Article open access publication

The association between socioeconomic status and tumour stage at diagnosis of ovarian cancer: A pooled analysis of 18 case-control studies

Cancer Epidemiology, Elsevier, ISSN 1877-7821

Volume 41, 2016

DOI:10.1016/j.canep.2016.01.012, Dimensions: pub.1006300922, PMC: PMC4993452, PMID: 26851750,



  1. (1) Danish Cancer Society, grid.417390.8
  2. (2) Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
  3. (3) Peter MacCallum Cancer Centre, grid.1055.1
  4. (4) QIMR Berghofer Medical Research Institute, grid.1049.c
  5. (5) Herlev Hospital, grid.411900.d, Capital Region
  6. (6) Yale University, grid.47100.32
  7. (7) University of Washington, grid.34477.33
  8. (8) Fred Hutchinson Cancer Research Center, grid.270240.3
  9. (9) Dartmouth College, grid.254880.3
  10. (10) Cedars-Sinai Medical Center, grid.50956.3f
  11. (11) Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Pittsburgh School of Medicine, Magee-Womens Hospital, 300 Halket Street (Room #2130), Pittsburgh, PA 15222, USA
  12. (12) Magee-Womens Hospital, grid.411487.f
  13. (13) University of Pittsburgh, grid.21925.3d
  14. (14) Roswell Park Cancer Institute, grid.240614.5
  15. (15) The University of Texas Health Science Center at Houston, grid.267308.8
  16. (16) Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital, 300 Halket Street (Room #2130), Pittsburgh, PA 15222, USA
  17. (17) Department of Health Science Research, Division of Epidemiology, Mayo Clinic, 200 First Street SW, Charlton 6, Rochester, MN, USA
  18. (18) University of Kansas, grid.266515.3
  19. (19) Brigham and Women's Hospital, grid.62560.37
  20. (20) Harvard University, grid.38142.3c
  21. (21) University of Virginia, grid.27755.32
  22. (22) Duke University Hospital, grid.189509.c
  23. (23) Rutgers, The State University of New Jersey, grid.430387.b
  24. (24) New Jersey State Cancer registry, PO Box 369, Trenton, NJ 08625-0369, USA
  25. (25) Radboud University Nijmegen Medical Centre, grid.10417.33
  26. (26) National Cancer Institute, grid.48336.3a
  27. (27) University of Cambridge, grid.5335.0
  28. (28) Stanford University, grid.168010.e
  29. (29) University of California, Irvine, grid.266093.8
  30. (30) University College London, grid.83440.3b
  31. (31) University of Southern California, grid.42505.36
  32. (32) University of Michigan, grid.214458.e
  33. (33) Memorial Sloan Kettering Cancer Center, grid.51462.34
  34. (34) German Cancer Research Center, grid.7497.d


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.


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