1. Descriptive Features and Incidence Trends in California Cyllene Morris, DVM, PhD California Cancer Registry

2.  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.

3.  LMP tumors no longer reportable However  LMP tumors included in large screening trials in the US and UK LMP Tumors Still Collected in California

4.  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)

5.  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?

6.  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

7.  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)

8. 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

16.  LMP: 12.2 cm (4.8 inches) Invasive: 10.6 cm (4.2 inches) P-value < 0.001

20.  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