Over 22,000 women will be diagnosed with ovarian cancer (OC) in 2019. While there have been significant therapeutic advances, effective screening for OC remains elusive. Women are more likely to present with an advanced disease stage, contributing to the dismal five-year survival rate of 47.6%. Mortality is disproportionately higher among African American (AA) women. Evidence has shown a multi-factorial contribution to this disparity including social and biological determinants. Acceptability is a dimension of health care access (HCA) that takes into account a patient's attitudes toward health providers and/or health care facilities. In the AA community, this acceptability may be significantly affected by perceived discrimination. In addition to influencing patient-provider interaction, perceived discrimination and associated psychosocial stress may also induce an inflammatory biological response in patients. Inflammation is a well-known contributor to carcinogenesis and cancer progression. The biological response to psychosocial stress results in the release of inflammatory factors that may promote oncogenesis and modulate immune function. This has been shown to increase the risk of inflammatory disease including pelvic inflammatory disease (PID). PID, an inflammatory gynecologic disease, has been linked to risk of OC. Given the increased risk of stress and inflammation in AA women, and the association with increased risk of PID, it is plausible that PID is a potential biological mediator for OC etiology and survival disparity between AA and white women with OC. The proposed study will examine the prevalence of perceived discrimination and psychosocial stress among AA and white women with OC as well as the association of these factors with PID. The results of this study will clarify the role of social and biological mechanisms that contribute to OC racial disparities. Findings from this study will direct future analysis of the compounded social and biological effect of perceived discrimination on OC etiology and survival. This knowledge will not only benefit AA women, but women of all races with similar tumor etiologies.
Ovarian cancer (OC) survival has improved over the past several decades as new, frontline treatment strategies have been developed; however, the benefits of improved treatment have not been shared equitably. While OC 5-year survival for White patients increased between 1975 and 2006, it declined for Black women during this same period. Given the immense complexity of cancer treatment and the importance of access to quality care, an improved understanding of factors underlying access to care ? and an understanding of how those factors differ across population sub-groups ? is urgently needed. Our proposed study will comprehensively evaluate the many factors that combine to determine access to quality OC care, quality of life and survival among Black and White patients. Findings will provide a deeper understanding of race-specific barriers to OC care and highlight specific modifiable factors that may be targeted to reduce disparities and improve care for all patients.
