title: The effect of time on racial differences in epithelial ovarian cancer (OVCA) diagnosis stage, overall and by histologic subtypes: a study of the National Cancer Database.
abstract: Previous studies assessing racial and ethnic differences in ovarian cancer (OVCA) diagnosis stage fail to present subtype-specific results and provide historic data on cases diagnosed between 10 and 20 years ago. The purpose of this analysis is to assess non-Hispanic Black (NHB) and non-Hispanic White (NHW) differences in late-stage diagnosis including; (1) factors associated with late-stage diagnosis of invasive epithelial OVCA overall and by histologic subtypes, (2) potential changes across time and (3) current patterns of trends in a national cancer registry in the USA and Puerto Rico between 1998 and 2011.
  
  
  
  NHB and NHW OVCA cases were derived from the National Cancer Database (NCDB). Diagnosis stage was analyzed as a dichotomous and a four level-category variable, respectively; early (stages I and II; localized) versus late (stages III and IV; regional and distant) and stages I, II, III and IV. Diagnosis period was trichotomized (1998-2002, 2003-2007, 2008-2011). Racial differences in stage were tested using Chi-square statistics. Odds ratios (OR) and 95 % confidence intervals (95 % CI) were estimated using multivariable binomial and generalized ordered logistic regressions. Interactions between race and diagnosis period were evaluated.
  
  
  
  Between 1998 and 2011, 11,562 (7.8 %) NHB and 137,106 (92.2 %) NHW were diagnosed with OVCA. In adjusted models, NHB were significantly more likely diagnosed with late-stage OVCA than NHW (ORadj 1.26, 95 % CI 1.19-1.33). Interaction between race and diagnosis period was marginally significant (p value = 0.09), with racial differences in stage decreasing over time (1998-2002: ORadj 1.36, 95 % CI 1.23-1.49; 2003-2007: ORadj 1.27, 95 % CI 1.15-1.39; 2008-2011; ORadj 1.15, 95 % CI 1.05-1.27). NHB were also more likely to be diagnosed with stage 4 high-grade serous (ORadj 1.46, 95 % CI 1.22-1.74), clear cell (ORadj 2.71, 95 % CI 1.94-3.79) and mucinous (ORadj 2.78, 95 % CI 2.24-3.46) carcinomas than NHW.
  
  
  
  Racial differences in late-stage OVCA diagnosis exist; however, these differences are decreasing with time. Within NCDB, NHB are significantly more likely diagnosed with late-stage OVCA and more specifically high-grade serous, clear cell and mucinous carcinomas than NHW.
authors: Department of Epidemiology and Biostatistics, University of Illinois at Chicago, 1603 W. Taylor Ave., Chicago, IL, 60612, USA.
authors: Anna B
authors: 0000-0003-1447-7419
authors: AB
authors: Beckmeyer-Borowko
authors: Department of Epidemiology and Biostatistics, University of Illinois at Chicago, 1603 W. Taylor Ave., Chicago, IL, 60612, USA.|Cancer Control and Population Science Research Program, University of Illinois at Chicago Cancer Center, 1855 W. Taylor St, Ste.3.154, Chicago, IL, 60612, USA.|Institute for Health Research and Policy, 747 W Roosevelt Rd, Chicago, IL, 60608, USA.
authors: Caryn E
authors: CE
authors: Peterson
authors: Department of Epidemiology and Biostatistics, University of Illinois at Chicago, 1603 W. Taylor Ave., Chicago, IL, 60612, USA.
authors: Katherine C
authors: KC
authors: Brewer
authors: Department of Epidemiology and Biostatistics, University of Illinois at Chicago, 1603 W. Taylor Ave., Chicago, IL, 60612, USA.|Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 W. Taylor Street, M/C 648, Chicago, IL, 60612, USA.
authors: Mary A
authors: MA
authors: Otoo
authors: 3-317 Edmonton Clinic Health Academy, University of Alberta School of Public Health, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada.
authors: Faith G
authors: FG
authors: Davis
authors: Cancer Control and Population Science Research Program, University of Illinois at Chicago Cancer Center, 1855 W. Taylor St, Ste.3.154, Chicago, IL, 60612, USA.|Institute for Health Research and Policy, 747 W Roosevelt Rd, Chicago, IL, 60608, USA.|College of Medicine, Department of Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, 60612, USA.
authors: Kent F
authors: KF
authors: Hoskins
authors: Department of Epidemiology and Biostatistics, University of Illinois at Chicago, 1603 W. Taylor Ave., Chicago, IL, 60612, USA. charjosl@uic.edu.|Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 W. Taylor Street, M/C 648, Chicago, IL, 60612, USA. charjosl@uic.edu.|Cancer Control and Population Science Research Program, University of Illinois at Chicago Cancer Center, 1855 W. Taylor St, Ste.3.154, Chicago, IL, 60612, USA. charjosl@uic.edu.
authors: Charlotte E
authors: CE
authors: Joslin
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000453:epidemiology* / Q000208:ethnology* / Q000473:pathology; D010051:Ovarian Neoplasms / Q000453:epidemiology* / Q000208:ethnology* / Q000473:pathology; D011647:Puerto Rico / Q000453:epidemiology; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
keywords: Diagnosis stage; High-grade serous; Non-Hispanic Black; Non-Hispanic White; Ovarian cancer; Racial differences; Racial disparities; Time-trend