Cancer
Ambient air pollution and survival among Black women with epithelial ovarian cancer across diverse geographical regions of the United States Ekaterina Chirikova* Ekaterina Chirikova Courtney E. Johnson Anke Huels Pushkar P Inamdar Elisa V. Bandera Lawrence H. Kushi Jennifer A. Doherty Joellen M. Schildkraut Melissa Bondy Edward S. Peters Kendra Ratnapradipa Salma Shariff-Marco Scarlett L. Gomez Andrew Lawson
Ovarian cancer is a leading cause of gynecologic cancer mortality, with Black females experiencing five-year survival rates of only 41%. Disproportionate air pollution exposure may impact survival, but this relationship remains understudied. We evaluated associations of fine particulate matter (PM2.5) and nitrogen dioxide (NO2) exposure with survival among Black females diagnosed with epithelial ovarian cancer (EOC) using data from the California Cancer Registry (CCR) and the multi-state African American Cancer Epidemiology Study (AACES).
Annual PM2.5 and NO2 levels were estimated at a 1 km resolution using well-validated ensemble-based prediction models derived from the Socioeconomic Data and Application Center. Average PM2.5 and NO2 exposures during the year of diagnosis (2004-2016) were assigned to the participants’ residential addresses. We used adjusted Weibull accelerated failure time models to assess air pollutant exposure associations with overall survival, addressing unobserved confounding by including participant-level frailty.
The study included 1,286 Black females with primary EOC. Average PM2.5 and NO2 exposures were 11.3 μg/m³ and 25.8 ppb in CCR, and 9.7 μg/m³ and 17.5 ppb in AACES. Associations between PM2.5 or NO2 exposure and overall survival were not statistically significant, with event time ratios in CCR analysis of 1.08 (95% CI: 0.97–1.20) per 1 μg/m³ PM2.5 and 1.07 (95% CI: 0.99–1.15) per 10 ppb NO2, and in AACES analysis of 1.00 (95% CI: 0.93–1.07) per 1 μg/m³ PM2.5 and 1.04 (95% CI: 0.91–1.19) per 10 ppb NO2. Replication analysis of prior CCR studies confirmed that our results differed due to variations in methods and exposure measures.
Using precise exposure measures and robust methods addressing unobserved confounding, we found no evidence of associations between PM2.5 or NO2 exposure and overall survival in Black females with EOC in a geographically diverse U.S. area. These results emphasize the need to explore other contextual factors.