Objective To identify characteristics associated with long-term survival forepithelial ovarian cancer patients using the California Cancer Registry. Methods A descriptive analysis of survival of all California residents diagnosed with epithelial ovarian cancer between 1994 and 2001 was conducted using patients identified through the cancer registry with follow up through 2011. Characteristics of the patients who survived more than 10 years (long-term survivors) were compared to three other cohorts: patients who survived less than 2 years, those who survived at least 2 but no more than 5 years, and those who survived at least 5 but no more than 10 years. Results A total of 3,582 out of 11,541 (31% CI=30.2%, 31.8%) of the patients survived more than 10 years. Younger age, early stage, low-grade, and non-serous histology were significant predictors of long-term survival, but long-term survivors also included women with high-risk cancer. Conclusion Long-term survival is not unusual in patients with epithelial ovarian cancer, even in those with high-risk disease. Many of the prognostic factors are well known, but it remains to be determined why some patients with advanced stage high-grade cancers survive longer than others with the same histology. These findings are important for patient counseling.

Purpose To describe the utilization of gene expression profiling (GEP) among California breast cancer patients, identify predictors of use of GEP, and evaluate how utilization of GEP influenced treatment of early stage breast cancer. Methods All women diagnosed with hormone receptor positive, node-negative breast cancer reported to the California Cancer Registry between January 2008 and December 2010 were linked to Oncotype DX (ODX) assay results. Results Overall, 26.7% of 23,789 eligible patients underwent the assay during the study period. Women age 65 or older were much less likely than women under age 50 to be tested (15.1% versus 41.4%, p<0.001). Black women were slightly less likely and Asian women slightly more likely than non-Hispanic white women to undergo GEP with the ODX assay (22.2% and 28.9% versus 26.9% respectively, p<0.001). Patients residing in low SES census tracts had the lowest use of the test (8.9%), with the proportion increasing with higher SES category. Women with Medicaid health insurance were less likely than other women to be tested (17.7% versus 27.5%, p<0.001). Receipt of adjuvant chemotherapy (ACT) was associated with the ODX recurrence score, although only 63% of patients whose recurrence scores indicated a high benefit received ACT. Of patients not tested, 15% received ACT. Conclusions Nearly three-fourths of eligible breast cancer patients in California during the 3-year period 2008 through 2010 did not undergo GEP. As a result, it is likely that many women unnecessarily received ACT and suffered associated morbidity. In addition, some high risk women who would have benefited most from ACT were not identified.