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Published on: April 5, 2024
Racial Differences in the Association of Endometriosis and Uterine Leiomyomas With the Risk of Ovarian Cancer
Holly R Harris1, Lauren C Peres, Courtney E Johnson
1Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Center, and the Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington; the Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; the Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, Connecticut; the Department of Medicine, Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee; Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey; the Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Campus, Washington, DC; the Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago School of Medicine, and the Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, Illinois; the Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California; the Department of Obstetrics and Gynecology, Duke University Medical Center, and the Department of Family Medicine & Community Health, Duke University School of Medicine, Durham, North Carolina; the Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, the State University of New York, Buffalo, New York; and the Slone Epidemiology Center at Boston University, Boston, Massachusetts.
Objective:
To evaluate associations between endometriosis and uterine leiomyomas with ovarian cancer risk by race and the effect of hysterectomy on these associations.
Methods:
We used data from four case-control studies and two case-control studies nested within prospective cohorts in the OCWAA (Ovarian Cancer in Women of African Ancestry) consortium. The study population included 3,124 Black participants and 5,458 White participants, of whom 1,008 Black participants and 2,237 White participants had ovarian cancer. Logistic regression was used to calculate odds ratios (ORs) and 95% CIs for the associations of endometriosis and leiomyomas with ovarian cancer risk, by race, stratified by histotype and hysterectomy.
Results:
The prevalences of endometriosis and leiomyomas were 6.4% and 43.2% among Black participants and 7.0% and 21.5% among White participants, respectively. Endometriosis was associated with an increased risk of endometrioid and clear-cell ovarian cancer in both racial groups (eg, OR for endometrioid tumors for Black and White participants 7.06 [95% CI 3.86-12.91] and 2.17 [95% CI 1.36-3.45], respectively, Phetereogeneity =.003). The association between endometriosis and ovarian cancer risk in White participants was stronger in those without hysterectomy, but no difference was observed in Black participants (all Pinteraction ≥.05). Leiomyomas were associated with an elevated risk of ovarian cancer only in those without hysterectomy in both Black (OR 1.34, 95% CI 1.11-1.62) and White (OR 1.22, 95% CI 1.05-1.41) participants (all Pinteraction ≥.05).
Conclusions:
Black and White participants with endometriosis had a higher risk of ovarian cancer, and hysterectomy modified this association among White participants. Leiomyomas were associated with an increased risk of ovarian cancer in both racial groups, with hysterectomy modifying the risk in both groups. Understanding how racial differences in access to care and treatment options (eg, hysterectomy) may help guide future risk reduction strategies.
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