Ovarian Cancer Risk Assessment Research Articles

Promoting guideline-based cancer genetic risk assessment for hereditary breast and ovarian cancer in ethnically and geographically diverse cancer survivors: Rationale and design of a 3-arm randomized controlled trial

BackgroundAlthough national guidelines for cancer genetic risk assessment (CGRA) for hereditary breast and ovarian cancer (HBOC) have been available for over two decades, less than half of high-risk women have accessed these services, especially underserved minority and rural populations. Identification of high-risk individuals is crucial for cancer survivors and their families to benefit from biomedical advances in cancer prevention, early detection, and treatment. MethodsThis paper describes community-engaged formative research and the protocol of the ongoing randomized 3-arm controlled Genetic Risk Assessment for Cancer Education and Empowerment (GRACE) trial. Ethnically and geographically diverse breast and ovarian cancer survivors at increased risk for hereditary cancer predisposition who have not had a CGRA are recruited through the three statewide cancer registries. The specific aims are to: 1) compare the effectiveness of a targeted intervention (TP) vs. a tailored counseling and navigation(TCN) intervention vs. usual care (UC) on CGRA utilization at 6 months post-diagnosis (primary outcome); compare the effectiveness of the interventions on genetic counseling uptake at 12 months after removal of cost barriers (secondary outcome); 2) examine potential underlying theoretical mediating and moderating mechanisms; and 3) conduct a cost evaluation to guide dissemination strategies. DiscussionThe ongoing GRACE trial addresses an important translational gap by developing and implementing evidence-based strategies to promote guideline-based care and reduce disparities in CGRA utilization among ethnically and geographically diverse women. If effective, these interventions have the potential to reach a large number of high-risk families and reduce disparities through broad dissemination.Trial registration number: NCT03326713; clinicaltrials.gov.

Provider's Perceptions of Barriers and Facilitators for Latinas to Participate in Genetic Cancer Risk Assessment for Hereditary Breast and Ovarian Cancer.

The Comprehensive Cancer Network (NCCN) recommends genetic cancer risk assessment (GCRA) referral to women at high risk of hereditary breast and ovarian cancer. Latinas affected by breast cancer have the second highest prevalence of BRCA1/2 mutations after Ashkenazi Jews. Compared to non-Hispanic Whites, Latinas have lower GCRA uptake. While some studies have identified barriers for GCRA use in this population, few studies have focused on health care providers’ perspectives. The purpose of the study was to examine providers’ perceptions of barriers and facilitators for at-risk Latina women to participate in GCRA and their experiences providing services to this population. We conducted semi-structured interviews with 20 healthcare providers (e.g., genetic counselors, patient navigators) recruited nationally through snowballing. Interviews were transcribed. Two coders independently coded each interview and then met to reconcile the codes using Consensual Qualitative Research guidelines. Providers identified several facilitators for GCRA uptake (e.g., family, treatment/prevention decisions) and barriers (e.g., cost, referrals, awareness, stigma). Genetic counselors described important aspects to consider when working with at-risk Latina including language barriers, obtaining accurate family histories, family communication, and testing relatives who live outside the US. Findings from this study can inform future interventions to enhance uptake and quality of GCRA in at-risk Latina women to reduce disparities.

Risk assessment for ovarian cancer

Risk assessment for ovarian cancer

Attitudes towards a programme of risk assessment and stratified management for ovarian cancer: a focus group study of UK South Asians’ perspectives

ObjectivePopulation-based risk assessment, using genetic testing and the provision of appropriate risk management, could lead to prevention, early detection and improved clinical management of ovarian cancer (OC). Previous research with...

Health care professionals\u2019 attitudes towards population-based genetic testing and risk-stratification for ovarian cancer: a cross-sectional survey

BackgroundOvarian cancer is usually diagnosed at a late stage when outcomes are poor. Personalised ovarian cancer risk prediction, based on genetic and epidemiological information and risk stratified management in adult women could improve outcomes. Examining health care professionals’ (HCP) attitudes to ovarian cancer risk stratified management, willingness to support women, self-efficacy (belief in one’s own ability to successfully complete a task), and knowledge about ovarian cancer will help identify training needs in anticipation of personalised ovarian cancer risk prediction being introduced.MethodsAn anonymous survey was distributed online to HCPs via relevant professional organisations in the UK. Kruskal-Wallis tests and pairwise comparisons were used to compare knowledge and self-efficacy scores between different types of HCPs, and attitudes toward population-based genetic testing and risk stratified management were described. Content analysis was undertaken of free text responses concerning HCPs willingness to discuss risk management options with women.ResultsOne hundred forty-six eligible HCPs completed the survey: oncologists (31%); genetics clinicians (30%); general practitioners (22%); gynaecologists (10%); nurses (4%); and ‘others’. Scores for knowledge of ovarian cancer and genetics, and self-efficacy in conducting a cancer risk consultation were generally high but significantly lower for general practitioners compared to genetics clinicians, oncologists, and gynaecologists. Support for population-based genetic testing was not high (<50%). Attitudes towards ovarian cancer risk stratification were mixed, although the majority of participants indicated a willingness to discuss management options with patients.ConclusionsLarger samples are required to investigate attitudes to population-based genetic testing for ovarian cancer risk and to establish why some HCPs are hesitant to offer testing to all adult female patients. If ovarian cancer risk assessment using genetic testing and non-genetic information including epidemiological information is rolled out on a population basis, training will be needed for HCPs in primary care to enable them to provide appropriate support to women at each stage of the process.

Anticipated health behaviour changes and perceived control in response to disclosure of genetic risk of breast and ovarian cancer: a quantitative survey study among women in the UK

BackgroundGenetic risk assessment for breast cancer and ovarian cancer (BCOC) is expected to make major inroads into mainstream clinical practice. It is important to evaluate the potential impact on women...

Ovarian Cancer Risk Assessment for Women Carrying Pathogenic Variants

Ovarian Cancer Risk Assessment for Women Carrying Pathogenic Variants

Bright Pink’s “Assess Your Risk” Patient Survey: Feasibility of Utilizing Social Media for Research [12I

INTRODUCTION: Recent studies have highlighted strengths of utilizing social media to recruit for and conduct research when compared to traditional methods. Our study aims to confirm the feasibility of using social media to recruit large numbers of research participants to Bright Pink’s digital “Assess Your Risk” breast and ovarian cancer risk assessment survey. METHODS: Data was obtained from participants driven by Facebook advertising to the “Assess Your Risk” survey between April 1st and September 30th, 2016. Advertisements appeared on the pages of Facebook users whose profiles matched the following inclusion criteria: female, ages 18-45, with interest in either breast and ovarian cancer topics, social impact brands, or fitness. RESULTS: The Facebook advertisements garnered 6,865,108 impressions, defined as the number of women exposed to the advertisements. 192,546 of those exposed to the advertisements clicked on them, and of those, 84.3%, or 162,132 women, went on to complete the 19 question assessment quiz. Cost per completion was $0.16 compared to email ($15-25) or mail ($25-35) surveys. CONCLUSION: Internet recruiting through social media has been an underused strategy in attracting individuals in health research. The response rate of the Assess Your Risk survey tool shows the potential to harness data collection to conduct meaningful and cost-effective research through the use of social media advertising.

Evaluation of African American Women at High Risk for Ovarian Cancer in the Southeast [34E

INTRODUCTION: This study aimed to describe patient characteristics in African American (AA) women seen at a large southeastern comprehensive cancer center. METHODS: We reviewed an IRB approved, prospectively gathered cohort of patients seen in an Ovarian Cancer Risk Assessment Clinic. Data evaluated included family history, frequency of genetic testing, frequency and types of genetic mutations, and frequency of surgical intervention and development of ovarian cancer. RESULTS: 1227 patients were evaluated from 2003-2015, of which 97 (7.9%) were AA. Eighteen patients had a personal history of ovarian cancer. Sixty-eight (70%) underwent genetic testing and 29 (30%) elected for genetic counseling only. Of women tested 38 (56%) had abnormal results. Nine and 14 patients had deleterious mutations for BRCA 1 and 2 respectively. Twelve had BRCA variants of undetermined significance. Two were found to have PALB2 mutations and one MLH 1 mutation was identified. Of the patients with abnormal testing, five of 23 women with BRCA deletions underwent risk reducing salpingo-oophorectomy (RRSO). CONCLUSION: Our study demonstrates that in a region where AAs represent 27% of the population, the proportion of AA patients referred to an Ovarian Cancer Risk Assessment Clinic remains low. Rates of genetic testing were comparable to Caucasians, potentially signifying that barriers to genetic counseling may be overcome when evaluated in a dedicated clinic. Mutation and variant rates were high in patients tested, possibly representing a selection bias of high risk patients. Endeavors should continue to identify minorities at risk for ovarian cancer and institute measures to provide thorough genetic counseling and testing.

The Changing Landscape of Genetic Testing for Inherited Breast Cancer Predisposition.

The advent of multiple-gene germline panel testing has led to significant advances in hereditary breast and ovarian cancer risk assessment. These include guideline-specific cancer risk management recommendations for patients and their families, such as screening with breast magnetic resonance imaging and risk-reducing surgeries, which have the potential to reduce substantially the morbidity and mortality associated with a hereditary cancer predisposition. However, controversy remains about the clinical validity and actionability of genetic testing in a broader patient population. We discuss events leading to the wider availability of commercialized multiple-gene germline panel testing, the recent data that support using this powerful tool to improve cancer risk assessment and reduction strategies, and remaining challenges to clinical optimization of this new genetic technology.

Uncertainty quantification in breast cancer risk prediction models using self-reported family health history.

Introduction. Family health history (FHx) is an important factor in breast and ovarian cancer risk assessment. As such, multiple risk prediction models rely strongly on FHx data when identifying a patient's risk. These models were developed using verified information and when translated into a clinical setting assume that a patient's FHx is accurate and complete. However, FHx information collected in a typical clinical setting is known to be imprecise and it is not well understood how this uncertainty may affect predictions in clinical settings. Methods. Using Monte Carlo simulations and existing measurements of uncertainty of self-reported FHx, we show how uncertainty in FHx information can alter risk classification when used in typical clinical settings. Results. We found that various models ranged from 52% to 64% for correct tier-level classification of pedigrees under a set of contrived uncertain conditions, but that significant misclassification are not negligible. Conclusions. Our work implies that (i) uncertainty quantification needs to be considered when transferring tools from a controlled research environment to a more uncertain environment (i.e, a health clinic) and (ii) better FHx collection methods are needed to reduce uncertainty in breast cancer risk prediction in clinical settings.

Parity and Oral Contraceptive Use in Relation to Ovarian Cancer Risk in Older Women.

Several studies have suggested that the ovarian cancer risk reductions associated with parity and oral contraceptive use are weaker in postmenopausal than premenopausal women, yet little is known about the persistence of these reductions as women age. This question gains importance with the increasing numbers of older women in the population. We addressed the question using data from three large U.S. cohort studies involving 310,290 white women aged 50+ years at recruitment, of whom 1,815 developed subsequent incident invasive epithelial ovarian cancer. We used Cox regression, stratified by cohort, to examine age-related trends in the HRs per full-term pregnancy and per year of oral contraceptive use. The parity-associated risk reductions waned with age (Ptrend < 0.001 in HR with increasing age), particularly among women aged 75 years or more, for whom we observed no association with parity. However, we observed no such attenuation in the oral contraceptive-associated risk reductions (P = 0.79 for trend in HR with increasing age). These findings suggest that prior oral contraceptive use is important for ovarian cancer risk assessment among women of all ages, while the benefits of parity wane as women age. This information, if duplicated in other studies, will be useful to preventive counseling and risk prediction, particularly for women at increased ovarian cancer risk due to a personal history of breast cancer or a family history of ovarian cancer. Cancer Epidemiol Biomarkers Prev; 25(7); 1059-63. ©2016 AACR.

A Retrospective Exploration of the Impact of the 'Angelina Jolie Effect' on the Single State-Wide Familial Cancer Program in Perth, Western Australia.

Global media has the power to influence the ways the public engage with health services. On May 14th 2013, Angelina Jolie published an article in the New York Times magazine, outlining her decision to undergo BRCA mutation testing due to a family history of cancer; then proceed with a mastectomy. The article evoked significant interest from the media and the public. During the months that followed, the Familial Cancer Program (FCP) at Genetic Services of Western Australia (GSWA) experienced a significant increase in referrals and enquiries. Resources were overstretched and it became clear we needed to adjust work practices to manage the escalating numbers. New strategies were devised to cope with the influx of enquiries, albeit without the benefit of additional resources. We conducted an audit of referrals to the FCP made between January 2012 and December 2014. This included a comparison of the months prior to and following the New York Times article. The aim of the audit was to quantify the impact of the "Angelina Jolie effect" on referrals to the FCP. Whilst the increased awareness of the role of genetic services in risk assessment and testing for familial breast and ovarian cancer was considered positive, pre-referral risk assessment at the primary health level to evaluate the appropriateness of their patients for referral could have been helpful. Potentially, many inappropriate referrals to FCP may have been avoided with primary health evaluation thus lessening the burden on our service and preventing unnecessary worry in well women who possessed minimal family history or risk factors. It is important to understand the factors driving the uptake of risk reduction activities, particularly if engagement with a genetics service is considered part of that pathway. Continued education about cancer risk due to family history, individual features and awareness surrounding genetic testing criteria, costs and availability is required for both the public and health professionals.

Editorial: Hereditary Cancer Risk Assessment: New Perspectives and Challenges for the Next-Gen Sequencing Era.

Editorial: Hereditary Cancer Risk Assessment: New Perspectives and Challenges for the Next-Gen Sequencing Era.

Clinical Performance Comparison of Two IVDMIAs for Pre-Surgical Assessment of Ovarian Cancer Risk [4D

Clinical Performance Comparison of Two IVDMIAs for Pre-Surgical Assessment of Ovarian Cancer Risk [4D

Abstract A50: Differences in perceived personal control among Latina women undergoing genetic cancer risk assessment for hereditary breast and ovarian cancer

Abstract Introduction: Genetic cancer risk assessment (GCRA) is a growing subspecialty that identifies individuals at risk for hereditary predisposition to cancer. Despite recognition of GCRA as a standard-of-care service, there are significant disparities in access to GCRA among at-risk underserved Latina women. Therefore, little is known about the emotional and decisional experience of Latinas undergoing GCRA. Previous studies have looked at the concept of perceived personal control (PPC) as an outcome variable of GCRA, measuring an individual's feelings of control related to the possibility of having a hereditary condition. This study examined PPC among patients participating in a randomized controlled study examining the effect of an adapted motivational interview (AMI) pre-GCRA telephone intervention to promote uptake of GCRA by underserved Latinas. Purpose: To evaluate the influence of the AMI intervention and GCRA on PPC at baseline, immediately pre- and post-GCRA among English and Spanish-speaking Latinas at risk for hereditary breast and ovarian cancer. Method: Eligible participants were adult women who self-identified as Latina, understood English and/or Spanish, and met NCCN criteria for BRCA1 and BRCA2 testing. Participants were randomized to a motivational interview intervention, time and attention control, or usual care. A validated 9-item instrument to assess three dimensions of perceived personal control (behavioral, decisional, and cognitive control) over a genetic problem and the counseling process was translated to Spanish and verbally administered in the patients' preferred language at baseline (prior to randomization) and immediately pre and post-GCRA. A higher PPC score indicates an increased sense of PPC. The three dimensions of PPC encompass a total PPC score. Results: Of the 411 participants, 323 (78.6%) were affected by breast cancer and 88 (21.4%) were unaffected at time of enrollment. Two-hundred and eighty-two (68.6%) were Spanish-speakers and 129 (31.4%) spoke English. While not significant, total PPC scores increased from baseline to post-GCRA and from pre-GCRA to post-GCRA, but decreased from baseline to pre-GCRA for all participants (the affected and unaffected individuals, including English and Spanish-speakers). Unaffected women had significantly higher total PPC scores than women affected with cancer (p=0.001). Unaffected patients had higher cognitive PPC scores at baseline (p=0.008), pre-GCRA (p=0.019), and post-GCRA (p=0.001) compared to the affected participants at all three time points. Unaffected individuals scored higher in behavioral PPC at post-GCRA than the affected participants (p=0.012). The unaffected individuals scored higher in decisional PPC at post-GCRA compared to the affected individuals (p=0.005). There were no significant differences in PPC scores between English and Spanish-speaking participants or between study arms. Conclusion: Cognitive, decisional, behavioral, and total PPC scores were highest at post-GCRA among all groups (unaffected and affected individuals, and English and Spanish-speakers). Unaffected individuals had higher cognitive PPC scores at all three times points compared to affected participants. Interestingly, the affected participants scored higher in behavioral PPC at baseline, but scored lower post-GCRA compared to those who are unaffected. This suggests that after receiving information during GCRA, the unaffected individuals may believe that they have more control over their health and opportunities for cancer prevention. Decrease in total PPC from baseline to pre-GCRA may be associated with pre-counseling anxiety. More investigation into the three dimensions of PPC should be conducted in order to better understand their distinctions and relationship to GCRA. Citation Format: Tanya A. Chavez, Bita Nehoray, Charité Ricker, Kathleen R. Blazer, Sharon Sand, Kimlin T. Ashing, Jaime Cordova, Gwen Uman, Kai Yang, Nancy Feldman, Jeffrey N. Weitzel. Differences in perceived personal control among Latina women undergoing genetic cancer risk assessment for hereditary breast and ovarian cancer. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A50.

Abstract IA31: Molecular epidemiology of ovarian cancer

Abstract Epithelial ovarian cancer (EOC) accounts for 5% of all cancer deaths and is the fifth leading cause of cancer death in women in the United States. While the incidence is slightly higher in European Americans (EA) than in African American (AA) women, five-year relative survival is much worse for AA women at 36.4% compared to 44.3% for EA women. AA women also have a poorer survival for breast cancer and for both ovarian and breast cancer access to appropriate treatment is a major contributor. Additionally poorer breast cancer survival among AA women has been attributed to aggressive subtypes being more common in AA women compared to EA women. Although the definition of ovarian cancer subtypes has lagged behind that of breast cancer, there have been major changes in the understanding of EOC over the past decade where EOC is not seen as a single disease but as a heterogeneous group of distinct diseases with different morphologic, protein and gene expression profiles. There is now strong evidence that the diverse histologic types comprising ovarian cancer arise not primarily from the ovarian surface epithelium but from various extra-ovarian tissues. Systematic molecular characterization of the most common and lethal morphologic disease subgroup, high grade serous ovarian cancer (HGOSC), provides evidence that subtypes of HGSOC exist and are definable based on gene expression patterns. Four subtypes appear to have robust definitions across different datasets and populations, which resemble the TCGA subtypes labeled as mesenchymal, proliferative, differentiated, and immunoreactive. Most of the molecular profiles of HGSOC in AA women have been based on white cases, with only 24 AA cases available in the TCGA dataset and 29 AA cases in the North Carolina Ovarian Cancer Study. In our recent study which included 164 EA and 29 AA women enrolled in the North Carolina Ovarian Cancer Study, we reported differences in the relative proportion of the four HGOSC gene expression subtypes by race. Preliminary results of HGSOC gene expression patterns in a larger sample of cases enrolled in the African American Cancer Epidemiology Study (AACES), an ongoing multi-center population-based study, support the existence of similar and novel subtypes as reported in EA women with ovarian cancer. Additionally, intrinsic mutational subtypes have been described using the TCGA data of which four have been found to predict survival. However, these mutational subtypes were not found to correspond to the gene expression subtypes. The majority of the ovarian cancer cases were EA and further work in this area which specifically addresses AAs with ovarian cancer is warranted. Although there are over 20 known genome-wide ovarian cancer risk associated SNPs, none have yet been evaluated in AAs and most were determined among EA women. Evaluation of association with these susceptibility variants is currently underway in AA ovarian cancer cases and controls within the NCI-funded GAME-ON consortium. Nearly all EOC research has been performed in EA women with limited focus on racially diverse populations. Comparisons across populations will aid in precisely defining genetic association, molecular subtypes and identify subtype-specific features for future functional characterization with implications for improving treatment and understanding the etiology of one of the most deadly cancers. Below are research objectives that will address important gaps in the molecular epidemiology of ovarian cancer in African American women: Determine molecular subtypes among African-American womenEvaluate genetic risk variants for ovarian cancer susceptibility and survival in African-American womenIncorporate assessment of ovarian cancer risk of African Americans in risk prediction modelsDevelop evidence-based interventions to reduce risk and increase survival Citation Format: Joellen M. Schildkraut. Molecular epidemiology of ovarian cancer. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr IA31.

Germline BRCA testing is moving from cancer risk assessment to a predictive biomarker for targeting cancer therapeutics.

Originally, BRCA testing was used for risk assessment and prevention strategies for breast and ovarian cancer. Nowadays, BRCA status may influence therapeutic decision making at cancer diagnosis. Our objective was to analyze whether the medical advances have changed the burden and pattern of referral, and the pathogenic mutation detection rate. We included 969 probands from our hereditary cancer registry who undertook a full BRCA analysis between 2006 and 2014. Chi-square tests were used to compare categorical variables. The number of genetic tests have raised from 28 to 170, representing a sixfold increase. In 2006, we tested 1.6 relatives/proband while this proportion was four in 2014. Overall, 20% harbored a deleterious mutation and 11% had a variant of unknown significance (VUS). There has been a downward trend in the detection rate of VUS. Testing patients with breast cancer during neoadjuvancy has raised from 4 to 25% (p=0.002), while testing them during remission has decreased from 79 to 29% (p<0.001). The proportion of patients assessed during the first 6months after their cancer diagnosis has increased from 3 to 34% (p=0.001). Risk reducing mastectomy and salpingoophorectomy have raised from 0 to 24%, and from 36 to 65%, respectively. BRCA testing has experienced a sixfold increase, the number of relatives being tested has doubled, and the test is being performed at earlier phases of the disease. It is necessary to adequate the health resources to preserve the BRCA genetic counseling quality while incorporating BRCA testing for therapeutic decision making.

Clinical Actionability of Multigene Panel Testing for Hereditary Breast and Ovarian Cancer Risk Assessment

The practice of genetic testing for hereditary breast and/or ovarian cancer (HBOC) is rapidly evolving owing to the recent introduction of multigene panels. While these tests may identify 40% to 50% more individuals with hereditary cancer gene mutations than does testing for BRCA1/2 alone, whether finding such mutations will alter clinical management is unknown. To define the potential clinical effect of multigene panel testing for HBOC in a clinically representative cohort. Observational study of patients seen between 2001 and 2014 in 3 large academic medical centers. We prospectively enrolled 1046 individuals who were appropriate candidates for HBOC evaluation and who lacked BRCA1/2 mutations. We carried out multigene panel testing on all participants, then determined the clinical actionability, if any, of finding non-BRCA1/2 mutations in these and additional comparable individuals. We evaluated the likelihood of (1) a posttest management change and (2) an indication for additional familial testing, considering gene-specific consensus management guidelines, gene-associated cancer risks, and personal and family history. Among 1046 study participants, 40 BRCA1/2-negative patients (3.8%; 95% CI, 2.8%-5.2%) harbored deleterious mutations, most commonly in moderate-risk breast and ovarian cancer genes (CHEK2, ATM, and PALB2) and Lynch syndrome genes. Among these and an additional 23 mutation-positive individuals enrolled from our clinics, most of the mutations (92%) were consistent with the spectrum of cancer(s) observed in the patient or family, suggesting that these results are clinically significant. Among all 63 mutation-positive patients, additional disease-specific screening and/or prevention measures beyond those based on personal and family history alone would be considered for most (33 [52%] of 63; 95% CI, 40.3%-64.2%). Furthermore, additional familial testing would be considered for those with first-degree relatives (42 [72%] of 58; 95% CI, 59.8%-82.2%) based on potential management changes for mutation-positive relatives. This clinical effect was not restricted to a few of the tested genes because most identified genes could change clinical management for some patients. In a clinically representative cohort, multigene panel testing for HBOC risk assessment yielded findings likely to change clinical management for substantially more patients than does BRCA1/2 testing alone. Multigene testing in this setting is likely to alter near-term cancer risk assessment and management recommendations for mutation-affected individuals across a broad spectrum of cancer predisposition genes.

Abstract IA42: Risk factors and ovarian cancer in African American women: Contributors to disparities

Abstract IA42: Risk factors and ovarian cancer in African American women: Contributors to disparities