title: The association between socioeconomic status and tumour stage at diagnosis of ovarian cancer: A pooled analysis of 18 case-control studies.
abstract: OBJECTIVE
  Socioeconomic status (SES) is a known predictor of survival for several cancers and it has been suggested that SES differences affecting tumour stage at diagnosis may be the most important explanatory factor for this. However, only a limited number of studies have investigated SES differences in tumour stage at diagnosis of ovarian cancer. In a pooled analysis, we investigated whether SES as represented by level of education is predictive for advanced tumour stage at diagnosis of ovarian cancer, overall and by histotype. The effect of cigarette smoking and body mass index (BMI) on the association was also evaluated.
  
  
  METHODS
  From 18 case-control studies, we obtained information on 10,601 women diagnosed with epithelial ovarian cancer. Study specific odds ratios (ORs) with corresponding 95% confidence intervals (CI) were obtained from logistic regression models and combined into a pooled odds ratio (pOR) using a random effects model.
  
  
  RESULTS
  Overall, women who completed ≤high school had an increased risk of advanced tumour stage at diagnosis compared with women who completed >high school (pOR 1.15; 95% CI 1.03-1.28). The risk estimates for the different histotypes of ovarian cancer resembled that observed for ovarian cancers combined but did not reach statistical significance. Our results were unchanged when we included BMI and cigarette smoking.
  
  
  CONCLUSIONS
  Lower level of education was associated with an increased risk of advanced tumour stage at diagnosis of ovarian cancer. The observed socioeconomic difference in stage at diagnosis of ovarian cancer calls for further studies on how to reduce this diagnostic delay.
authors: Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.
authors: Camilla
authors: C
authors: Præstegaard
authors: Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark; Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
authors: Susanne K
authors: SK
authors: Kjaer
authors: Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.
authors: Thor S S
authors: TS
authors: Nielsen
authors: Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.
authors: Signe M
authors: SM
authors: Jensen
authors: Population Health Department, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Herston, Queensland 4006, Brisbane, Australia; Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
authors: Penelope M
authors: PM
authors: Webb
authors: Population Health Department, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Herston, Queensland 4006, Brisbane, Australia.
authors: Christina M
authors: CM
authors: Nagle
authors: Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark; Molecular Unit, Department of Pathology, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 75, DK-2730 Herlev, Denmark.
authors: Estrid
authors: E
authors: Høgdall
authors: Department of Chronic Disease Epidemiology, Yale School of Public Health, LEPH 413, 60 College Street, New Haven, CT 06510, USA.
authors: Harvey A
authors: HA
authors: Risch
authors: Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, PO Box 19024, Seattle, WA 98109-1024, USA; Department of Epidemiology, University of Washington, PO Box 19024, Seattle, WA 98109-1024, USA.
authors: Mary Anne
authors: MA
authors: Rossing
authors: Department of Community and Family Medicine, Section of Biostatistics & Epidemiology, Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive, 7927 Rubin Building, Room 884, Lebanon, Hanover, NH 03756, USA.
authors: Jennifer A
authors: JA
authors: Doherty
authors: Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, PO Box 19024, Seattle, WA 98109-1024, USA.
authors: Kristine G
authors: KG
authors: Wicklund
authors: Cancer Prevention and Control, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Room 1S37, Los Angeles 90048, CA, USA; Community and Population Health Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Room 1S37, Los Angeles 90048, CA, USA.
authors: Marc T
authors: MT
authors: Goodman
authors: Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Pittsburgh School of Medicine, Magee-Womens Hospital, 300 Halket Street (Room #2130), Pittsburgh, PA 15222, USA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Magee-Womens Hospital, 300 Halket Street (Room #2130), Pittsburgh, PA 15222, USA; Womens Cancer Research Program, Magee-Womens Research Institute and University of Pittsburgh Cancer Institute, Magee-Womens Hospital, 300 Halket Street (Room #2130), Pittsburgh, PA 15222, USA.
authors: Francesmary
authors: F
authors: Modugno
authors: Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA.
authors: Kirsten
authors: K
authors: Moysich
authors: The University of Texas, School of Public Health, P.O. Box 20186, Houston, TX 77225, USA.
authors: Roberta B
authors: RB
authors: Ness
authors: Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital, 300 Halket Street (Room #2130), Pittsburgh, PA 15222, USA.
authors: Robert P
authors: RP
authors: Edwards
authors: Department of Health Science Research, Division of Epidemiology, Mayo Clinic, 200 First Street SW, Charlton 6, Rochester, MN, USA.
authors: Ellen L
authors: EL
authors: Goode
authors: Department of Biostatistics, University of Kansas, 5028B Robinson Building, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
authors: Stacey J
authors: SJ
authors: Winham
authors: Department of Biostatistics, University of Kansas, 5028B Robinson Building, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
authors: Brooke L
authors: BL
authors: Fridley
authors: Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, 221 Longwood Avenue, RFB 368, Boston, MA 02115, USA.
authors: Daniel W
authors: DW
authors: Cramer
authors: Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, 221 Longwood Avenue, RFB 368, Boston, MA 02115, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 221 Longwood Avenue, RFB 368, Boston, MA 02115, USA.
authors: Kathryn L
authors: KL
authors: Terry
authors: Department of Public Health Sciences, School of Medicine, University of Virginia, Box: 800717, Charlottesville, VA 22908, USA.
authors: Joellen M
authors: JM
authors: Schildkraut
authors: Department of Obstetrics and Gynecology, Duke University Medical Center, 3079, Durham, NC 27710, USA.
authors: Andrew
authors: A
authors: Berchuck
authors: Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, Room 5568, New Brunswick, NJ 08903, USA.
authors: Elisa V
authors: EV
authors: Bandera
authors: New Jersey State Cancer registry, PO Box 369, Trenton, NJ 08625-0369, USA; Rutgers School of Public Health, Piscataway, NJ, USA.
authors: Lisa
authors: L
authors: Paddock
authors: Department for Health Evidence, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands; Department of Urology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
authors: Lambertus A
authors: LA
authors: Kiemeney
authors: Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
authors: Leon F
authors: LF
authors: Massuger
authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Blvd, Rockville, MD 20852, USA.
authors: Nicolas
authors: N
authors: Wentzensen
authors: Department of Oncology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Wortscauseway, Cambridge, CB1 8RN, United Kingdom.
authors: Paul
authors: P
authors: Pharoah
authors: Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Wortscauseway, Cambridge, CB1 8RN, United Kingdom.
authors: Honglin
authors: H
authors: Song
authors: Department of Health Research and Policy-Epidemiology, Stanford University School of Medicine, 259 Campus Drive, Stanford, CA 94305-5405, USA.
authors: Alice S
authors: AS
authors: Whittemore
authors: Department of Health Research and Policy-Epidemiology, Stanford University School of Medicine, 259 Campus Drive, Stanford, CA 94305-5405, USA.
authors: Valerie
authors: V
authors: McGuire
authors: Department of Health Research and Policy-Epidemiology, Stanford University School of Medicine, 259 Campus Drive, Stanford, CA 94305-5405, USA.
authors: Weiva
authors: W
authors: Sieh
authors: Department of Health Research and Policy-Epidemiology, Stanford University School of Medicine, 259 Campus Drive, Stanford, CA 94305-5405, USA.
authors: Joseph
authors: J
authors: Rothstein
authors: Department of Epidemiology, University of California Irvine, Center for Cancer Genetics Research & Prevention, School of Medicine, 224 Irvine Hall, Irvine, CA 92697-7550, USA.
authors: Hoda
authors: H
authors: Anton-Culver
authors: Department of Epidemiology, University of California Irvine, 224 Irvine Hall, Irvine, CA 92697-7550, USA.
authors: Argyrios
authors: A
authors: Ziogas
authors: Women's Cancer, UCL EGA Institute for Women's Health, Maple House 1st Floor, 149 Tottenham Court Road, London W1T 7DN, United Kingdom.
authors: Usha
authors: U
authors: Menon
authors: Women's Cancer, UCL EGA Institute for Women's Health, Maple House 1st Floor, 149 Tottenham Court Road, London W1T 7DN, United Kingdom.
authors: Simon A
authors: SA
authors: Gayther
authors: Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Harlyne Norris Research Tower 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA.
authors: Susan J
authors: SJ
authors: Ramus
authors: Women's Cancer, UCL EGA Institute for Women's Health, Maple House 1st Floor, 149 Tottenham Court Road, London W1T 7DN, United Kingdom.
authors: Aleksandra
authors: A
authors: Gentry-Maharaj
authors: Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Harlyne Norris Research Tower 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA.
authors: Anna H
authors: AH
authors: Wu
authors: Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Harlyne Norris Research Tower 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA; Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, SPH Tower, Office #4642, Ann Arbor, MI 48109-2029, USA.
authors: Celeste L
authors: CL
authors: Pearce
authors: Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Harlyne Norris Research Tower 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 307 East 63rd Street, New York, NY 10065, USA.
authors: Malcolm C
authors: MC
authors: Pike
authors: Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Harlyne Norris Research Tower 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA.
authors: Alice W
authors: AW
authors: Lee
authors: German Cancer Research Center, Division of Cancer Epidemiology, Postfach 101949, 69009 Heidelberg, Germany.
authors: Jenny
authors: J
authors: Chang-Claude
authors: Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark. Electronic address: allan@cancer.dk.
authors: Allan
authors: A
authors: Jensen
mesh_terms: D000368:Aged; D000077216:Carcinoma, Ovarian Epithelial; D016022:Case-Control Studies; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000453:epidemiology* / Q000473:pathology; D016017:Odds Ratio; D010051:Ovarian Neoplasms / Q000453:epidemiology* / Q000473:pathology; D012923:Social Class
keywords: Epidemiology; Ovarian cancer; Pooled analysis; Socioeconomic status; Tumour stage