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Descriptive Features and Incidence Trends in California Cyllene Morris, DVM, PhD California Cancer Registry
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Based on morphologic features, epithelial ovarian tumors classified as: Benign Borderline or Low Malignant Potential (LMP) Malignant Still unresolved: are LMP precursors of invasive ovarian cancer (OC) or separate entities? Few serous LMP tumors progress to malignant OC, but some mucinous LMP tumors do.
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LMP tumors no longer reportable However LMP tumors included in large screening trials in the US and UK LMP Tumors Still Collected in California
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Both staged I – IV (AJCC and FIGO), based on tumor extension (nodes and tumor size do not affect stage) LMP: node Involvement predicts recurrence, but not survival Survival: distant stage LMP ≅ localized OC (excellent prognosis)
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Similar epidemiologic features for LMP and invasive OC, except: ◦ LMP: more likely among younger women ◦ BRCA1 – BCRA2 mutations in 24.2% of invasive OC and 4.3% of LMP tumors (2005 Israeli study) ◦ Oral Contraceptives: no protective effect for LMP?
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Describe epidemiologic features of LMP tumors compared with invasive OC in California Evaluate incidence trends of LMP tumors by race/ethnicity in the diverse California population
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9,433 cases of LMP ovarian tumors diagnosed 1988-2009 (as of 03/31/10) Microscopically confirmed Cases detected through autopsy or death certificate only excluded Incidence trends: JoinPoint (1988-2007)
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LMPInvasive Race/Ethnicity & Age N%N% NH White5,85562.133,66670.7 African American4234.52,1714.6 Hispanic2,23023.67,32115.4 NH Asian/PI8088.64,1278.7 Other/Unknown Race1171.23320.7 Median Age at DX4663 NH: Non-Hispanic PI: Pacific Islander
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LMP: 12.2 cm (4.8 inches) Invasive: 10.6 cm (4.2 inches) P-value < 0.001
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Substantial differences between Invasive and LMP tumors: Age-specific rates Race/Ethnicity: Hispanics 24% cases Unlike invasive OC, incidence of LMP tumors among African American and Hispanic women Even though majority of LMP tumors are Stage I, relative survival not 100%, and is lower among African Americans
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