Abstract B59: Analysis of High-Grade Serous Ovarian Cancer in a Cohort of Women diagnosed Epithelial Ovarian Cancer at University of Miami/Jackson Memorial Hospital
Authors: George Sophia HL , Huang Marilyn , Dodds Leah , Butler Raleigh , Oldak Sean , Batista Moraima , Hurley Judith , Pearson Joseph , Kobetz Erin , Slomovitz Brian 
Published: March 2017

Background: High-grade serous ovarian (HGSC) cancer is the most common and aggressive histotype of epithelial ovarian cancer in women, accounting for 75% of epithelial ovarian carcinomas. Most women present at advanced stages III/IV at diagnosis and 5-year survival for patients with advanced stage disease is approximately 20-30%. However, for patients with stage I disease, five-year survival rates exceed 90%.

Ovarian cancer risk factors include nulliparity, early age of menarche, late age of menopause, hormone replacement, obesity and strong family history of hereditary breast and ovarian cancer (HBOC). It is estimated that about 1 in 500 Americans have a mutation in BRCA1 or BRCA2. In women with a germline mutation there is a lifetime risk of: 40%-60% (BRCA1) and 11%-27% (BRCA2), of developing ovarian cancer. Recent studies of different immigrant populations in the United States and in their respective countries of origin have identified pockets of women who bare a similarly high genetic burden as the Ashkenazi Jewish population. Women of Bahamian and Trinidadian heritage are estimated to have 27.1% of breast cancer cases due to BRCA founder mutations. The ovarian cancer burden in these isolated high-risk populations is still unclear, but likely to be as high as those women of Ashkenazi descent.

South Florida has the highest Caribbean immigrant community in the US and nearly 4 out of 10 immigrants in Florida were born in the Caribbean. We sought to elucidate the patient demographic, pathologic, and outcome within a university health system between the safety net hospital - Jackson Memorial Hospital (JMH) and the Sylvester comprehensive cancer center (SCCC).

Methods: We conducted a retrospective chart review study of women diagnosed with epithelial ovarian cancer with the high-grade serous carcinoma histotype at Sylvester Comprehensive Cancer Center/Jackson Memorial Hospital between 2011 and 2015. We collected data including date of diagnosis, age, body mass index (BMI), country of birth, ethnicity, germ-line and somatic genetic tests results, medical insurance, treatment and vital status. SPSS software was used to analyze using independent samples t-tests when parametric and using Wilcoxon-Mann-Whitney tests when non-parametric; and Chi-squared tests for categorical and binary data.

Results: 374 patients were diagnosed and treated for high-grade serous ovarian cancer (HGSC). 50.8% were non-Hispanic, 47.9% Hispanic and 1.3% Unknown. 12.% of the patient population was Black with a significantly higher BMI (39.1 vs 27.9, p=0.004). Mean age was 58 (Hispanic white 57.7yrs (17-93), non-Hispanic white 58.5yrs (17-93) and Black (53.7yrs (18-78), p=0.019)) compared to US national average of 63. At least 32.3% of patients were born in the US while, 60% of patients were born in Latin America and the Caribbean. 72.3% of patients born outside the US were diagnosed and treated at JMH (p&lt;0.001). In a subset analysis of 102 patients, 31% had genetic or somatic testing, of these, 2 patients were Black, not of Afro-Caribbean descent. Patients at JMH presented with 8% Stage I vs 74.7% Stage III/IV, compared to 16.3% Stage I vs 73% Stage IV at SCCC. They had more advanced stage V - 42.7% vs 16.3% at SCCC. JMH patients were more likely to be on Medicaid or uninsured (68% vs 14.2%, p&lt;0.001). Median survival was 47.0 months (44.1-49.9) at SCCC compared to 45.0 months (37.6-52.3) for women at JMH (p=0.392).

Conclusion: The majority of women sought care at the SCCC when diagnosed with HGSC had a higher likelihood of early stage diagnosis, were insured and born in the USA, there was no difference in outcome between patients treated at JMH versus SCCC. Genetic testing within the Black population was low compared to Hispanic and non-Hispanic white patients. This data indicate that the quality of care received in this university health system is similar at both sites. Further studies are indicated to explore uptake of genetic testing, disparities between safety net systems and comprehensive cancer centers, particularly with the shift toward targeted disease prevention and personalized therapy.

Note: This abstract was not presented at the conference.

Citation Format: Sophia HL George, Marilyn Huang, Leah Dodds, Raleigh Butler, Sean Oldak, Moraima Batista, Judith Hurley, Joseph Pearson, Erin Kobetz, Brian Slomovitz. Analysis of High-Grade Serous Ovarian Cancer in a Cohort of Women diagnosed Epithelial Ovarian Cancer at University of Miami/Jackson Memorial Hospital. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B59.