How Does Ovarian Cancer Affect Women of Color?
Some groups of people are at higher risk of developing ovarian cancer. There are also groups that can benefit from extra attention about the disease. Women of color are more seriously affected by ovarian cancer than white women, with disparities in treatment and survival.1
Having more information about healthcare and treatment disparities can help you make treatment decisions. It can also help you start honest conversations with your care team about your treatment and how decisions about your care are made.
What are health disparities?
A health disparity is a health difference that is associated with unequal access to quality healthcare. If a health outcome is seen more or seen less between certain populations, there is a disparity.2,3
Disparities can be related to:2
- Disability status
- Race or ethnicity
- Sexual identity
- Geographic location
- Socioeconomic status
All of these factors can impact a person’s health and health outcomes.2
It is important to remember that disparities impacting women of color with ovarian cancer contain many variables, and more research needs to be done. Many factors work together to impact healthcare, and this results in disparities for many different reasons.
Disparities in treatment
Many women of color, particularly Black and Hispanic women, may be at risk of not getting the treatments recommended by medical guidelines.1
Multiple studies found that Black women also may be at increased risk of receiving treatment that does not adhere to National Comprehensive Cancer Center Network Guidelines. Black women are reported to be less likely to have surgery and chemotherapy for ovarian cancer. Some of this may be due to a lack of access to healthcare or cancer centers. Unequal access to treatment impacts survival.1,4
One review of multiple studies found that non-white Hispanic women were less likely to receive treatment for ovarian cancer compared to white women and women of other races.4
Disparities in mortality
Black women are more likely to be diagnosed with advanced-stage ovarian cancer than white women. Non-Hispanic Black women also have an increased overall risk of mortality from ovarian cancer than non-Hispanic white women, especially when they are diagnosed under the age of 50.1,4
Non-Hispanic Black women, non-Hispanic Asian/Pacific Islander women, and Hispanic women are all at significantly higher risk of dying within the first 12 months of ovarian cancer diagnosis compared to non-Hispanic white women. Lower socioeconomic status (SES) may be one reason, but some studies have found that even when that is accounted for in the study design, the disparities still remain.1,5
Asian women are more likely to be diagnosed with ovarian cancer at an earlier age, have more localized disease, and have better survival than white women. They typically have a lower body mass index (BMI), which may help with earlier diagnosis. They are also more likely to not have remaining cancer cells post-treatment.6
Access to healthcare could be a factor in disparities in mortality, as well as treatment delays and stopping treatment early. Black women diagnosed with ovarian cancer are more likely than white women to also have comorbidities like high blood pressure, kidney disease, and cardiovascular disease. A comorbidity is the presence of 2 or more medical conditions at the same time.1
Even post-treatment, Black women are more likely to have higher CA-125 (a test used to monitor ovarian cancer) levels, which can represent remaining cancer cells following treatment.1,6
It is important to note that racial and ethnic minorities are underrepresented in clinical trials. This is concerning because people of different races and ethnicities may react differently to drugs and treatments.7
Biological and genetic factors and racial disparities
Many non-biological and non-genetic factors contribute to disparities in ovarian cancer treatment and survival. However, biological and genetic factors are also important and need to be further studied.
In studies where things like lower socioeconomic status and access to healthcare were factored into the study design, progression-free survival (how long patients live without the disease getting worse) was lower in Black women than white women. This suggests that biological factors might be at play.1
Higher adiposity (higher levels of fat) is a known risk factor for ovarian cancer, and obesity tends to be higher in Black women. Vitamin D has been linked to cancer health disparities, and the darker skin pigmentation of Black women results in lower serum vitamin D levels. Various gene polymorphisms (changes in DNA) have also been to ovarian cancer in Black women.1
There are many factors to consider when looking at health disparities in ovarian cancer among women of color. More research needs to be done on how genetics, biological factors, and sociological factors play a role in ovarian cancer. All of these work to create disparities, and more research can start to reduce these disparities across racial and ethnic groups.