Ambient air pollution and survival among Black women with epithelial ovarian cancer across diverse geographical regions of the United States

Abstract

Background: Ovarian cancer is a leading cause of gynecologic cancer mortality, with Black women experiencing 5-year survival rates of only 41%. Disproportionate air pollution exposure may impact survival. We evaluated associations of fine particulate matter (PM_2.5) and nitrogen dioxide (NO₂) exposure with survival among Black women with epithelial ovarian cancer using data from the California Cancer Registry (CCR, n = 540) and the multi-state African American Cancer Epidemiology Study (AACES, n = 766).

Methods: Annual PM_2.5 and NO₂ levels were estimated at a 1 km resolution using well-validated ensemble-based prediction models derived from the Socioeconomic Data and Application Center and assigned to the participants' residential addresses per their year of diagnosis (2004-2016). Weibull accelerated failure time models with participant-level frailty were used to assess air pollutant exposure associations with overall survival.

Results: Average PM_2.5 and NO₂ exposures were 11.3 μg/m³ and 25.8 ppb in CCR and 9.7 μg/m³ and 17.5 ppb in AACES. There was little evidence of an association between air pollution exposures and survival, with event time ratios (> 1 indicate longer survival) in CCR of 1.08 (95% CI = 0.97, 1.20) per 1 μg/m³ PM_2.5 and 1.07 (95% CI = 0.99, 1.15) per 10 ppb NO₂, and in AACES of 1.00 (95% CI = 0.93, 1.07) per 1 μg/m³ PM_2.5 and 1.04 (95% CI = 0.91, 1.19) per 10 ppb NO₂.

Conclusions: Findings were modest and consistent across both cohorts and sensitivity analyses, supported by the use of advanced exposure modeling. Future research should use time-varying, long-term exposure data and examine interactions with occupation, physical activity, and neighborhood stressors.

Figure 1.

Distribution of assigned individual-level environmental concentrations of PM_2.5 and NO₂ in the study population, by cohort and state, AACES (2010–2015) and CCR (2004–2016) cohorts. AL, Alabama, CA, California, GA, Georgia, IL, Illinois, LA, Louisiana, MI, Michigan, NC, North Carolina, NJ, New Jersey, OH, Ohio, SC, South Carolina, TN, Tennessee, TX, Texas.