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Kaufman et al. J Cancer Metastasis Treat 2019;5:13 I http://dx.doi.org/10.20517/2394-4722.2018.25 Page 7 of 10
[1]
mutation . Limited resource settings are less likely to have a genetic counselor, and therefore patients are
less likely to receive counseling support. All patients with OC should receive genetic counseling according
to the NCCN guidelines. By undergoing genetic testing and genetic counseling, care providers can have a
better understanding of the type of tumor that a patient is presenting with [21,38] . If the patient has a known
BRCA1 or 2 mutation, then a provider has increased indications of what targeted therapies may work [1,20-23,26] .
A BRCA1 or 2 mutation may result in errors with homologous recombination mechanisms in the DNA
repair system, consequently there are downstream genes that are more likely to be mutated as well. These
downstream genes have been studied extensively and as a result, target-therapies have been developed
targeting these mutations. Additionally, patients who receive genetic counseling and genetic testing have
increased understanding of their cancer, which can help make more informed decisions when it comes to
their care [21,38] . They have increased understanding about the progression of disease, their risks of developing
cancer and their risks of passing this mutation onto their offspring. By providing this information, the
decision-making model is shifting from one of paternalism to a shared-decision model, and allows for
patients to be much more cognizant of early signs of developing cancer to begin treatment earlier, engage
in more preventative treatment measures, and make care decisions in a timely manner that are in line with
their values [1,38] . However, in this case patients with decreased SES and therefore decreased access to genetic
testing and counseling providing care teams have less information on base treatment, which essentially
limits patient involvement in their own care [1,19] . Proper genetic counseling prior to testing is a critical
component of delivering this test and understanding the results.

[47]
Peres et al. reported that women taking an aspirin regimen for cardiovascular diseases or a daily
nonsteroidal anti-inflammatory drug for arthritis had a decreased risk of developing epithelial OC, which
stood at 44%, and 26%, respectively. However, a significant disparity still exists between the compliance
[48]
rates for Caucasian and African American populations (44% vs. 29%, respectively) for these regimens .
Decreased compliance with these medications reduces the protective factor of these agents against OC.
African American and Hispanic women are much less likely to use oral contraceptives, a known reducer
of OC risk [1,49] . These data indicate that patients from underserved communities receive less preventive care
than other patients.

CONCLUSION
Eliminating healthcare disparities is critical in order to ensure optimal outcomes in all patients with OC.
Identifying what the healthcare disparities are is critical to their elimination. A paradigm shift, which leads
to redistribution in the allocation of healthcare resources to create more equality across populations, will
eliminate healthcare disparities.

Future research must focus upon the underlying genetic components that contribute to healthcare
outcomes. Research that will elucidate tumor and population-specific molecular modifications to genes and
proteins may positively impact the outcomes of patients with OC. The contribution of changes in dietary
considerations (i.e., low sugar), language barriers, and geographic differences to the elimination of healthcare
disparities requires additional research.

Physicians can impact the elimination of healthcare disparities through patient education (i.e., dietary
practices), effective use of interpreters, and outreach to resource-poor communities with less access to high-
quality healthcare. Population data demonstrate that the allocation of important equipment and resources
(i.e., ultrasound machines, special genetic counselors) to support community primary care physicians, and
the number of offers obstetric and gynecological specialists in the community will favor a lower incidence
[19]
of late-stage diagnosis of OC . Patients hailing from lower SES and underserved communities may be at
an additional disadvantage when they are excluded from promising investigational clinical trials. Hence,