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advanced-stage OC will relapse and require additional treatment. The likelihood for recurrence depends
on many factors, including distribution of disease at initial presentation, the success of initial surgical
[5]
cytoreduction, rapidity of CA-125 resolution, and treatment response after primary therapy . However, a
predictive marker for recurrence has not been prospectively verified. Patients should be followed closely
by a gynecologic oncologist to detect these signs of recurrence. The management of patients with relapsed
disease varies based on the platinum-free interval or months since last platinum treatment. Platinum
free interval has been shown to correlate with progression-free survival and overall survival, as well as
response to subsequent treatment. The complexity of managing patients with relapsed disease underscores
the importance of treatment plans to include a gynecologic oncologist. Mortality rates for advanced stage
disease are around 70%, and these rates differ between patients with OC among racial, ethnic, and social
groups could be a result of different social barriers [1,4,5] .

EPIDEMIOLOGY OF OC
[11]
OC is the sixth most common cancer in women and the seventh most common cause of cancer death .
There is substantial geographic variation in OC incidence and mortality. Higher rates are seen in the
United Kingdom, Northern Europe, Australia, and the USA, with lower rates observed in Asia, China, and
[11]
Africa . A recent study examining the international assessment of OC incidence and mortality confirmed
these findings, demonstrating the lowest incidence of OC in China, and the highest in Russia and the
[12]
United Kingdom . Similarly, other studies have confirmed that countries with a predominantly Caucasian
population such as Europe, the US, Canada, and Australia, have a higher incidence of OC and that the
[12]
incidence is lower in countries with other ethnic groups such as Asia, Brazil, and Mexico . These findings
are consistent with the fact that within the USA, rates of OC are higher among white women than black
[11]
women . Incidence rates of OC in the US are also lower in Asian/Pacific Islanders, American Indians/
Alaskan Natives that are also consistent with previous international studies. In the US the incidence rate
per 100,000 women of OC is 13.5 in whites compared to 9.9 in Asian/Pacific Islanders, 10.6 in American
[12]
Indians/Alaska Natives, and 10.0 in blacks and 11.6 in Hispanics . In other terms, compared to black and
[2]
Hispanic women, the risk of OC is 40% greater in white women . The exact reason for this racial disparity
in incidence is unknown however racial disparities in certain risk factors for OC may account for this
variation. For instance, this variation in geographic incidence rates of OC may be attributed to genetic
[13]
risk factors, such as the higher incidence of OC among women with Ashkenazi Jewish ancestry . Among
women with OC with Ashkenazi Jewish ancestry, 40% have a mutation in BRCA1 or 2 when diagnosed
[2]
with OC . Other risk factors for OC such as obesity, endogenous or exogenous hormonal exposure, parity,
and dietary factors such as smoking, alcohol use, caffeine consumption are highly related to cultural habits
and lifestyle practices that differ across different ethnic groups and may account for this geographical
variation [2,12] . Racial discrepancies of rates on gynecologic surgery such as tubal ligation and hysterectomy,
which are known protective factors against OC, may also account for some of these variations in OC
[2]
incidence . Similarly, rates of breastfeeding and combined oral contraceptive pill use, also known protective
factors against OC, are highly related to cultural practices and may differ across ethnic groups. Overall the
incidence of OC has gradually declined in most developed countries such as North America and Europe
[14]
since the 1990’s . Conversely, less developed countries with recent economic growth and lifestyle changes
[14]
have seen increases in incidence rates .

DISPARITIES IN THE SURVIVAL AND EXPERIENCE OF OC PATIENTS
The overall difficulty of early detection, early diagnosis, and the subsequent optimum treatment for patients
with OC is exacerbated by the social disparities that exist in underserved communities. These disparities, in
turn, lead to differences in survival rates and treatment. The existing literature supports the hypothesis that
the risk of all-cause mortality in African American OC patients is roughly 1.3 times higher when compared
[15]
to Caucasian women with OC, even when the access to care is equal . The mortality rates have increased