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Osazuwa-Peters OL, Deveaux A, Muehlbauer MJ, Ilkayeva O, Bain JR, Keku T, Berchuck A, Huang B, Ward K, Gates Kuliszewski M, Akinyemiju T. Racial Differences in Vaginal Fluid Metabolites and Association with Systemic Inflammation Markers among Ovarian Cancer Patients: A Pilot Study. Cancers (Basel) 2024; 16:1259. [PMID: 38610937 PMCID: PMC11011195 DOI: 10.3390/cancers16071259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
The vaginal microbiome differs by race and contributes to inflammation by directly producing or consuming metabolites or by indirectly inducing host immune response, but its potential contributions to ovarian cancer (OC) disparities remain unclear. In this exploratory cross-sectional study, we examine whether vaginal fluid metabolites differ by race among patients with OC, if they are associated with systemic inflammation, and if such associations differ by race. Study participants were recruited from the Ovarian Cancer Epidemiology, Healthcare Access, and Disparities Study between March 2021 and September 2022. Our study included 36 study participants with ovarian cancer who provided biospecimens; 20 randomly selected White patients and all 16 eligible Black patients, aged 50-70 years. Acylcarnitines (n = 45 species), sphingomyelins (n = 34), and ceramides (n = 21) were assayed on cervicovaginal fluid, while four cytokines (IL-1β, IL-10, TNF-α, and IL-6) were assayed on saliva. Seven metabolites showed >2-fold differences, two showed significant differences using the Wilcoxon rank-sum test (p < 0.05; False Discovery Rate > 0.05), and 30 metabolites had coefficients > ±0.1 in a Penalized Discriminant Analysis that achieved two distinct clusters by race. Arachidonoylcarnitine, the carnitine adduct of arachidonic acid, appeared to be consistently different by race. Thirty-eight vaginal fluid metabolites were significantly correlated with systemic inflammation biomarkers, irrespective of race. These findings suggest that vaginal fluid metabolites may differ by race, are linked with systemic inflammation, and hint at a potential role for mitochondrial dysfunction and sphingolipid metabolism in OC disparities. Larger studies are needed to verify these findings and further establish specific biological mechanisms that may link the vaginal microbiome with OC racial disparities.
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Affiliation(s)
- Oyomoare L. Osazuwa-Peters
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27701, USA; (A.D.); (T.A.)
| | - April Deveaux
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27701, USA; (A.D.); (T.A.)
| | - Michael J. Muehlbauer
- Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, NC 27701, USA; (M.J.M.); (O.I.); (J.R.B.)
| | - Olga Ilkayeva
- Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, NC 27701, USA; (M.J.M.); (O.I.); (J.R.B.)
- Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - James R. Bain
- Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, NC 27701, USA; (M.J.M.); (O.I.); (J.R.B.)
- Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Temitope Keku
- Division of Gastroenterology and Hepatology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Andrew Berchuck
- Duke Division of Gynecologic Oncology, Duke University School of Medicine, Durham, NC 27710, USA;
| | - Bin Huang
- Kentucky Cancer Registry, University of Kentucky, Lexington, KY 40506, USA;
| | - Kevin Ward
- Georgia Cancer Registry, Emory University, Atlanta, GA 30322, USA;
| | | | - Tomi Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27701, USA; (A.D.); (T.A.)
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC 27710, USA
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Mei S, Chelmow D, Gecsi K, Barkley J, Barrows E, Brooks R, Huber-Keener K, Jeudy M, O'Hara JS, Burke W. Health Disparities in Ovarian Cancer: Report From the Ovarian Cancer Evidence Review Conference. Obstet Gynecol 2023; 142:196-210. [PMID: 37348095 DOI: 10.1097/aog.0000000000005210] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/12/2023] [Indexed: 06/24/2023]
Abstract
Health disparity, defined by the Centers for Disease Control and Prevention (CDC) as "preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations," is seen across multiple diseases. We conducted an evidence review of health disparities and inequities and their mitigation strategies related to ovarian cancer as part of a CDC-sponsored project to develop educational materials for clinicians on the prevention and early diagnosis of gynecologic cancers. Our review found profound disparities in outcomes such as survival, treatment, and stage at diagnosis by factors such as race and ethnicity, insurance, socioeconomic status, and geographic location. We found little direct evidence on mitigation strategies. Studies support equivalent response to equivalent treatment between groups, suggesting that adherence to National Comprehensive Cancer Network guidelines can at least partially mitigate some of the differences.
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Affiliation(s)
- Shirley Mei
- Departments of Obstetrics and Gynecology, New York University Langone School of Medicine, New York, New York, Virginia Commonwealth University School of Medicine, Richmond, Virginia, the Medical College of Wisconsin, Milwaukee, Wisconsin, Creighton University School of Medicine, Phoenix, Arizona, the University of California, Davis, Davis, California, the University of Iowa Hospitals and Clinics, Ames, Iowa, and Stony Brook University Hospital, New York, New York; and the American College of Obstetricians and Gynecologists, Washington, DC
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Bethea TN, Ochs-Balcom HM, Bandera EV, Beeghly-Fadiel A, Camancho F, Chyn D, Cloyd EK, Harris HR, Joslin CE, Myers E, Moorman PG, Peres LC, Rosenow W, Setiawan VW, Wu AH, Rosenberg L, Schildkraut JM. First- and second-degree family history of ovarian and breast cancer in relation to risk of invasive ovarian cancer in African American and white women. Int J Cancer 2021; 148:2964-2973. [PMID: 33521947 PMCID: PMC8353974 DOI: 10.1002/ijc.33493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/05/2021] [Accepted: 01/20/2021] [Indexed: 11/07/2022]
Abstract
Family history (FH) of ovarian cancer and breast cancer are well-established risk factors for ovarian cancer, but few studies have examined this association in African American (AA) and white women by histotype. We assessed first- and second-degree FH of ovarian and breast cancer and risk of epithelial ovarian cancer in the Ovarian Cancer in Women of African Ancestry Consortium. Analyses included 1052 AA cases, 2328 AA controls, 2380 white cases and 3982 white controls. Race-specific odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multilevel logistic regression with adjustment for covariates. Analyses were stratified by histotype (high-grade serous vs others). First-degree FH of ovarian cancer was associated with high-grade serous carcinoma in AA (OR = 2.32, 95% CI: 1.50, 3.59) and white women (OR = 2.48, 95% CI: 1.82, 3.38). First-degree FH of breast cancer increased risk irrespective of histotype in AAs, but with high-grade serous carcinoma only in white women. Associations with second-degree FH of ovarian cancer were observed for overall ovarian cancer in white women and with high-grade serous carcinoma in both groups. First-degree FH of ovarian cancer and of breast cancer, and second-degree FH of ovarian cancer is strongly associated with high-grade serous ovarian carcinoma in AA and white women. The association of FH of breast cancer with high-grade serous ovarian carcinoma is similar in white women and AA women, but may differ for other histotypes.
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Affiliation(s)
- Traci N. Bethea
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Campus, Washington, D.C., USA
| | - Heather M. Ochs-Balcom
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Elisa V. Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Alicia Beeghly-Fadiel
- Department of Medicine, Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Fabian Camancho
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Deanna Chyn
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Emily K. Cloyd
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Holly R. Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center and Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Charlotte E. Joslin
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago School of Medicine and Division of Epidemiology and Biostatistics, School of Public Health, Chicago, Illinois, USA
| | - Evan Myers
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA
| | - Patricia G. Moorman
- Department of Family Medicine and Community Health, Duke University Medical Center, Durham, North Carolina, USA
| | - Lauren C. Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Will Rosenow
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Veronica W. Setiawan
- University of Southern California Norris Comprehensive Cancer Center and Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California, USA
| | - Anna H. Wu
- University of Southern California Norris Comprehensive Cancer Center and Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, Massachusetts, USA
| | - Joellen M. Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Khella CA, Mehta GA, Mehta RN, Gatza ML. Recent Advances in Integrative Multi-Omics Research in Breast and Ovarian Cancer. J Pers Med 2021; 11:149. [PMID: 33669749 PMCID: PMC7922242 DOI: 10.3390/jpm11020149] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/13/2021] [Accepted: 02/14/2021] [Indexed: 02/07/2023] Open
Abstract
The underlying molecular heterogeneity of cancer is responsible for the dynamic clinical landscape of this disease. The combination of genomic and proteomic alterations, including both inherited and acquired mutations, promotes tumor diversity and accounts for variable disease progression, therapeutic response, and clinical outcome. Recent advances in high-throughput proteogenomic profiling of tumor samples have resulted in the identification of novel oncogenic drivers, tumor suppressors, and signaling networks; biomarkers for the prediction of drug sensitivity and disease progression; and have contributed to the development of novel and more effective treatment strategies. In this review, we will focus on the impact of historical and recent advances in single platform and integrative proteogenomic studies in breast and ovarian cancer, which constitute two of the most lethal forms of cancer for women, and discuss the molecular similarities of these diseases, the impact of these findings on our understanding of tumor biology as well as the clinical applicability of these discoveries.
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Affiliation(s)
- Christen A Khella
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08903, USA
| | - Gaurav A Mehta
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08903, USA
| | - Rushabh N Mehta
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08903, USA
| | - Michael L Gatza
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08903, USA
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Siemon J, Galli J, Slomovitz B, Schlumbrecht M. Disparities in care among patients with low-grade serous ovarian carcinoma. Gynecol Oncol 2020; 157:46-54. [PMID: 32008792 DOI: 10.1016/j.ygyno.2019.12.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/23/2019] [Accepted: 12/25/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Low-grade serous carcinoma (LGSC) is a rare histotype of ovarian cancer with a unique disease course. Little data exist regarding the influence of sociodemographic factors on diagnosis and outcomes in this disease. Our objective was to evaluate the associations between these factors and the clinical characteristics, treatment approaches, and survival in LGSC. METHODS The National Cancer Database (NCDB) was queried for data between 2004 and 2015 on patients with LGSC. LGSC was inclusive of invasive, grade 1, serous carcinoma of the ovary, fallopian tube, or peritoneum. Patient demographics, insurance status, disease characteristics, treatment approach, and survival were evaluated. ANOVA, Chi Square, Kaplan-Meier, and Cox regression were used in the analysis. RESULTS 3221 patients with LGSC were evaluated (89.5% White, 6.2% Black; 7.2% Hispanic, 92.8% non-Hispanic). Compared to Whites, Blacks were diagnosed younger (50.4 vs. 55.9 years, p < 0.01), received less chemotherapy (61.8% vs 67.0%, p = 0.04), and had less CA-125 elevation (OR 4.14 [1.26-13.57], p = 0.02). Compared to non-Hispanics, Hispanics were younger (49.5 vs. 55.8 years, p < 0.01) and received less chemotherapy (55% vs 67%, p < 0.001). In contrast to private insurance, government insurance was associated with a higher 30-day mortality (1.5% vs 0.01%, p < 0.001). Race/ethnicity were not predictive of OS, while older age (HR 1.013 [1.002-1.024], p = 0.03), advanced stage (HR 3.09 [2.15-4.43], p < 0.001), and government insurance (HR 2.33 [1.65-3.30], p < 0.001) were all independently associated with worse OS. CONCLUSIONS Significant differences exist in the clinical characteristics, treatments, and outcomes of LGSC by sociodemographics, with Blacks and Hispanics being diagnosed younger and receiving less chemotherapy. Age, stage, and insurance status were predictive of overall survival.
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Affiliation(s)
- J Siemon
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States.
| | - J Galli
- University of Miami Ryan White Program, Miami, FL, United States
| | - B Slomovitz
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - M Schlumbrecht
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
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Abstract
Ovarian cancer is one of the most fatal cancers diagnosed in women in the United States (U.S.). Data from national databases, including the Surveillance Epidemiology and End Results (SEER) program, show racial/ethnic differences in risk and survival of epithelial ovarian cancer with higher incidence among white women yet worse survival among African-American women compared to other racial/ethnic groups. The reasons for these differences are not well understood, but are likely multi-factorial. Epidemiologic studies suggest there may be some risk factor differences across racial/ethnic groups that would explain differences in the incidence of this rare and heterogeneous disease. Likewise, although data suggest that socioeconomic factors and access to care contribute to the disparity in ovarian cancer survival among African-American women, there are likely other contributing factors that have not as of yet been identified. Small sample sizes of minority women from individual studies do not provide adequate power to evaluate fully the contributions of environmental, genetic, and clinical factors associated with ovarian cancer risk and survival within these groups. Pooling existing data from individual epidemiologic studies has made a valuable contribution; however, new data collection is warranted to further our understanding of the underpinnings of the disparities in ovarian cancer that may lead to prevention and improved survival across all racial/ethnic groups.
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Hildebrand JS, Wallace K, Graybill WS, Kelemen LE. Racial disparities in treatment and survival from ovarian cancer. Cancer Epidemiol 2019; 58:77-82. [DOI: 10.1016/j.canep.2018.11.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/08/2018] [Accepted: 11/27/2018] [Indexed: 11/26/2022]
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Kheiri SA, Kunna A, Babiker AY, Alsuhaibani SA, Ahmed RY, Alsammani MA. Histopathological Pattern and Age Distribution, of Malignant Ovarian Tumor among Sudanese Ladies. Open Access Maced J Med Sci 2018. [PMID: 29531580 PMCID: PMC5839424 DOI: 10.3889/oamjms.2018.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION: Ovarian cancer is the cause of a high case-fatality ratio, and most of the cases are diagnosed in late stages. OBJECTIVES: To determine the histopathological types, age distribution, and ovarian tumour stages among diagnosed with ovarian cancer at Al - Amal Tower a multi-referral polyclinic of Radiology & Isotope Center Khartoum (RICK), Sudan. METHODS: All histopathology reports patients’ case from January to June 2015 were reviewed. The cancers classified according to federation international of Obstetrics and Gynecology (FIGO). RESULTS: There were 127 cases of ovarian cancers. Surface epithelial cancers were the most common 77.7% (n = 98), followed by sex cord-stromal cancers 11.23% (n = 14), Germ cell tumor 1.6% (n = 2). Metastatic cancers were seen from colon and breast in 6.3% and 3.9 % of cases respectively. Few cases (14%) of ovarian cancers were reported before 40 years of age, after the age of 50 is a sharp increase in the incidence of a tumour. The mean age at presentation was 52.36 ± 14.210 years, there is mean age of menarche 13.59 ± 2.706 years. Very few patients used HRT (1.6%) or had been on ovulation induction treatment (8.7%). Most of patients 39 (30.7%) presented in stage IIIC, and stage 1V 32 (25.2%) indicating a poor prognosis. CONCLUSION: The incidence of different types of ovarian cancers in the present study is similar to worldwide incidence. The surface epithelial tumour is the commonest ovarian cancer, of which serous adenocarcinoma is the commonest and most of our patients present in late stages.
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Affiliation(s)
- Sumeya A Kheiri
- Department of Obstetrics and Gynecology, College of Medicine, University of Bahri, Khartoum, Sudan
| | - Abdelillah Kunna
- Department of Obstetrics and Gynecology, College of Medicine, University of Bahri, Khartoum, Sudan
| | - Ali Yousif Babiker
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraidah, Saudi Arabia
| | - Sultan A Alsuhaibani
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraidah, Saudi Arabia
| | - Rami Yousif Ahmed
- Department of Obstetrics and Gynecology, College of Medicine, University of Bahri, Khartoum, Sudan
| | - Mohamed Alkhatim Alsammani
- Department of Obstetrics and Gynecology, College of Medicine, University of Bahri, Khartoum, Sudan.,Department of Obstetrics and Gynecology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
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Srivastava SK, Ahmad A, Miree O, Patel GK, Singh S, Rocconi RP, Singh AP. Racial health disparities in ovarian cancer: not just black and white. J Ovarian Res 2017; 10:58. [PMID: 28931403 PMCID: PMC5607508 DOI: 10.1186/s13048-017-0355-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/01/2017] [Indexed: 01/24/2023] Open
Abstract
Ovarian cancer (OC) is the most lethal gynecological malignancy, which disproportionately affects African American (AA) women. Lack of awareness and socioeconomic factors are considered important players in OC racial health disparity, while at the same time, some recent studies have brought focus on the genetic basis of disparity as well. Differential polymorphisms, mutations and expressions of genes have been reported in OC patients of diverse racial and ethnic backgrounds. Combined, it appears that neither genetic nor the socioeconomic factors alone might explain the observed racially disparate health outcomes among OC patients. Rather, a more logical explanation would be the one that takes into consideration the combination and/or the interplay of these factors, perhaps even including some environmental ones. Hence, in this article, we attempt to review the available information on OC racial health disparity, and provide an overview of socioeconomic, environmental and genetic factors, as well as the epigenetic changes that can act as a liaison between the three. A better understanding of these underlying causes will help further research on effective cancer management among diverse patient population and ultimately narrow health disparity gaps.
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Affiliation(s)
- Sanjeev K Srivastava
- Department of Oncologic Sciences, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604-1405, USA. .,Division of Cell Biology and Genetics, Tatva Biosciences, Coastal Innovation Hub, 600 Clinic Drive, Mobile, AL, 36688, USA.
| | - Aamir Ahmad
- Department of Oncologic Sciences, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604-1405, USA
| | - Orlandric Miree
- Department of Oncologic Sciences, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604-1405, USA
| | - Girijesh Kumar Patel
- Department of Oncologic Sciences, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604-1405, USA
| | - Seema Singh
- Department of Oncologic Sciences, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604-1405, USA.,Department of Biochemistry and Molecular Biology, College of Medicine, University of South Alabama, Mobile, AL, 36688, USA
| | - Rodney P Rocconi
- Division of Gynecologic Oncology, Mitchell Cancer Institute, University of South Alabama, Mobile, AL, 36604, USA
| | - Ajay P Singh
- Department of Oncologic Sciences, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604-1405, USA. .,Department of Biochemistry and Molecular Biology, College of Medicine, University of South Alabama, Mobile, AL, 36688, USA.
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