@article{fb4eeba624ed493791fedf70ac40c50e,
title = "The association between socioeconomic status and tumour stage at diagnosis of ovarian cancer: A pooled analysis of 18 case-control studies",
abstract = "Purpose: Socioeconomic status (SES) is a known predictor of survival for several cancers and it has been suggested that SES differences affecting tumour stage at diagnosis may be the most important explanatory factor for this. However, only a limited number of studies have investigated SES differences in tumour stage at diagnosis of ovarian cancer. In a pooled analysis, we investigated whether SES as represented by level of education is predictive for advanced tumour stage at diagnosis of ovarian cancer, overall and by histotype. The effect of cigarette smoking and body mass index (BMI) on the association was also evaluated. Methods: From 18 case-control studies, we obtained information on 10,601 women diagnosed with epithelial ovarian cancer. Study specific odds ratios (ORs) with corresponding 95% confidence intervals (CI) were obtained from logistic regression models and combined into a pooled odds ratio (pOR) using a random effects model. Results: Overall, women who completed ≤high school had an increased risk of advanced tumour stage at diagnosis compared with women who completed >high school (pOR 1.15; 95% CI 1.03-1.28). The risk estimates for the different histotypes of ovarian cancer resembled that observed for ovarian cancers combined but did not reach statistical significance. Our results were unchanged when we included BMI and cigarette smoking. Conclusion: Lower level of education was associated with an increased risk of advanced tumour stage at diagnosis of ovarian cancer. The observed socioeconomic difference in stage at diagnosis of ovarian cancer calls for further studies on how to reduce this diagnostic delay.",
keywords = "Epidemiology, Ovarian cancer, Pooled analysis, Socioeconomic status, Tumour stage",
author = "{on behalf of the Ovarian Cancer Association Consortium} and {On behalf of the Australian Ovarian Cancer Study Group} and Camilla Pr{\ae}stegaard and Kjaer, {Susanne K.} and Nielsen, {Thor S.S.} and Jensen, {Signe M.} and Webb, {Penelope M.} and Nagle, {Christina M.} and Estrid H{\o}gdall and Risch, {Harvey A.} and Rossing, {Mary Anne} and Doherty, {Jennifer A.} and Wicklund, {Kristine G.} and Goodman, {Marc T.} and Francesmary Modugno and Kirsten Moysich and Ness, {Roberta B.} and Edwards, {Robert P.} and Goode, {Ellen L.} and Winham, {Stacey J.} and Fridley, {Brooke L.} and Cramer, {Daniel W.} and Terry, {Kathryn L.} and Schildkraut, {Joellen M.} and Andrew Berchuck and Bandera, {Elisa V.} and Lisa Paddock and Kiemeney, {Lambertus A.} and Massuger, {Leon F.} and Nicolas Wentzensen and Paul Pharoah and Honglin Song and Whittemore, {Alice S.} and Valerie McGuire and Weiva Sieh and Joseph Rothstein and Hoda Anton-Culver and Argyrios Ziogas and Usha Menon and Gayther, {Simon A.} and Ramus, {Susan J.} and Aleksandra Gentry-Maharaj and Wu, {Anna H.} and Pearce, {Celeste L.} and Pike, {Malcolm C.} and Lee, {Alice W.} and Jenny Chang-Claude and Allan Jensen",
note = "Funding Information: This work was supported by the European Commission{\textquoteright}s Seventh Framework Programme grant agreement no. 223175 (HEALTH-F2-2009-223175). The work was also supported by the National Institutes of Health (R01 CA074850 and R01 CA080742 (CON), R01 CA112523 and R01 CA87538 (DOV), R01 CA58598, N01 CN55424 and N01 PC 67001 (HAW), MO1-RR000056 (HOP), R01 CA61107 (MAL), R01 CA122443, P30 CA15083 and P50 CA136393 (MAY), R01 CA76016 (NCO), R01 CA54419 and P50 CA105009 (NEC), P30 CA072720, P30 CA008748, K07 CA095666, R01 CA83918 and K22 CA138563 (NJO), U01 CA71966, R01 CA16056, K07 CA143047 and U01 CA69417 (STA), R01 CA058860, R01 CA092044 and PSA 042205 (UCI), P30 CA14089, R01 CA61132 and N01 PC67010 (USC)); Danish Cancer Society (94 222 52 (MAL)); Mermaid 1 (MAL); U.S. Army Medical Research and Materiel Command (DAMD17-01-1-0729) (AUS), National Health & Medical Research Council of Australia (199600 and 400281) (AUS); Cancer Councils of New South Wales, Victoria, Queensland, South Australia and Tasmania (AUS); Cancer Foundation of Western Australia (AUS); German Federal Ministry of Education and Research, Program of Clinical Biomedical Research (01GB9401 (GER)); German Cancer Research Center (GER); US Army Medical Research and Material Command (DAMD17-02-1-0669 (HOP), DAMD17-02-1-0666 (NCO) and W81XWH-10-1-02802 (NEC)); Mayo Foundation (MAY); Minnesota Ovarian Cancer Alliance (MAY); Fred C. and Katherine B. Andersen Foundation (MAY); The Cancer Institute of New Jersey (NJO); Radboud University Nijmegen Medical Centre (NTH); Intramural Research Program of the National Cancer Institute (POL); Cancer Research UK (C490/A10119 and C490/A10124 (SEA)); Lon V Smith Foundation (LVS-39420 (UCI)); Cancer Research UK (UKO, SEA); Eve Appeal (UKO); OAK Foundation (UKO); California Cancer Research Program (00-01389V-20170, N01 CN025403, R03 CA113148, R03 CA115195 (USC)); California Cancer Research Program (2II0200 (USC)); National Institute of Environmental Health Sciences T32ES013678 (USC) and US National Cancer Institute (P01 CA17054 (USC) and K07-CA80668 and P50-CA159981 (HOP)). The New Jersey State Cancer Registry is funded by the Center for Disease Control (5U58DP003931-02) and The National Cancer Institute{\textquoteright}s Surveillance, Epidemiology, and End Results Program (HHSN 261201300021I NCI Control No. N01PC-2013-00021). A portion of this was done at UCLH/UCL within the {\textquoteright}Women{\textquoteright}s Health Theme{\textquoteright} of the NIHR UCLH/UCL Comprehensive Biomedical Research Centre supported by the Department of Health (UKO). The German group thanks Ursula Eilber and Tanja Koehler for competent technical assistance (GER). The Australian group thanks all the clinical and scientific collaborators (http://www.aocstudy.org/) and the women for their contribution (AUS). The cooperation of the 32 Connecticut hospitals, including Stamford Hospital, in allowing patient access, is gratefully acknowledged (CON). Certain data in the CON study were obtained from the Connecticut Tumor Registry, Connecticut Department of Public Health. The CON study assumes full responsibility for analyses and interpretation of these data. The MALOVA study is grateful to Nick Martinussen for data management assistance (MAL). The NJO group thanks the New Jersey State Cancer Registry staff, M. King and L. Rodriguez. The SEARCH group thanks the SEARCH team, Craig Luccarini, Caroline Baynes and Don Conroy. The UKOPS group thanks I. Jacobs, M.Widschwendter, E. Wozniak, A. Ryan, J. Ford and N. Balogun for their contribution to the study (UKO). Publisher Copyright: {\textcopyright} 2016 Elsevier Ltd.",
year = "2016",
month = apr,
day = "1",
doi = "10.1016/j.canep.2016.01.012",
language = "English (US)",
volume = "41",
pages = "71--79",
journal = "Cancer Epidemiology",
issn = "1877-7821",
publisher = "Elsevier BV",
}