Abstract B25: Stage of diagnosis and survival of ovarian cancer: A fundamental cause approach

The associations between race/socioeconomic status (SES) and diseases and adverse outcomes have been well established. One of the ways in which race/SES affect health outcomes is by influencing one's exposure to risk factors, including behavioral, psychological, biological, environmental, occupation, and access to services. Furthermore, race/SES often determine one's access to resources, such as knowledge, money, prestige, power, and social networks. Individuals utilize available resources to avoid and/or mitigate adverse outcomes.

The fundamental cause of disease perspective assumes that the association between race/SES and disease is due to racial and SES differences in access to resources that can be used to prevent and protect one's health. Therefore, when a new screening or treatment tool is introduced, individuals with greater resources tend to have better access to the new innovation, thus benefiting from early detection and treatment leading to better survival. Conversely, where there is no established screening tool, racial differences in stage of diagnosis may be less pronounced.

Ovarian cancer cases are often diagnosed at advanced stages, because of lack of effective screening tool and few early symptoms. Ovarian cancer is the fourth leading cause of female cancer deaths in the US. In 2008, it is projected that more than 22,000 new cases will be diagnosed and 15,000 women will die of the disease.

Utilizing the fundamental cause approach, we assume that racial differences in ovarian cancer detection may be less pronounced compared to other cancer types, due to the lack of availability of an effective screening tool, once the disease is detected, however, the mortality rate and survival outcome of ovarian cancer cases may exhibit racial differences.

For the purpose of the study, we examine the patterns of racial differences in diagnosis and survival among women diagnosed with ovarian cancer during 1994–1998 participating in a case-control study conducted in Cook County, Illinois (N=351). Deaths in the cohort were ascertained through December 2005 from the National Death Index (mean 9.9 years of follow-up).

Stage at ovarian cancer diagnosis did not differ between black and white women (53% vs. 52% at Stages 3&4). However, the overall follow-up and within-stage mortality rates were both greater for blacks (59%) compared to whites (47%). Also, the length of survival was significantly shorter for black (2,132 days) compared to white women (2,510 days).

Fundamental cause perspective provides a useful framework to better understand subtleties in racial disparities and guide more focused analysis. Broader social causes need to be identified that explain post-diagnosis racial disparities. To understand the specific mechanisms, research on differential treatment recommendations and access to care is needed. Contextual/neighborhood characteristics may also exist in cancer care that contributes to survival outcomes after diagnosis.