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Ovarian Cancer Epidemiology: Risk, Diagnosis, and Prognosis

Kurta, Michelle L. (2013) Ovarian Cancer Epidemiology: Risk, Diagnosis, and Prognosis. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Abstract

There are approximately 22,200 new cases of ovarian cancer (OC) within the US each year. The overall 5-year survival rate for OC is 44%, due to late diagnosis among the majority of patients. OC is a complex, heterogeneous, and multifactorial disease.
The relationship between OC and fertility drug use is complicated due to the link between infertility and other established reproductive risk factors. We found that fertility drug use does not significantly impact OC risk among the majority of women when accounting for confounding factors. However, we observed increased OC risk among women who despite fertility drug use remained nulligravid.
Improved understanding of symptom presentation among OC patients could lead to earlier detection. However, the identification of OC-related symptoms is difficult due to their non-specific nature. Our second project identified 3 subgroups of OC patients that were defined according to the total number of symptoms experienced prior to diagnosis. Interestingly, the number of symptoms experienced did not differ significantly between early and late stage cases.
Conditional disease-free survival (DFS) accounts for elapsed time after remission thereby providing more relevant prognostic information than traditional DFS estimates. Results from our third project demonstrate that DFS estimates improve dramatically over time and that conditional DFS provides more relevant and accurate information to patients who have already survived a period of remission. Characteristics that are predictive of DFS at time of remission, such as stage and age, lose significance as the period of remission increases.
The research presented in this dissertation is of public health significance because it contributes to what is known about the risk, diagnosis, and prognosis of OC. Enhanced knowledge of OC risk factors may improve the identification of women at increased risk of OC and contribute to our understanding of OC etiology. The characterization of symptom presentation among OC patients prior to diagnosis may assist the development of a screening tool that is able to identify women with earlier stage disease. Furthermore, more accurate methods to estimate the risk of recurrence among OC survivors has the potential to facilitate personalized follow-up care that is cost effective and improves cancer outcomes.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Kurta, Michelle L.mlk50@pitt.eduMLK50
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairDiergaarde, Brendadiergaardeb@upmc.edu
Committee MemberWeissfeld, Joel Ljwepid@pitt.eduJWEPID
Committee MemberEdwards, Robertedwarp@mail.magee.eduRPE1
Committee MemberBertolet, Marniebertoletm@edc.pitt.eduMHB12
Committee MemberCatov, Janet Mcatovjm@upmc.edu
Date: 27 September 2013
Date Type: Publication
Defense Date: 4 June 2013
Approval Date: 27 September 2013
Submission Date: 3 June 2013
Access Restriction: 5 year -- Restrict access to University of Pittsburgh for a period of 5 years.
Number of Pages: 114
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: ovarian cancer; epidemiology; fertility drug use; ovarian cancer symptoms; disease-free survival
Date Deposited: 27 Sep 2013 14:52
Last Modified: 01 Jul 2018 05:15
URI: http://d-scholarship.pitt.edu/id/eprint/18843

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