title: A multi-center population-based case-control study of ovarian cancer in African-American women: the African American Cancer Epidemiology Study (AACES).
abstract: BACKGROUND
  Ovarian cancer (OVCA) is the leading cause of death from gynecological cancer, with poorer survival for African American (AA) women compared to whites. However, little is known about risk factors for OVCA in AA. To study the epidemiology of OVCA in this population, we started a collaborative effort in 10 sites in the US. Here we describe the study and highlight the challenges of conducting a study of a lethal disease in a minority population.
  
  
  METHODS
  The African American Cancer Epidemiology Study (AACES) is an ongoing, population-based case-control study of OVCA in AA in 10 geographic locations, aiming to recruit 850 women with invasive epithelial OVCA and 850 controls age- and geographically-matched to cases. Rapid case ascertainment and random-digit-dialing systems are in place to ascertain cases and controls, respectively. A telephone survey focuses on risk factors as well as factors of particular relevance for AAs. Food-frequency questionnaires, follow-up surveys, biospecimens and medical records are also obtained.
  
  
  RESULTS
  Current accrual of 403 AA OVCA cases and 639 controls exceeds that of any existing study to date. We observed a high proportion (15%) of deceased non-responders among the cases that in part is explained by advanced stage at diagnosis. A logistic regression model did not support that socio-economic status was a factor in advanced stage at diagnosis. Most risk factor associations were in the expected direction and magnitude. High BMI was associated with ovarian cancer risk, with multivariable adjusted ORs and 95% CIs of 1.50 (0.99-2.27) for obese and 1.27 (0.85- 1.91) for morbidly obese women compared to normal/underweight women.
  
  
  CONCLUSIONS
  AACES targets a rare tumor in AAs and addresses issues most relevant to this population. The importance of the study is accentuated by the high proportion of OVCA cases ascertained as deceased. Our analyses indicated that obesity, highly prevalent in this population (>60% of the cases), was associated with increased OVCA risk. While these findings need to be replicated, they suggest the potential for an effective intervention on the risk in AAs. Upon completion of enrollment, AACES will be the largest epidemiologic study of OVCA in AA women.
authors.affiliation: Duke Cancer Institute, Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA. schil001@dm.duke.edu.
authors.forename: Joellen M
authors.initials: JM
authors.lastname: Schildkraut
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Alberg
authors.forename: Elisa V
authors.initials: EV
authors.lastname: Bandera
authors.forename: Jill
authors.initials: J
authors.lastname: Barnholtz-Sloan
authors.forename: Melissa
authors.initials: M
authors.lastname: Bondy
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Cote
authors.forename: Ellen
authors.initials: E
authors.lastname: Funkhouser
authors.forename: Edward
authors.initials: E
authors.lastname: Peters
authors.forename: Ann G
authors.initials: AG
authors.lastname: Schwartz
authors.forename: Paul
authors.initials: P
authors.lastname: Terry
authors.forename: Kristin
authors.initials: K
authors.lastname: Wallace
authors.forename: Lucy
authors.initials: L
authors.lastname: Akushevich
authors.forename: Frances
authors.initials: F
authors.lastname: Wang
authors.forename: Sydnee
authors.initials: S
authors.lastname: Crankshaw
authors.forename: Patricia G
authors.initials: PG
authors.lastname: Moorman
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016017:Odds Ratio; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D011159:Population Surveillance; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D055815:Young Adult