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Cancer. 2019 Aug 15. doi: 10.1002/cncr.32451. [Epub ahead of print]

Perceived discrimination, trust in physicians, and prolonged symptom duration before ovarian cancer diagnosis in the African American Cancer Epidemiology Study.

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Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan.
Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Cancer Prevention and Population Sciences Program, Baylor College of Medicine, Houston, Texas.
Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Cancer Control and Population Sciences, Department of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina.
Epidemiology Program, Louisiana State University Health Sciences Center School of Public Health, New Orleans, Louisiana.
Department of Medicine, Graduate School of Medicine, University of Tennessee, Knoxville, Tennessee.
Population Studies and Disparities Research Program, Department of Oncology, Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, Michigan.
Hollings Cancer Center and Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina.
Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia.



Discrimination and trust are known barriers to accessing health care. Despite well-documented racial disparities in the ovarian cancer care continuum, the role of these barriers has not been examined. This study evaluated the association of everyday discrimination and trust in physicians with a prolonged interval between symptom onset and ovarian cancer diagnosis (hereafter referred to as prolonged symptom duration).


Subjects included cases enrolled in the African American Cancer Epidemiology Study, a multisite case-control study of epithelial ovarian cancer among black women. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for associations of everyday discrimination and trust in physicians with a prolonged symptom duration (1 or more symptoms lasting longer than the median symptom-specific duration), and it controlled for access-to-care covariates and potential confounders.


Among the 486 cases in this analysis, 302 women had prolonged symptom duration. In the fully adjusted model, a 1-unit increase in the frequency of everyday discrimination increased the odds of prolonged symptom duration 74% (OR, 1.74; 95% CI, 1.22-2.49), but trust in physicians was not associated with prolonged symptom duration (OR, 0.86; 95% CI, 0.66-1.11).


Perceived everyday discrimination was associated with prolonged symptom duration, whereas more commonly evaluated determinants of access to care and trust in physicians were not. These results suggest that more research on the effects of interpersonal barriers affecting ovarian cancer care is warranted.


access to care; ovarian cancer; perceived discrimination; prolonged symptoms; racial disparity


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