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  • br To evaluate trends in overall ovarian cancer

    2022-09-08


    To evaluate trends in overall ovarian cancer AAIRs from 1990 to 2014, average annual percent change (AAPC) statistics were calculated using joinpoint regression models for each race/ethnicity [18,19]. AAPC is a summary measure of trend that weights the average of the annual percent change over multiple time intervals. Trends for each tumor histotype or stage were not examined due to limited numbers of cases.
    All tests of statistical significance were two-sided.
    3. Results
    Table 1 shows the percentage of ovarian cancer cases by age at diagnosis and tumor characteristics for each race/ethnicity. There was a significant difference in histotype distribution when comparing across NHWs and all six Asian American ethnicities together (p < 0.0001) (Table 1). Although serous tumors constituted the majority of ovarian cancer diagnoses for all women, clear cell tumors accounted for less than 5% of all NHW cases in comparison to 13.66% and 11.76% of all Chinese and Vietnamese cases, respectively; however, they Sotrastaurin only ac-counted for 7.35% of Asian Indian/Pakistani cases, which was lowest among the Asian subgroups (Table 1). In addition, there were fewer low-grade ovarian cancers regardless of race/ethnicity although the tumor grade distribution varied with NHWs having the lowest percent of low-grade tumors (6.89%) and Koreans having the highest percent (9.24%) (Table 1). We also noted a significant difference in the dis-tribution of tumor staging when we compared across NHWs and the six Asian American ethnicities together (p < 0.0001) and across the six Asian subgroups only (p = 0.0002); localized and regional tumors constituted 21.31% of NHW ovarian cancer cases and 26.18% of Asian Indian/Pakistani ovarian cancer cases, yet they accounted for over 31% for the other five Asian subgroups (Table 1). Lastly, all Asian American ovarian cancer cases were diagnosed at younger ages than NHW cases; 65.40% of ovarian cancer diagnoses among Vietnamese were under the age of 60 versus 35.64% among NHWs (Table 1). There was also sig-nificant variation in the age distribution of ovarian cancer cases across the six Asian American subgroups (p < 0.0001) (Table 1).
    Fig. 1. Age-adjusted incidence rates for ovarian cancer by race/ethnicity, 1990–2014. The error bars represent 95% confidence intervals. Note: * indicates statistical significance at a p < 0.0001 level with non-Hispanic Whites as the reference.
    Fig. 2. Age-adjusted incidence rates for ovarian cancer by race/ethnicity and time period, 1990–2014. Note: AAPC = average annual percent change; * indicates statistical significance at a p < 0.05 level.
    Lastly, the ASIRs for NHWs were statistically significantly higher than the ASIRs for all Asian American ethnic groups after age 50 with the exception of Asian Indians/Pakistanis in the 80+ years group (Table 4). Asian Indian/Pakistani women also constituted the only 
    4. Discussion
    Our analysis comprehensively examines ovarian cancer among the six largest ethnic groups of the Asian American population. We ob-served significant differences in ovarian cancer tumor characteristics, incidence rates and trends not only between Asian subgroups and NHWs, but also across the various Asian ethnicities, highlighting the heterogeneity of ovarian cancer incidence rates among Asian
    Table 3
    Age-adjusted incidence rates of ovarian cancer by histotype and race/ethnicity, 1990–2014.
    Histotype Race/Ethnicity N AAIR (95% CI)* IRR (95% CI) IRR P-value
    Abbreviation: AAIR = age-adjusted incidence rate, IRR = incidence rate ratio, CI = confidence interval, NOS = not otherwise specified.
    † Includes carcinosarcomas as well as mixed, other, undifferentiated, and unspecified tumors.
    Americans, as well as the need for ethnic-specific cancer statistics and research for Asian Americans, as previously noted by previous studies for other cancer sites [6,11].
    Although all Asian American ethnic groups had a lower incidence rate of ovarian cancer relative to NHWs, there are some very interesting findings of unique incidence patterns associated with certain ethnic groups. For example, in our analysis, Asian Indian/Pakistani women showed a higher ovarian cancer incidence rate than other Asians and had a lower percentage of the clear cell tumor that is known to be more common among Asians [3,20,21]. Genetics may play a role in such observations, since previous phylogenetic work has presented Asian Indians/Pakistanis as distinct from other Asian ethnicities and more closely related to Caucasians [22]. This could explain why Asian In-dian/Pakistani women’s ovarian cancer incidence rates and percent distributions of tumor characteristics, such as stage and histotype, were more comparable to those for NHWs.