Schildkraut Joellen M, Alberg Anthony J, Bandera Elisa V, Barnholtz-Sloan Jill, Bondy Melissa, Cote Michelle L, Funkhouser Ellen, Peters Edward, Schwartz Ann G, Terry Paul, Wallace Kristin, Akushevich Lucy, Wang Frances, Crankshaw Sydnee, Moorman Patricia G
Duke Cancer Institute, Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA.
BMC Cancer. 2014 Sep 22;14:688. doi: 10.1186/1471-2407-14-688.
Ovarian cancer (OVCA) is the leading cause of death from gynecological cancer, with poorer survival for African American (AA) women compared to whites. However, little is known about risk factors for OVCA in AA. To study the epidemiology of OVCA in this population, we started a collaborative effort in 10 sites in the US. Here we describe the study and highlight the challenges of conducting a study of a lethal disease in a minority population.
The African American Cancer Epidemiology Study (AACES) is an ongoing, population-based case-control study of OVCA in AA in 10 geographic locations, aiming to recruit 850 women with invasive epithelial OVCA and 850 controls age- and geographically-matched to cases. Rapid case ascertainment and random-digit-dialing systems are in place to ascertain cases and controls, respectively. A telephone survey focuses on risk factors as well as factors of particular relevance for AAs. Food-frequency questionnaires, follow-up surveys, biospecimens and medical records are also obtained.
Current accrual of 403 AA OVCA cases and 639 controls exceeds that of any existing study to date. We observed a high proportion (15%) of deceased non-responders among the cases that in part is explained by advanced stage at diagnosis. A logistic regression model did not support that socio-economic status was a factor in advanced stage at diagnosis. Most risk factor associations were in the expected direction and magnitude. High BMI was associated with ovarian cancer risk, with multivariable adjusted ORs and 95% CIs of 1.50 (0.99-2.27) for obese and 1.27 (0.85- 1.91) for morbidly obese women compared to normal/underweight women.
AACES targets a rare tumor in AAs and addresses issues most relevant to this population. The importance of the study is accentuated by the high proportion of OVCA cases ascertained as deceased. Our analyses indicated that obesity, highly prevalent in this population (>60% of the cases), was associated with increased OVCA risk. While these findings need to be replicated, they suggest the potential for an effective intervention on the risk in AAs. Upon completion of enrollment, AACES will be the largest epidemiologic study of OVCA in AA women.
卵巢癌（OVCA）是妇科癌症致死的主要原因，与白人女性相比，非裔美国（AA）女性的生存率更低。然而，关于非裔美国女性卵巢癌的风险因素知之甚少。为了研究该人群中卵巢癌的流行病学，我们于2006年在美国10个地点展开了一项合作研究。在此，我们描述该研究并强调在少数族裔人群中开展致命疾病研究的挑战。
非裔美国癌症流行病学研究（AACES）是一项正在进行的、基于人群的病例对照研究，旨在研究美国10个地理位置的非裔美国女性的卵巢癌情况，计划招募850名浸润性上皮性卵巢癌女性患者和850名年龄及地理位置与病例匹配的对照。分别采用快速病例确诊和随机数字拨号系统来确定病例和对照。通过电话调查关注风险因素以及与非裔美国女性特别相关的因素。还会获取食物频率问卷、随访调查、生物样本和医疗记录。
目前已累计403例非裔美国卵巢癌病例和639名对照，超过了迄今为止任何现有研究的病例数。我们观察到病例中有较高比例（15%）的已故无应答者，部分原因是诊断时处于晚期。逻辑回归模型不支持社会经济地位是诊断时处于晚期的一个因素。大多数风险因素关联的方向和程度符合预期。高体重指数与卵巢癌风险相关，与正常/体重过轻的女性相比，肥胖女性的多变量调整比值比（OR）和95%可信区间（CI）为1.50（0.99 - 2.27），病态肥胖女性为1.27（0.85 - 1.91）。
AACES针对非裔美国女性中的一种罕见肿瘤，并解决了与该人群最相关的问题。确诊为已故的卵巢癌病例比例很高，凸显了该研究的重要性。我们的分析表明，肥胖在该人群中非常普遍（>60%的病例），与卵巢癌风险增加有关。虽然这些发现需要重复验证，但它们表明有可能对非裔美国女性的风险进行有效干预。在完成招募后，AACES将成为非裔美国女性中最大规模的卵巢癌流行病学研究。
