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Page 4 of 10 Kaufman et al. J Cancer Metastasis Treat 2019;5:13 I http://dx.doi.org/10.20517/2394-4722.2018.25
[16]
specifically for African American populations over time [15,16] . A study conducted by Srivastava et al.
demonstrated that from 1992 to 2008 the 5-year survival rates for Caucasian women rose from 40.7% to 45%,
yet 5-year survival rates for African American women declined over that same time period from 47.9% to
40.3%. A similar study found that the 5-year survival rate for African American women had fallen to 36%
from 2006 to 2012, while all races combined had a 45% 5-year survival rate, with Caucasian women having
[16]
the highest 5-year survival rate at 46% . This variation in survival rates appears to be due to a decreased
[17]
likelihood of receiving guideline-recommended care . Other studies have suggested that after controlling
for factors like socioeconomic status (SES), patients with the same stage of OC have similar survival
rates [3,18] . Studies suggest that patients of a lower SES are receiving care less in line with NCCN guidelines
and have decreased access to preventative medicine and genetic testing, which could contribute to delayed
presentation. However, most studies are limited by their inability to detect if a patient’s SES and a delay of
presentation to the clinic are correlated, which could, in turn, affect 5-year survival rates [3,18] . The current
literature on the different survival rates of OC between diverse populations and the frightening statistics
facing our underserved communities introduces a series of compelling questions. Why are patients with low
SES presenting to the clinics with a more advanced disease? What preventative factors (i.e., the difference in
the fund of knowledge, access, communication and financial resources) impact these differences in survival?
Are there certain factors that are creating more disadvantages for patients who are underserved than other
factors? What can be done to effectively mitigate these disparities? Studies have tried to control for such
factors, with little success in large part because a multitude of critical contributing confounding variables
is at work, not just one sole factor that is key in precluding underserved communities from attaining equal
outcomes [18,19] . Currently there is a need for increased randomized control studies and interventional studies
that could shed more light on the impact of these social determinants of health, however the challenge is to
isolate certain variables in these studies and have a sample size large enough to draw impactful conclusions.

GENOMIC DISPARITIES AMONG OC PATIENTS
The lifetime risk of developing OC is low, at 1.5%, and the vast majority of patients who develop OC
[1]
comprise sporadic cases with no significant family history of the disease . In contrast, the remaining group
of patients with deleterious genomic germline mutations (i.e., BRCA1 and BRCA2 genes) carry a much
greater lifetime risk for breast cancer and OC (i.e., 50%-85% and 20%-40%, respectively) [1,20-23] . Patients with a
known genetic susceptibility to OC are typically followed closely with a combination of pelvic examination,
ultrasound imaging, and CA-125 testing in order to detect abnormalities at early curable stages. These
patients are also typically offered risk-reducing surgery, which consists of removal or the fallopian tubes and
ovaries at the completion of childbearing in order to prevent the onset of disease. Patients in underserved
communities may have lack of access to this type of preventive medical care. Among these OC patients
with deleterious germline mutations, a significantly decreased overall survival and the worse prognosis is
[27]
reported in OC patients from underserved populations [24-26] . Bandera et al. reported an increased OC
risk, associated with a worse survival rate, in underserved communities after controlling for confounding
variable. Factors, such as medical comorbidity risk, and prevalence of BRCA1 and BRCA2 mutation,
pointing instead to other contributing etiologic factors, such as quality of care and delay in care, to explain
the significantly poorer outcome. Although a higher incidence of unmanaged medical comorbidities (i.e.,
hypertension, coronary artery disease, and diabetes) may be associated with an increased OC risk, these
medical comorbidities alone cannot explain the poor outcomes in underserved populations [16,27-29] .

PUBLIC HEALTH, SOCIAL DISPARITIES, AND LANGUAGE BARRIERS AFFECT OUTCOMES IN
OC PATIENTS
High adiposity and inflammatory diets consisting of high sugar intake are associated with an increased risk
of developing OC [16,27-30] . A systematic review of 28 studies reported a statistically significant, association
2
[31]
between obesity [body mass index (BMI) 30 kg/m or more] and OC . Another large prospective study