An Assessment of Ovarian Cancer Histotypes Across the African Diaspora

Abstract

ObjectiveOvarian cancer in Black women is common in many West African countries but is relatively rare in North America. Black women have worse survival outcomes when compared to White women. Ovarian cancer histotype, diagnosis, and age at presentation are known prognostic factors for outcome. We sought to conduct a preliminary comparative assessment of these factors across the African diaspora.MethodsPatients diagnosed with ovarian cancer (all histologies) between June 2016-December 2019 in Departments of Pathology at 25 participating sites in Nigeria were identified. Comparative population-based data, inclusive of Caribbean-born Blacks (CBB) and US-born Blacks (USB), were additionally captured from the International Agency for Research on Cancer and Florida Cancer Data Systems. Histology, country of birth, and age at diagnosis data were collected and evaluated across the three subgroups: USB, CBB and Nigerians. Statistical analyses were done using chi-square and student’s t-test with significance set at p<0.05.ResultsNigerians had the highest proportion of germ cell tumor (GCT, 11.5%) and sex-cord stromal (SCST, 16.2%) ovarian cancers relative to CBB and USB (p=0.001). CBB (79.4%) and USB (77.3%) women were diagnosed with a larger proportion of serous ovarian cancer than Nigerians (60.4%) (p<0.0001). Nigerians were diagnosed with epithelial ovarian cancers at the youngest age (51.7± 12.8 years) relative to USB (58.9 ± 15.0) and CBB (59.0± 13.0,p<0.001). Black women [CBB (25.2 ± 15.0), Nigerians (29.5 ± 15.1), and USB (33.9 ± 17.9)] were diagnosed with GCT younger than White women (35.4 ± 20.5, p=0.011). Black women [Nigerians (47.5 ± 15.9), USB (50.9 ± 18.3) and CBB (50.9 ± 18.3)] were also diagnosed with SCST younger than White women (55.6 ± 16.5, p<0.01).ConclusionThere is significant variation in age of diagnosis and distribution of ovarian cancer histotype/diagnosis across the African diaspora. The etiology of these findings requires further investigation.

Ovarian Papillary Adenocarcinoma in a Single Young Nullipara: Challenges of Management in a Low-Income Setting

“…These results mean that serous adenocarcinoma had the best prognosis of the three pathologic types of ovarian carcinoma (p<0.001), with no significant difference between papillary serous cystadenocarcinoma and mixed cell ovarian adenocarcinoma [10]. These various histotypes have been previously reported in a Nigerian multi-centre study [16]. Unlike in our case, few patients after cytoreductive surgery retain child-bearing potential due to the high rate of hysterectomy and oophorectomy at time of surgery [17].…”

Call for action: expanding global access to hereditary cancer genetic testing

“…For example, cancer trends show that, from 2020 to 2040, the incidence of ovarian cancer will rise by 86•8% in African countries, compared with only 9•6% in Europe. 10 In sum, we call for expanded access to CGT, especially for patients diagnosed with breast or ovarian cancer, and for testing to not be restricted by ancestry. Country-specific guidelines are needed to establish which patients with cancer qualify for CGT, considering local resources, and we favour models that emphasise specific cancer diagnosis because the identification of a pathogenic variant has implications for cancer treatment.…”

Closing the diagnostic gap: Liquid biopsy potential to transform ovarian cancer outcomes in sub-Saharan Africa

“…LB relies on isolating CTCs from peripheral blood samples, a technically challenging process, given the low concentration of CTCs in blood. [ 7 ] Regions with limited access to reliable transportation and consistent electricity face significant hurdles in safely transporting and storing collected samples. Proper sample handling and storage are paramount to the success and accuracy of LB, and inadequate infrastructure can compromise the quality of results.…”

“…[6] Despite its promise in various parts of the world, the application of LB in ovarian cancer diagnostics and its potential impact on SSA remains underexplored. [7] There is a pressing need to examine the feasibility and implications of incorporating LB into the healthcare systems of SSA countries to address the diagnostic gap and improve outcomes for ovarian cancer patients. This paper explores LB potential to transform ovarian cancer outcomes in SSA.…”

“…[ 6 ] Despite its promise in various parts of the world, the application of LB in ovarian cancer diagnostics and its potential impact on SSA remains underexplored. [ 7 ]…”