title: The Association Between Body Mass Index and Presenting Symptoms in African American Women with Ovarian Cancer.
abstract: BACKGROUND
  Ovarian cancer, the most lethal gynecologic malignancy, typically comes to clinical attention due to nonspecific gastrointestinal or pelvic symptoms. African Americans with ovarian cancer have a greater mortality burden than whites and are also much more likely to be obese. The objective of this study is to explore whether the presentation and duration of symptoms differ by body mass index (BMI) in African Americans with ovarian cancer.
  
  
  METHODS
  We conducted a case-only analysis using data from a multicenter population-based study of invasive epithelial ovarian cancer in African American women. Information on risk factors and symptoms leading to diagnosis was obtained in a telephone interview. Frequency and duration of symptoms by BMI categories were compared using logistic regression and linear regression analyses.
  
  
  RESULTS
  Of the 326 women, ∼60% was obese (BMI ≥30), with 30.8% having a BMI ≥35 kg/m(2). Ninety-four percent of women reported ≥1 symptom during the year before diagnosis. We observed differences in frequency of symptoms by BMI categories, with most being reported more frequently by the heaviest women. The reported duration of symptoms was longer in women with higher BMI, with statistically significant trend tests for 6 of the 10 symptoms evaluated.
  
  
  CONCLUSIONS
  BMI appears to impact ovarian cancer symptomatology. Women with higher BMI report having symptoms for a longer period of time before diagnosis of ovarian cancer. Healthcare providers should be vigilant and consider ovarian cancer in the differential diagnosis for obese women presenting with abdominal and pelvic symptoms.
authors.affiliation: 1 Duke University School of Medicine , Durham, North Carolina.
authors.forename: Chioma O
authors.initials: CO
authors.lastname: Erondu
authors.affiliation: 2 Department of Public Health Sciences, Hollings Cancer Center, Medical University of South Carolina , Charleston, South Carolina.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Alberg
authors.affiliation: 3 Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey , New Brunswick, New Jersey.
authors.forename: Elisa V
authors.initials: EV
authors.lastname: Bandera
authors.affiliation: 4 Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine , Cleveland, Ohio.
authors.forename: Jill
authors.initials: J
authors.lastname: Barnholtz-Sloan
authors.affiliation: 5 Cancer Prevention and Population Sciences Program, Baylor College of Medicine , Houston, Texas.
authors.forename: Melissa
authors.initials: M
authors.lastname: Bondy
authors.affiliation: 6 Population Studies and Disparities Research Program, Department of Oncology, Wayne State University School of Medicine , Karmanos Cancer Institute, Detroit, Michigan.
authors.forename: Michele L
authors.initials: ML
authors.lastname: Cote
authors.affiliation: 7 Division of Preventive Medicine, University of Alabama at Birmingham , Birmingham, Alabama.
authors.forename: Ellen
authors.initials: E
authors.lastname: Funkhouser
authors.affiliation: 8 Epidemiology Program, Louisiana State University School of Public Health , New Orleans, Louisiana.
authors.forename: Edward
authors.initials: E
authors.lastname: Peters
authors.affiliation: 6 Population Studies and Disparities Research Program, Department of Oncology, Wayne State University School of Medicine , Karmanos Cancer Institute, Detroit, Michigan.
authors.forename: Ann G
authors.initials: AG
authors.lastname: Schwartz
authors.affiliation: 9 Departments of Public Health and Surgery, University of Tennessee-Knoxville , Knoxville, Tennessee.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Terry
authors.affiliation: 2 Department of Public Health Sciences, Hollings Cancer Center, Medical University of South Carolina , Charleston, South Carolina.
authors.forename: Kristin
authors.initials: K
authors.lastname: Wallace
authors.affiliation: 10 Department of Community and Family Medicine, Duke Cancer Institute, Duke University Medical Center , Durham, North Carolina.
authors.forename: Lucy
authors.initials: L
authors.lastname: Akushevich
authors.affiliation: 10 Department of Community and Family Medicine, Duke Cancer Institute, Duke University Medical Center , Durham, North Carolina.
authors.forename: Frances
authors.initials: F
authors.lastname: Wang
authors.affiliation: 10 Department of Community and Family Medicine, Duke Cancer Institute, Duke University Medical Center , Durham, North Carolina.
authors.forename: Sydnee
authors.initials: S
authors.lastname: Crankshaw
authors.affiliation: 11 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center , Durham, North Carolina.
authors.forename: Andrew
authors.initials: A
authors.lastname: Berchuck
authors.affiliation: 10 Department of Community and Family Medicine, Duke Cancer Institute, Duke University Medical Center , Durham, North Carolina.|12 Department of Public Health Sciences, University of Virginia , Charlottesville, Virginia.
authors.forename: Joellen M
authors.initials: JM
authors.lastname: Schildkraut
authors.affiliation: 10 Department of Community and Family Medicine, Duke Cancer Institute, Duke University Medical Center , Durham, North Carolina.
authors.forename: Patricia G
authors.initials: PG
authors.lastname: Moorman
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D015992:Body Mass Index; D000077216:Carcinoma, Ovarian Epithelial; D055812:Community-Based Participatory Research; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000175:diagnosis / Q000208:ethnology*; D009765:Obesity / Q000208:ethnology; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000208:ethnology*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology