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Racial differences in the association of body mass index and ovarian cancer risk in the OCWAA Consortium



Obesity disproportionately affects African American (AA) women and has been shown to increase ovarian cancer risk, with some suggestions that the association may differ by race.


We evaluated body mass index (BMI) and invasive epithelial ovarian cancer (EOC) risk in a pooled study of case–control and nested case–control studies including AA and White women. We evaluated both young adult and recent BMI (within the last 5 years). Associations were estimated using multi-level and multinomial logistic regression models.


The sample included 1078 AA cases, 2582 AA controls, 3240 White cases and 9851 White controls. We observed a higher risk for the non-high-grade serous (NHGS) histotypes for AA women with obesity (ORBMI 30+= 1.62, 95% CI: 1.16, 2.26) and White women with obesity (ORBMI 30+= 1.20, 95% CI: 1.02, 2.42) compared to non-obese. Obesity was associated with higher NHGS risk in White women who never used HT (ORBMI 30+= 1.40, 95% CI: 1.08, 1.82). Higher NHGS ovarian cancer risk was observed for AA women who ever used HT (ORBMI 30+= 2.66, 95% CI: 1.15, 6.13), while in White women, there was an inverse association between recent BMI and risk of EOC and HGS in ever-HT users (EOC ORBMI 30+= 0.81, 95% CI: 0.69, 0.95, HGS ORBMI 30+= 0.73, 95% CI: 0.61, 0.88).


Obesity contributes to NHGS EOC risk in AA and White women, but risk across racial groups studied differs by HT use and histotype.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.


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The authors thank the WHI investigators and staff for their dedication, and the study participants for making the study possible. A full listing of WHI investigators can be found at Pathology data were obtained from the following state cancer registries (AZ, CA, CO, CT, DE, DC, FL, GA, IL, IN, KY, LA, MD, MA, MI, NJ, NY, NC, OK, PA, SC, TN, TX, VA), and results reported do not necessarily represent their views. The IRBs of participating institutions and cancer registries have approved these studies, as required. Opinions expressed by the authors are their own, and this material should not be interpreted as representing the official viewpoint of the U.S. Department of Health and Human Services, the National Institutes of Health, or the National Cancer Institute.


This study is supported by the National Institutes of Health (R01-CA207260 to Schildkraut and Rosenberg and K01-CA212056 to Bethea). AACES was funded by NCI (R01-CA142081 to Schildkraut); BWHS is funded by NIH (R01-CA058420,UM1-CA164974, and U01-CA164974 to Rosenberg); CCCCS was funded by NIH/NCI (R01-CA61093 to Rosenblatt); LACOCS was funded by NCI (R01-CA17054 to Pike, R01-CA58598 to Goodman and Wu, and Cancer Center Core Grant P30-CA014089 to Henderson and Wu) and by the California Cancer Research Program (2II0200 to A Wu); and NCOCS was funded by NCI (R01-CA076016 to Schildkraut). The WHI program is funded by the National Heart, Lung, and Blood Institute through contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C and HHSN268201600004C. Additional grants to support WHI inclusion in OCWAA include UM1-CA173642-05 (to Anderson) and NIH/NHLBI-CSB-WH-2016-01-CM.

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Authors and Affiliations



Conceptualisation: EVB, HMO, JMS and LR. Data curation: TNB, HRH, CEJ, PGM, WR, EM, HMO, VWS, AHW, LR, JMS and EVB. Formal analysis: CEJ. Funding acquisition: JMS and LR. Methodology: HMO, EVB, CEJ, BQ, JMS and LR. Writing—original draft: HMO, EVB and JMS. Writing—review and editing: all authors.

Corresponding author

Correspondence to Heather M. Ochs-Balcom.

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Competing interests

PGM has received compensation for work related to litigation in regard to talc and ovarian cancer. The remaining authors declare no competing interests.

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Each study obtained informed consent from its participants; the individual studies and the OCWAA Consortium were approved by the relevant Institutional Review Boards.

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Ochs-Balcom, H.M., Johnson, C., Guertin, K.A. et al. Racial differences in the association of body mass index and ovarian cancer risk in the OCWAA Consortium. Br J Cancer 127, 1983–1990 (2022).

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