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treatment options.3' Ovarian Cancer

Incidence rates of ovarian cancer, which are strongly influenced by both oral contraceptive use and reproductive experiences, declined in the United States from 1991 through 1998 in both African-American and white women: approximately — 1% in African Americans and —8% in whites (Table 1.2). The decrease was similar for women above and below 50 years of age. Mortality rates also declined in this period (—7.1%, African Americans; —5.6%, whites) (Table 1.3). While declining rates of ovarian cancer are encouraging, the total percent change in incidence over the entire SEER tracking period (1973-1998) was relatively small ( — 1%, whites; 0.5%, African Americans) compared to the dramatic changes seen for breast and prostate cancers (Fig. 1.4). Declining rates of ovarian cancer are likely to be a consequence of extended oral contraceptive use, which interrupts ovulation and endogenous cyclic hormonal changes. Several explanations have been proposed to explain the association between ovarian cancer rates and ovulatory cycles, including incessant ovulation, increased exposure to gonadotropins, and increased exposure to high levels of estrogen that occur within the ovary during a normal men-

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Breast Cancer White Women —*— Breast Cancer Black Women —•— Uterine Cancer White Women Uterine Cancer Black Women —*- Ovarian Cancer White Women Ovarian Cancer Black Women

Figure 1.4 Breast, ovarian, and uterine cancer incidence among African-American and white women, ages 0-85, SEER 1973-1993. (Adapted from Ries et al.27 with permission.)

Table 1.3 Mortality in the United States from Select Hormone-Related Cancers, Comparing Percentage Change for 1979-1991 to Trends in 1991-1998

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African-American Mortality

White Mortality

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