disparities in diagnosis, histological type, treatment and survival in ovarian cancer patients in the US from 1992 to 2018: SEER-based analysis

Ovarian malignancies are the 7th diagnosed malignancy and the 8th cause of death in females worldwide. Ovarian cancer includes a great heterogeneous group of neoplasms that differs in histological type, pathological stage, risk factors, prognosis, and treatment. Racial disparities in incidence, treatment, and mortality in cancers exist globally. With Surveillance, Epidemiology, and End Results (SEER) program in place, detection of these disparities would be feasible. herein racial disparities in ovarian cancer are analyzed.

Uncovering Mitochondrial Determinants of Racial Disparities in Ovarian Cancer

Ovarian cancer (OC) incidence and mortality rates differ between racial groups. Mitochondrial genetic factors are now emerging as determinants of racial disparities in OC. A comprehensive understanding of the role of mitochondria in OC health disparities will help in developing novel therapeutic strategies targeting mitochondria to reduce or eliminate racial health disparities.

Abstract PR16: Investigating the determinants of racial disparities in ovarian cancer incidence: The OCWAA consortium

Abstract Background: The Ovarian Cancer in Women of African Ancestry consortium (OCWAA) was established to address racial disparities in epithelial ovarian cancer (EOC) risk and survival. Specifically, we aim to estimate the degrees to which racial differences in incidence and survival of EOC between African-American (AA) and white women are attributable to differences in the prevalence and timing of risk factors and in the magnitude of risk associations. Methods: OCWAA includes four case-control studies (the African-American Cancer Epidemiology Study, the North Carolina Ovarian Cancer Study, the Los Angeles County Ovarian Cancer Study, and the Cook County Case-Control Study) and two nested case-control studies within cohort studies (the Black Women's Health Study and the Multiethnic Cohort Study). A centralized core database consisting of demographic and epidemiologic risk factors for borderline and invasive EOC, tumor characteristics and prognostic factors has been created, and the majority of data has been harmonized across studies. A histotype classification scheme was uniformly applied using a combination of morphology and grade information to best represent the most recent diagnostic guidelines for ovarian cancer as detailed in the 2014 WHO Classification of Tumors of the Female Reproductive System. Results: A total of 1,169/2,324 AA cases and controls and 2,963/3,934 white cases and controls have been included in the OCWAA database to date. Approximately 83% of cases are invasive EOC, 15% are borderline tumors, and 2% are missing tumor behavior information. Among the invasive EOC cases, 61% are high-grade serous carcinomas. The average age at diagnosis of EOC cases is the same in AA and white women (57.2 years), and the year of diagnosis ranges from 1991 to 2016. The following risk factors showed marked prevalence differences in AA and white controls: obesity (46.3% vs 19.2%), breastfeeding (42.7% vs 54.3%), tubal ligation (31.1% vs 17.9%), postmenopausal hormone use (23.8% vs 40.8%), nulliparity (14.9% vs 19.2%), at least a college degree (35.5% vs 56.4%), and menarche age <13 (51.6% vs 47.4%; p<.01); p<.0001 for all except where noted. In preliminary EOC risk analyses, we observed positive associations with body mass index and nulliparity and inverse associations with tubal ligation, oral contraceptive use and breastfeeding in both AA and white women. The harmonization of other factors including duration, frequency and timing of key risk factors, physical activity, comorbidities, medication use, and treatment information is ongoing. Conclusions: OCWAA represents the largest study investigating disparities in ovarian cancer risk and survival between AA and white women. This consortium is uniquely positioned to study the epidemiology of ovarian cancer in AA, focusing on the role of lifestyle and behavioral characteristics, reproductive risk factors, treatment and other prognostic factors in explaining racial differences in ovarian cancer incidence and survival. This abstract is also being presented as Poster C083. Citation Format: Veronica Wendy Setiawan, Lauren Peres, Lynn Rosenberg, Traci Bethea, Patricia Moorman, Evan Myers, Anna Wu, Charlotte Joslin, Elisa Bandera, Deanna Chyn, Fabian Camacho, Joellen Schildkraut. Investigating the determinants of racial disparities in ovarian cancer incidence: The OCWAA consortium [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr PR16.

Racial/ethnic disparities in ovarian cancer research.

Ovarian cancer is one of the most fatal cancers diagnosed in women in the United States (U.S.). Data from national databases, including the Surveillance Epidemiology and End Results (SEER) program, show racial/ethnic differences in risk and survival of epithelial ovarian cancer with higher incidence among white women yet worse survival among African-American women compared to other racial/ethnic groups. The reasons for these differences are not well understood, but are likely multi-factorial. Epidemiologic studies suggest there may be some risk factor differences across racial/ethnic groups that would explain differences in the incidence of this rare and heterogeneous disease. Likewise, although data suggest that socioeconomic factors and access to care contribute to the disparity in ovarian cancer survival among African-American women, there are likely other contributing factors that have not as of yet been identified. Small sample sizes of minority women from individual studies do not provide adequate power to evaluate fully the contributions of environmental, genetic, and clinical factors associated with ovarian cancer risk and survival within these groups. Pooling existing data from individual epidemiologic studies has made a valuable contribution; however, new data collection is warranted to further our understanding of the underpinnings of the disparities in ovarian cancer that may lead to prevention and improved survival across all racial/ethnic groups.

Clear differences in ovarian cancer incidence and trends by ethnicity among Asian Americans

BackgroundAcross major races in the United States (U.S.), ovarian cancer incidence is low among Asian American women. However, this observation aggregates Asian Americans as a single group despite their heterogeneity. Disaggregating the ethnic Asian population will produce more useful information to better understand ovarian cancer incidence among Asian women in the U.S. MethodsData from the Surveillance, Epidemiology, and End Results Program from 1990 to 2014 were used to compare age-adjusted incidence rates (AAIRs, per 100,000 women) for ovarian cancer for the six largest U.S. Asian ethnicities (Asian Indian/Pakistani, Chinese, Filipino, Japanese, Korean, Vietnamese) to non-Hispanic whites (NHWs). The race/ethnicity-specific AAIRs were calculated by time period and histotype. We examined the magnitude and direction of AAIR trends using average annual percent change (AAPC) statistics. ResultsAll Asian ethnicities had significantly lower ovarian cancer incidence rates than NHWs. However, among Asian ethnicities, Asian Indians/Pakistanis had the highest rate of ovarian cancer (AAIR = 10.51, 95% CI: 9.65–11.42) while Koreans had the lowest (AAIR = 7.23, 95% CI: 6.62–7.88). Clear cell ovarian cancer had significantly higher incidence rates among Chinese, Filipino, and Japanese women than NHW women (incidence rate ratio (IRR) = 1.49, 95% CI: 1.29–1.72, IRR = 1.30, 95% CI: 1.12–1.51, IRR = 1.64, 95% CI: 1.36–1.97, respectively). Incidence trends also differed by Asian ethnicity with significant decreases only observed for Chinese (AAPC = −1.49, 95% CI: −2.22 to −0.74) and Japanese (AAPC = −1.75, 95% CI: −2.57 to −0.92). ConclusionsExamining Asian Americans as a single group results in missed ethnic-specific disparities in ovarian cancer, hence disaggregating this heterogeneous population in future research is warranted.

Ovarian Cancer in Women of African Ancestry (OCWAA) consortium: a resource of harmonized data from eight epidemiologic studies of African American and white women.

Although the incidence rate of epithelial ovarian cancer (EOC) is somewhat lower in African American (AA) than white women, survival is worse. The Ovarian Cancer in Women of African Ancestry (OCWAA) consortium will overcome small, study-specific sample sizes to better understand racial differences in EOC risk and outcomes. We harmonized risk factors and prognostic characteristics from eight U.S. the North Carolina Ovarian Cancer Study (NCOCS), the Los Angeles County Ovarian Cancer Study (LACOCS), the African American Cancer Epidemiology Study (AACES), the Cook County Case-Control Study (CCCCS), the Black Women's Health Study (BWHS), the Women's Health Initiative (WHI), the Multiethnic Cohort Study (MEC), and the Southern Community Cohort Study (SCCS). Determinants of disparities for risk and survival in 1,146 AA EOC cases and 2,922 AA controls will be compared to 3,368 white EOC cases and 10,270 white controls. Analyses include estimation of population-attributable risk percent (PAR%) by race. OCWAA is uniquely positioned to study the epidemiology of EOC in AA women compared with white women to address disparities. Studies of EOC have been underpowered to address factors that may explain AA-white differences in the incidence and survival. OCWAA promises to provide novel insight into disparities in ovarian cancer.

Epithelial ovarian cancer mortality among Hispanic women: Sub-ethnic disparities and survival trend across time: An analysis of SEER 1992–2013

BackgroundOver the past half century the proportion of Hispanics in the US population has been steadily increasing, and groups of Hispanic origin have diversified. Despite notable racial and ethnic disparities in ovarian cancer (OC) mortality, population-based studies on OC among Hispanic females are lacking. ObjectivesTo examine sub-ethnic disparities in OC mortality and survival trends using the Surveillance, Epidemiology, and End Results Program (SEER) 18 data on Hispanic women diagnosed with epithelial OC during 1992–2013. MethodsThe disparities in OC 5 year survival and mortality were examined using log-rank tests and Cox proportional hazards models, adjusted for sociodemographic and pathological characteristics, time of diagnosis, receipt of resection surgery and county socioeconomic status. Trends in 5-year survival rates were examined using joinpoint regression models. ResultsThe 5-year survival was lowest in Puerto Ricans (median survival: 33 months; survival rate: 31.07%) and was highest in the “Other” Hispanic subgroup (median survival: 59 months; survival rate: 49.14%) (log-rank test: P < 0.001). The OC-specific death hazards in Mexicans (HRadj: 0.82, 95%CI: 0.67–1.00, P = 0.048), South or Central Americans (HRadj: 0.77, 95%CI: 0.62–0.96, P = 0.005) and Other Hispanics (HRadj: 0.76, 95%CI: 0.63–0.92, P = 0.038) were significantly lower than for Puerto Ricans. Mortality rates of Cubans and Puerto Ricans were not significantly different. During 1992–2008, there were non-significant increasing trends in the 5-year all-cause and OC-specific survival rates: from 43.37% to 48.94% (APC = 0.41, P = 0.40) and from 48.72% to 53.46% (APC = 0.29, P = 0.50), respectively. ConclusionsOC mortality in Hispanic patients varied by sub-ethnicity. This heterogeneity should be considered in future cancer data collection, reports and research.

Abstract IA41: Standard of care and clinical disparities in epithelial ovarian cancer

Abstract Ovarian cancer afflicts approximately 204,000 women worldwide, with ∼125,000/year deaths. In the United States more than 22,000 new cases of ovarian cancer diagnosed with over 14,000 disease-related deaths.[1] The standard of care in ovarian cancer includes expedient access to the health care system, consultation with a gynecologic oncologist, surgical intervention, and multiagent platinum-based chemotherapy. Prognostic factors for improved survival in women with ovarian cancer include younger age; early stage; low-grade and serous histology; good performance status; disease biology (BRCA1 and 2 mutation carriers have a better prognosis); and low volume of residual disease at the time of cytoreductive surgery. In contrast, African-American race, low socioeconomic status (SES), geographic location, and insurance status have been associated with worse survival and increased probability of not receiving appropriate standard of care treatment.[2-7] These differences in ovarian cancer outcomes linked to race, social, and economic factors indicate that health care disparities exist in the treatment of this gynecologic cancer. In this presentation, we will (1) review the standard of care for epithelial ovarian cancer treatment, (2) discuss the variables affecting the outcome for patients with epithelial ovarian cancer, (3) describe the factors contributing to healthcare disparities, and (4) discuss the evidence for clinical disparities in epithelial ovarian cancer care and outcomes. Causes of healthcare disparities are complex and include differences in race/ethnicity, SES, insurance status, education level, geographic location, culture, healthcare system factors (adherence to treatment guidelines, and access to care), and disease biology.[2-7] The following are highlighted in this presentation: Population-based studies have demonstrated that African-American women are at increased risk of ovarian cancer death compared to non-Hispanic Caucasian women.Population-based studies have demonstrated that African-American women are less likely to undergo site-specific surgery or surgical staging for ovarian cancer compared to Caucasian women.African-American women were less likely to seek care at high-volume hospitals or be operated on by high-volume surgeons.African-American women and those with Medicaid/Medicare payer status are less likely to receive standard of care therapy based on National Comprehensive Cancer Network (NCCN) guidelines.Geographic location away from a high-volume hospital is associated with increased risk of non-adherent ovarian cancer care.Geographic barriers to standard treatment disproportionately affect racial minorities and women of low-SES.In contrast to population-based studies, retrospective single academic institution studies and ancillary analysis of large cooperative group phase III trials in advanced ovarian cancer have demonstrated no difference in overall survival in women of African-American and Caucasian descent. The reported research in ovarian cancer indicates that unequal delivery of quality care, obstacles to the delivery of recommended care, and limited access to expert care may account for the disparities seen in ovarian cancer care. The U.S. Department of Health and Human Services has targeted disparities in access to health care as the centerpiece of the Healthy People 2020 campaign and the Department of Health and Human Services (HHS) has unveiled an action plan to reduce racial and ethnic Health disparities.[8, 9] The 5 goals of the HHS Disparities Action Plan are: (1) transform health care; (2) strengthen the nation's Health and Human Services infrastructure and workforce; (3) advance the health, safety, and well-being of the American people; (4) advance scientific knowledge and innovation; and (5) increase the efficiency, transparency, and accountability of HHS programs. The HHS Disparities initiative will specifically target programs to increase knowledge of, access to, and utilization of biomedical and behavioral procedures to reduce cancer disparities.[9] Listed below are future research objectives that will reduce and potentially eliminate health care disparities in ovarian cancer in the United States: Improve our knowledge of the interaction between race, ethnicity, SES, geographic location and ovarian cancer health care disparities across the United States to harmonize existing data and identify opportunities for intervention.Improve our knowledge regarding cultural barriers to care.Promote community-based participatory research to increase ovarian cancer awareness and review standards of care.Develop interventions to provide expedient access to expert care by trained specialists in Gynecology Oncology, cytoreductive surgery, and administration of multiagent platinum-based chemotherapy in order to increase the likelihood of NCCN adherent standard of care therapy.

Racial and ethnic disparities in ovarian cancer at a multidisciplinary cancer center

Objective: To determine whether racial disparities in outcome between Black and White women with epithelial ovarian cancer in the United States reported in population-based studies persist when care is delivered at an NCI-designated comprehensive cancer center by a multidisciplinary team of gynecologic cancer specialists.

Have racial disparities in ovarian cancer increased over time? An analysis of SEER data

ObjectiveRace has been postulated to be a prognostic factor in women with ovarian cancer. The reasons for racial disparities are multifactorial. Recent literature suggests that racial disparities in ovarian cancer survival emerged in the 1980s, when modern treatments such as aggressive surgical debulking and platinum-based chemotherapy first gained widespread use. We suspect that as improvements in treatment have evolved, the effects of access to treatment have amplified racial disparities in survival from ovarian cancer. MethodsSEER 9 data were analyzed, including African American and white patients diagnosed with ovarian cancer from 1973 to 2007, with 2008 as the cutoff for follow-up. Using the Kaplan–Meier method, we evaluated racial differences in survival, to determine whether this difference has increased over time. ResultsThere were 44,562 white and 3190 African American women available for analysis. Overall African Americans had 1.10 times the crude hazard (95% CI 1.06–1.15) of all-cause mortality compared to whites, with a widening trend over time (p<0.01). Adjusted for SEER registry, age, tumor stage, marital status and time of diagnosis, the hazard ratio (HR) for all-cause mortality comparing African Americans to whites was 1.31 (95% CI 1.26–1.37). When the receipt of surgery was added to the model, the HR for all-cause mortality remained higher for African American women at 1.27 (95% CI 1.21–1.34). ConclusionsAfrican Americans diagnosed with ovarian cancer have worse survival than whites, and this disparity has increased over time. Measured differences in treatment, such as receipt of surgery, account for part of the disparity.

Race in ovarian cancer treatment and survival: a systematic review with meta-analysis

There has long been recognition of racial disparities in cancer treatment and survival. In order to investigate the etiology of racial disparities in ovarian cancer, we undertook a systematic review of the published literature. Focusing on North America, our search of MEDLINE, PsychInfo, and EMBASE databases recovered 513 abstracts of which 98 underwent full text screening resulting in 24 studies included in the final review. After assessing heterogeneity, results were pooled where possible in a meta-analysis using a random effects model. Eight articles reported treatment outcomes, nine survival, and seven both. Overall African Americans were less likely to receive any form of surgical treatment for ovarian cancer [pooled relative risk (RR) 1.17 (95% confidence interval (CI): 1.10, 1.23)] compared with white women. Although the majority of the included articles reporting survival outcomes did not control for known covariates such as medical co-morbidities or treatment, we were able to pool the unadjusted results from eight articles. Taken together the meta-analysis of 106,704 women did not find a difference in five-year survival between whites and African Americans, RR 1.07 (95% CI: 0.97, 1.18). When the results were stratified by year of cancer diagnosis, studies which captured patients prior to 1985 yielded a five-year RR of survival for whites compared to African Americans of 0.93 (95% CI: 0.89, 0.97) compared with 1.17 (95% CI: 1.05, 1.31) after 1985. These results suggest that racial disparities in ovarian cancer are not due to underlying biological differences rather to the unequal application of existing treatments.