A case-control study published recently by Harris et al in Obstetrics & Gynecology evaluated associations between endometriosis, uterine leiomyomas, and ovarian cancer risk by race, as well as the impact of hysterectomy on these associations. The investigators found that hysterectomy may modify the risk of ovarian cancer in both Black patients and White patients with leiomyomas, but among patients with endometriosis, hysterectomy modified that risk only in White patients.
Background
Ovarian cancer is the fifth leading cause of cancer mortality among female patients. The National Cancer Institute estimated that 236,511 patients in the United States were living with ovarian cancer in 2020.
“Conditions such as endometriosis and fibroids can impact health and quality of life,” stressed Barbara Norquist, MD, Associate Professor of Gynecologic Oncology at the University of Washington School of Medicine and Medical Director of the Breast and Ovarian Cancer Prevention Program at the Fred Hutchinson Cancer Center. “Medical interventions—such as hysterectomies—used to treat these conditions can have an impact on future health outcomes. This study is an important step toward understanding these outcomes and better understanding ovarian cancer risk,” she highlighted.
“Almost no research has been done examining the experiences of Black [patients] with endometriosis, including how endometriosis can heighten the risk for ovarian cancer,” explained lead study author Holly Harris, MPH, ScD, Associate Professor of Epidemiology in the Division of Public Health Sciences at the Fred Hutchinson Cancer Center. “We need to continue making more discoveries in this area and conduct further research into how variables such as medical interventions as well as access to care and treatment also impact the risk of ovarian cancer in all populations,” she added.
Study Methods and Results
In the new study, the investigators examined the data of 8,582 patients with fibroids and/or endometriosis—3,124 of whom identified as Black and 5,458 of whom identified as White—by utilizing the Ovarian Cancer in Women of African Ancestry Consortium with the primary goal of understanding how racial differences may have impacted the outcomes of medical interventions used to treat the conditions as well as the risk of developing ovarian cancer.
Among the patients involved in the study, 32.3% (n = 1,008/3,124) of the Black patients and 41.0% (n = 2,237/5,458) of the White patients had ovarian cancer. Additionally, 43.2% and 6.4% of the Black patients and 21.5% and 7% of White patients experienced fibroids and endometriosis, respectively.
Conclusions
“Like many other diseases of reproductive health, endometriosis and fibroid research is severely underfunded in proportion to their population burden,” emphasized Elizabeth Swisher, MD, Professor and Director of the Division of Gynecologic Oncology at the University of Washington School of Medicine and Co-Leader of the Breast and Ovarian Cancer Research Program at the Fred Hutchinson/University of Washington Cancer Consortium. “Because of this, our knowledge of these diseases is severely limited, leaving patients with subpar treatments and substantial impacts on their quality of life,” she underscored.
The investigators hope to further analyze how racial differences may impact the risk of developing ovarian cancer in future studies.
“Despite the lower occurrence of ovarian cancer in Black [patients], this group has the highest mortality [rate] from [the disease]. Identifying how racial differences in access to care and treatment impact this disparity is critical to formulating risk-reduction strategies,” Dr. Harris concluded.
Disclosure: For full disclosures of the study authors, visit journals.lww.com.
