Camilla Præstegaard1, Susanne K Kjaer2, Thor S S Nielsen1, Signe M Jensen3, Penelope M Webb4, Christina M Nagle5, Estrid Høgdall6, Harvey A Risch7, Mary Anne Rossing8, Jennifer A Doherty9, Kristine G Wicklund10, Marc T Goodman11, Francesmary Modugno12, Kirsten Moysich13, Roberta B Ness14, Robert P Edwards15, Ellen L Goode16, Stacey J Winham17, Brooke L Fridley17, Daniel W Cramer18, Kathryn L Terry19, Joellen M Schildkraut20, Andrew Berchuck21, Elisa V Bandera22, Lisa Paddock23, Lambertus A Kiemeney24, Leon F Massuger25, Nicolas Wentzensen26, Paul Pharoah27, Honglin Song28, Alice S Whittemore29, Valerie McGuire29, Weiva Sieh29, Joseph Rothstein29, Hoda Anton-Culver30, Argyrios Ziogas31, Usha Menon32, Simon A Gayther32, Susan J Ramus33, Aleksandra Gentry-Maharaj32, Anna H Wu33, Celeste L Pearce34, Malcolm C Pike35, Alice W Lee33, Jenny Chang-Claude36, Allan Jensen37. 1. Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark. 2. Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark; Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. 3. Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark. 4. Population Health Department, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Herston, Queensland 4006, Brisbane, Australia; Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia. 5. Population Health Department, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Herston, Queensland 4006, Brisbane, Australia. 6. Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark; Molecular Unit, Department of Pathology, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 75, DK-2730 Herlev, Denmark. 7. Department of Chronic Disease Epidemiology, Yale School of Public Health, LEPH 413, 60 College Street, New Haven, CT 06510, USA. 8. Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, PO Box 19024, Seattle, WA 98109-1024, USA; Department of Epidemiology, University of Washington, PO Box 19024, Seattle, WA 98109-1024, USA. 9. Department of Community and Family Medicine, Section of Biostatistics & Epidemiology, Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive, 7927 Rubin Building, Room 884, Lebanon, Hanover, NH 03756, USA. 10. Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, PO Box 19024, Seattle, WA 98109-1024, USA. 11. Cancer Prevention and Control, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Room 1S37, Los Angeles 90048, CA, USA; Community and Population Health Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Room 1S37, Los Angeles 90048, CA, USA. 12. Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Pittsburgh School of Medicine, Magee-Womens Hospital, 300 Halket Street (Room #2130), Pittsburgh, PA 15222, USA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Magee-Womens Hospital, 300 Halket Street (Room #2130), Pittsburgh, PA 15222, USA; Womens Cancer Research Program, Magee-Womens Research Institute and University of Pittsburgh Cancer Institute, Magee-Womens Hospital, 300 Halket Street (Room #2130), Pittsburgh, PA 15222, USA. 13. Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA. 14. The University of Texas, School of Public Health, P.O. Box 20186, Houston, TX 77225, USA. 15. Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital, 300 Halket Street (Room #2130), Pittsburgh, PA 15222, USA. 16. Department of Health Science Research, Division of Epidemiology, Mayo Clinic, 200 First Street SW, Charlton 6, Rochester, MN, USA. 17. Department of Biostatistics, University of Kansas, 5028B Robinson Building, 3901 Rainbow Blvd, Kansas City, KS 66160, USA. 18. Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, 221 Longwood Avenue, RFB 368, Boston, MA 02115, USA. 19. Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, 221 Longwood Avenue, RFB 368, Boston, MA 02115, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 221 Longwood Avenue, RFB 368, Boston, MA 02115, USA. 20. Department of Public Health Sciences, School of Medicine, University of Virginia, Box: 800717, Charlottesville, VA 22908, USA. 21. Department of Obstetrics and Gynecology, Duke University Medical Center, 3079, Durham, NC 27710, USA. 22. Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, Room 5568, New Brunswick, NJ 08903, USA. 23. New Jersey State Cancer registry, PO Box 369, Trenton, NJ 08625-0369, USA; Rutgers School of Public Health, Piscataway, NJ, USA. 24. Department for Health Evidence, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands; Department of Urology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands. 25. Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands. 26. Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Blvd, Rockville, MD 20852, USA. 27. Department of Oncology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Wortscauseway, Cambridge, CB1 8RN, United Kingdom. 28. Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Wortscauseway, Cambridge, CB1 8RN, United Kingdom. 29. Department of Health Research and Policy-Epidemiology, Stanford University School of Medicine, 259 Campus Drive, Stanford, CA 94305-5405, USA. 30. Department of Epidemiology, University of California Irvine, Center for Cancer Genetics Research & Prevention, School of Medicine, 224 Irvine Hall, Irvine, CA 92697-7550, USA. 31. Department of Epidemiology, University of California Irvine, 224 Irvine Hall, Irvine, CA 92697-7550, USA. 32. Women's Cancer, UCL EGA Institute for Women's Health, Maple House 1st Floor, 149 Tottenham Court Road, London W1T 7DN, United Kingdom. 33. Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Harlyne Norris Research Tower 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA. 34. Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Harlyne Norris Research Tower 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA; Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, SPH Tower, Office #4642, Ann Arbor, MI 48109-2029, USA. 35. Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Harlyne Norris Research Tower 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 307 East 63rd Street, New York, NY 10065, USA. 36. German Cancer Research Center, Division of Cancer Epidemiology, Postfach 101949, 69009 Heidelberg, Germany. 37. Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark. Electronic address: allan@cancer.dk.
Abstract
PURPOSE: Socioeconomic status (SES) is a known predictor of survival for several cancers and it has been suggested that SES differences affecting tumour stage at diagnosis may be the most important explanatory factor for this. However, only a limited number of studies have investigated SES differences in tumour stage at diagnosis of ovarian cancer. In a pooled analysis, we investigated whether SES as represented by level of education is predictive for advanced tumour stage at diagnosis of ovarian cancer, overall and by histotype. The effect of cigarette smoking and body mass index (BMI) on the association was also evaluated. METHODS: From 18 case-control studies, we obtained information on 10,601 women diagnosed with epithelial ovarian cancer. Study specific odds ratios (ORs) with corresponding 95% confidence intervals (CI) were obtained from logistic regression models and combined into a pooled odds ratio (pOR) using a random effects model. RESULTS: Overall, women who completed ≤high school had an increased risk of advanced tumour stage at diagnosis compared with women who completed >high school (pOR 1.15; 95% CI 1.03-1.28). The risk estimates for the different histotypes of ovarian cancer resembled that observed for ovarian cancers combined but did not reach statistical significance. Our results were unchanged when we included BMI and cigarette smoking. CONCLUSION: Lower level of education was associated with an increased risk of advanced tumour stage at diagnosis of ovarian cancer. The observed socioeconomic difference in stage at diagnosis of ovarian cancer calls for further studies on how to reduce this diagnostic delay.
PURPOSE: Socioeconomic status (SES) is a known predictor of survival for several cancers and it has been suggested that SES differences affecting tumour stage at diagnosis may be the most important explanatory factor for this. However, only a limited number of studies have investigated SES differences in tumour stage at diagnosis of ovarian cancer. In a pooled analysis, we investigated whether SES as represented by level of education is predictive for advanced tumour stage at diagnosis of ovarian cancer, overall and by histotype. The effect of cigarette smoking and body mass index (BMI) on the association was also evaluated. METHODS: From 18 case-control studies, we obtained information on 10,601 women diagnosed with epithelial ovarian cancer. Study specific odds ratios (ORs) with corresponding 95% confidence intervals (CI) were obtained from logistic regression models and combined into a pooled odds ratio (pOR) using a random effects model. RESULTS: Overall, women who completed ≤high school had an increased risk of advanced tumour stage at diagnosis compared with women who completed >high school (pOR 1.15; 95% CI 1.03-1.28). The risk estimates for the different histotypes of ovarian cancer resembled that observed for ovarian cancers combined but did not reach statistical significance. Our results were unchanged when we included BMI and cigarette smoking. CONCLUSION: Lower level of education was associated with an increased risk of advanced tumour stage at diagnosis of ovarian cancer. The observed socioeconomic difference in stage at diagnosis of ovarian cancer calls for further studies on how to reduce this diagnostic delay.
Authors: Ellen L Goode; Georgia Chenevix-Trench; Honglin Song; Susan J Ramus; Maria Notaridou; Kate Lawrenson; Martin Widschwendter; Robert A Vierkant; Melissa C Larson; Susanne K Kjaer; Michael J Birrer; Andrew Berchuck; Joellen Schildkraut; Ian Tomlinson; Lambertus A Kiemeney; Linda S Cook; Jacek Gronwald; Montserrat Garcia-Closas; Martin E Gore; Ian Campbell; Alice S Whittemore; Rebecca Sutphen; Catherine Phelan; Hoda Anton-Culver; Celeste Leigh Pearce; Diether Lambrechts; Mary Anne Rossing; Jenny Chang-Claude; Kirsten B Moysich; Marc T Goodman; Thilo Dörk; Heli Nevanlinna; Roberta B Ness; Thorunn Rafnar; Claus Hogdall; Estrid Hogdall; Brooke L Fridley; Julie M Cunningham; Weiva Sieh; Valerie McGuire; Andrew K Godwin; Daniel W Cramer; Dena Hernandez; Douglas Levine; Karen Lu; Edwin S Iversen; Rachel T Palmieri; Richard Houlston; Anne M van Altena; Katja K H Aben; Leon F A G Massuger; Angela Brooks-Wilson; Linda E Kelemen; Nhu D Le; Anna Jakubowska; Jan Lubinski; Krzysztof Medrek; Anne Stafford; Douglas F Easton; Jonathan Tyrer; Kelly L Bolton; Patricia Harrington; Diana Eccles; Ann Chen; Ashley N Molina; Barbara N Davila; Hector Arango; Ya-Yu Tsai; Zhihua Chen; Harvey A Risch; John McLaughlin; Steven A Narod; Argyrios Ziogas; Wendy Brewster; Aleksandra Gentry-Maharaj; Usha Menon; Anna H Wu; Daniel O Stram; Malcolm C Pike; Jonathan Beesley; Penelope M Webb; Xiaoqing Chen; Arif B Ekici; Falk C Thiel; Matthias W Beckmann; Hannah Yang; Nicolas Wentzensen; Jolanta Lissowska; Peter A Fasching; Evelyn Despierre; Frederic Amant; Ignace Vergote; Jennifer Doherty; Rebecca Hein; Shan Wang-Gohrke; Galina Lurie; Michael E Carney; Pamela J Thompson; Ingo Runnebaum; Peter Hillemanns; Matthias Dürst; Natalia Antonenkova; Natalia Bogdanova; Arto Leminen; Ralf Butzow; Tuomas Heikkinen; Kari Stefansson; Patrick Sulem; Sören Besenbacher; Thomas A Sellers; Simon A Gayther; Paul D P Pharoah Journal: Nat Genet Date: 2010-09-19 Impact factor: 38.330
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