What is the risk of ovarian cancer in African American females?

Risk of Ovarian Cancer in African American Females

African American women have a somewhat lower risk of epithelial ovarian cancer compared to white women, with an odds ratio of 0.7 (95% CI 0.5 to 0.9), though this difference narrows after adjusting for known risk factors (odds ratio 0.8,95% CI 0.6 to 1.0). 1

General Ovarian Cancer Risk

• The estimated lifetime risk for any woman developing ovarian cancer is approximately 1 in 54 (about 1.1% in the general population) 2
• Ovarian cancer is the fifth most common type of cancer in women and the fourth most common cause of cancer death in women 2
• Ovarian cancer predominantly affects older, postmenopausal women with more than 80% of cases diagnosed in women over 50 years of age 2
• Most ovarian cancers (51%) are diagnosed at stage III and 29% at stage IV, when 5-year survival rates are less than 30% 2

Risk Factors Relevant to African American Women

Reproductive and Hormonal Factors

• African American women are more likely to have five or more pregnancies and to have had a hysterectomy compared to white women, which may partially explain their lower ovarian cancer risk 1
• Multiple pregnancies, oral contraceptive use, tubal ligation, and breastfeeding are protective factors against ovarian cancer that may differ in prevalence between racial groups 2, 1

Genetic and Family History Factors

• African American women are less likely to have a family history of ovarian cancer compared to white women 1
• However, African American women have a significantly higher population attributable risk (PAR) for first-degree family history of breast cancer (10.1%) compared to white women (2.6%) 3
• Genetic testing rates are lower among African American, Asian, and Hispanic patients compared to non-Hispanic White patients, which may affect risk assessment 2

Benign Gynecologic Conditions

• A history of endometriosis in African American women is associated with increased risk of ovarian cancer (OR 1.78; 95% CI 1.09-2.90) 4
• A positive trend exists for increasing number of reported gynecologic conditions and ovarian cancer risk in African American women 4

Modifiable Risk Factors

• Collectively, modifiable exposures (including body mass index, oral contraceptives, aspirin, and body powder use) account for a higher proportion of ovarian cancer risk in African American women (PAR = 36.0%) compared to white women (PAR = 13.8%) 3

Disparities in Outcomes

• Despite having a somewhat lower incidence rate, African American women with ovarian cancer have worse survival outcomes compared to white women 5
• The African American Cancer Epidemiology Study showed that African American women with epithelial ovarian cancer had a significantly lower 5-year overall survival rate (49%) compared to white women (60%) 2
• Contributing factors to this disparity include lower levels of income, education, and insurance coverage among African American women, which are associated with reduced access to optimal treatment 2

Clinical Implications

• Genetic counseling and testing rates remain low among African American women, with only 7.7% of patients seen for gynecologic cancer risk assessment in one large southeastern comprehensive cancer center being African American, despite representing 27% of the regional population 6
• When genetic testing is performed in high-risk African American women, pathogenic variant rates can be substantial, highlighting the importance of appropriate risk assessment 6
• Efforts should focus on identifying African American women at risk for ovarian cancer and providing thorough genetic counseling and testing 6
• Interventions targeting modifiable risk factors may be more beneficial for African American women than white women at risk for ovarian cancer 3

Screening Considerations

• No routine screening is recommended for average-risk women of any race, as randomized controlled trials have not demonstrated a mortality benefit 2
• For high-risk women, including those with genetic predisposition, screening with pelvic ultrasound may be appropriate, though data remain limited 2
• The U.S. Preventive Services Task Force recommends against routine screening for ovarian cancer in average-risk women 2