Ovarian cancer is the leading cause of death from gynecologic malignancies in the United States. Because symptoms tend be nonspecific, early detection is difficult and most ovarian cancers are diagnosed at an advanced stage when the prognosis is poor. Nonetheless, there is clinical evidence that even given the same tumor characteristics, some cases experience much better survival than others. However, little is known about lifestyle factors affecting ovarian cancer survival. Obesity in particular may delay diagnosis, hinder optimal surgical and cytotoxic treatment, and cause postoperative complications. Kaiser Permanente Northern California (KPNC) offers a unique opportunity to evaluate the impact of obesity and weight changes on several aspects of ovarian cancer clinical management, including detection, treatment, and survival, as it comprises a large population with detailed laboratory, clinical, and treatment information. We propose to conduct a retrospective cohort study including approximately 1,900 invasive ovarian cancer cases diagnosed between 2000-2008 and follow-up information through 2010 among KPNC members. Our main objectives are to examine the role of body mass index (BMI) on ovarian cancer survival and on CA-125 levels, a tumor marker routinely used in the clinical management of ovarian cancer. Multivariate Cox Proportional Regression methods will be used to estimate hazard ratios and 95% confidence intervals. We will also use multivariate logistic regression to evaluate the association between BMI and elevated CA-125 (defined as >35 U/ml). Our findings may provide critical information to improve our understanding of ovarian cancer prognostic factors and to reduce disparities in the quality of cancer care in obese patients, with the ultimate goal of improving clinical management of ovarian cancer to reduce ovarian cancer deaths. This study represents the first step in the preparation of an R01 application to develop a prospective cohort study of ovarian cancer survivors among KPNC members to study genetic and lifestyle factors affecting survival. In addition to addressing significant issues, the study is designed to provide experience in cancer survivorship, as well as familiarity with KPNC files and procedures, and to generate preliminary data and publications to support the R01 proposal. The proposed plans for a K22 Award will complement the strong foundation provided by the candidate's K07 Award and afford her the additional protected time needed during her critical transition phase to become an independent investigator and a leading expert in the nutritional epidemiology of female hormonal cancers, spanning prevention and survival.

Public Health Relevance

We propose to evaluate the role of excess body mass and changes in weight on ovarian cancer prognosis using the unique opportunity provided by the Kaiser Permanente of Northern California system, which includes a large population with detailed laboratory and clinical information. Our study has the potential to provide critical information for the optimal management of ovarian cancer with the ultimate goal of reducing ovarian cancer deaths.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Career Transition Award (K22)
Project #
Application #
Study Section
Subcommittee G - Education (NCI)
Program Officer
Jakowlew, Sonia B
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Medicine & Dentistry of NJ
Schools of Medicine
United States
Zip Code
Praestegaard, Camilla; Jensen, Allan; Jensen, Signe M et al. (2017) Cigarette smoking is associated with adverse survival among women with ovarian cancer: Results from a pooled analysis of 19 studies. Int J Cancer 140:2422-2435
Minlikeeva, Albina N; Freudenheim, Jo L; Cannioto, Rikki A et al. (2017) History of hypertension, heart disease, and diabetes and ovarian cancer patient survival: evidence from the ovarian cancer association consortium. Cancer Causes Control 28:469-486
Minlikeeva, Albina N; Freudenheim, Jo L; Cannioto, Rikki A et al. (2017) History of thyroid disease and survival of ovarian cancer patients: results from the Ovarian Cancer Association Consortium, a brief report. Br J Cancer 117:1063-1069
Kar, Siddhartha P; Adler, Emily; Tyrer, Jonathan et al. (2017) Enrichment of putative PAX8 target genes at serous epithelial ovarian cancer susceptibility loci. Br J Cancer 116:524-535
Bandera, Elisa V; Lee, Valerie S; Qin, Bo et al. (2017) Impact of body mass index on ovarian cancer survival varies by stage. Br J Cancer 117:282-289
Rasmussen, Christina B; Kjaer, Susanne K; Albieri, Vanna et al. (2017) Pelvic Inflammatory Disease and the Risk of Ovarian Cancer and Borderline Ovarian Tumors: A Pooled Analysis of 13 Case-Control Studies. Am J Epidemiol 185:8-20
Reid, Brett M; Permuth, Jennifer B; Chen, Y Ann et al. (2017) Integration of Population-Level Genotype Data with Functional Annotation Reveals Over-Representation of Long Noncoding RNAs at Ovarian Cancer Susceptibility Loci. Cancer Epidemiol Biomarkers Prev 26:116-125
Lawrenson, Kate (see original citation for additional authors) (2016) Functional mechanisms underlying pleiotropic risk alleles at the 19p13.1 breast-ovarian cancer susceptibility locus. Nat Commun 7:12675
Winham, Stacey J; Pirie, Ailith; Chen, Yian Ann et al. (2016) Investigation of Exomic Variants Associated with Overall Survival in Ovarian Cancer. Cancer Epidemiol Biomarkers Prev 25:446-54
Ovarian Cancer Association Consortium, Breast Cancer Association Consortium, and Consortium of Modifiers of BRCA1 and BRCA2 (see original citation for additional authors) (2016) No clinical utility of KRAS variant rs61764370 for ovarian or breast cancer. Gynecol Oncol 141:386-401

Showing the most recent 10 out of 78 publications