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(Unpublished)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