Disparities in ovarian cancer survival in the United States (2001-2009): Findings from the CONCORD-2 study

Abstract

Background: Ovarian cancer is the fifth leading cause of cancer death among women in the United States. This study reports ovarian cancer survival by state, race, and stage at diagnosis using data from the CONCORD-2 study, the largest and most geographically comprehensive, population-based survival study to date.

Methods: Data from women diagnosed with ovarian cancer between 2001 and 2009 from 37 states, covering 80% of the US population, were used in all analyses. Survival was estimated up to 5 years and was age standardized and adjusted for background mortality (net survival) using state-specific and race-specific life tables.

Results: Among the 172,849 ovarian cancers diagnosed between 2001 and 2009, more than one-half were diagnosed at distant stage. Five-year net survival was 39.6% between 2001 and 2003 and 41% between 2004 and 2009. Black women had consistently worse survival compared with white women (29.6% from 2001-2003 and 31.1% from 2004-2009), despite similar stage distributions. Stage-specific survival for all races combined between 2004 and 2009 was 86.4% for localized stage, 60.9% for regional stage, and 27.4% for distant stage.

Conclusions: The current data demonstrate a large and persistent disparity in ovarian cancer survival among black women compared with white women in most states. Clinical and public health efforts that ensure all women who are diagnosed with ovarian cancer receive appropriate, guidelines-based treatment may help to decrease these disparities. Future research that focuses on the development of new methods or modalities to detect ovarian cancer at early stages, when survival is relatively high, will likely improve overall US ovarian cancer survival. Cancer 2017;123:5138-59. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Keywords: cancer registries; ovarian cancer; population-based survival; surveillance; survival.

Figure 1

Ovarian cancer 5-year, age-standardized net survival (%) among females ages 15 to 99 years and absolute change in net survival (%) are illustrated by calendar period between 2001 and 2009. Note that states are ranked within Census Region by the survival estimate for the years 2004 to 2009. Dark colors are registries affiliated with the National Program of Cancer Registries; and pale colors are registries affiliated with the Surveillance, Epidemiology, and End Results program. An asterisk denotes registries affiliated with both programs.

Figure 2

Ovarian cancer 5-year, age-standardized net survival (NS) (%) among females ages 15 to 99 years is illustrated by state, race, and calendar period of diagnosis. Note that the pooled US survival estimates for each calendar period are indicated by horizontal (solid) lines with corresponding 95% and 99.8% control limits (dashed lines).