PITTSBURGH - A new study led by researchers at the University of Pittsburgh found that women living in socially vulnerable communities face a 20% higher risk of death after an ovarian cancer diagnosis compared with women living in less vulnerable communities. The study, published today in JAMA Network Open, also discovered that Black women face a 45% higher risk of death than white women. When coupled, the findings suggest that neighborhood conditions may help explain persistent racial disparities in ovarian cancer survival.
"We expected residential context to influence outcomes, but what surprised us was how much stronger the impact was for Black women," said Francesmary Modugno, Ph.D., M.S., MPH, professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at Pitt and senior author of the study. "Our findings suggest that it's not simply where someone lives. The interaction between a woman's lived experience and her residential environment may be helping drive these persistent disparities," added Modugno who is part of The Women's Cancer Research Center (WCRC) is a collaboration between the UPMC Hillman Cancer Center and Magee-Womens Research Institute (MWRI).
Epithelial ovarian cancer is the deadliest gynecologic cancer, with only about half of patients surviving five years after diagnosis. Survival is even lower among Black women, with fewer than 40% alive five years later. While differences in factors such as age at diagnosis, cancer stage and tumor type explain some of that disparity, a substantial survival gap remains unexplained.
Researchers hypothesized that factors beyond biology and clinical care may influence survival and sought to determine whether social determinants of health reflected in the communities where patients live could explain the remaining difference in outcomes.
The study, conducted in collaboration with researchers at the University of Alabama at Birmingham, analyzed data from 2,544 women diagnosed with epithelial ovarian cancer and treated at the O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham. The study data included 509 Black women and 2,035 white women. Researchers linked patients' residential census tracts to the Centers for Disease Control and Prevention's Social Vulnerability Index, a measure that incorporates neighborhood-level factors such as poverty, housing conditions, transportation access, educational attainment and other socioeconomic challenges.
Further analyses showed that Black women were more likely to live in highly vulnerable neighborhoods. Yet residential context alone did not fully explain the survival disparity. Black women experienced worse survival than white women even when living in similarly advantaged communities, and the combination of being Black and living in a highly vulnerable neighborhood was associated with a greater risk of death than would be expected from either factor alone.
The findings point to opportunities for health systems and cancer programs to identify patients at increased risk and provide additional support services. Examples include patient navigation programs, transportation assistance, childcare support, survivorship resources and other interventions that can help patients complete treatment and manage the challenges associated with cancer care.
"Our findings reinforce that we must better understand and address the barriers patients face in their communities and ensure that every woman has equitable access to high-quality care," said Rebecca Arend, M.D., MSPH, associate professor of gynecology oncology in the Department of Obstetrics and Gynecology at the University of Alabama at Birmingham.
"Translating research into meaningful improvements in cancer outcomes is only possible through strong collaborations among academic medical centers, researchers and community partners," said Arend, who also serves as associate director of clinical research at the O'Neal Comprehensive Cancer Center.
The study builds on previous research published in 2025 led by Modugno and Pitt colleagues using data from UPMC Hillman Cancer Center in western Pennsylvania, which found that social vulnerability was associated with ovarian cancer survival. The new study expands on those findings by including a substantially larger population of Black women and examining how residential context may contribute to racial disparities in outcomes.
The findings will need to be replicated in other regions of the United States and among additional racial and ethnic groups to determine how broadly they apply. Future studies will also explore other social and environmental factors that may influence ovarian cancer survival, including neighborhood pollution, food access and community resources.
Ultimately, the researchers hope their findings will lead health systems to develop more targeted approaches to support patients at greatest risk of poor outcomes. By incorporating neighborhood-level measures such as the Social Vulnerability Index into cancer care planning, health systems may be able to better identify patients facing barriers to care and connect them with supportive resources during treatment.
Additional authors on the study are Emily O'Brien, M.D., Lauren Borho, B.S., Austin Hicks, B.S., Nate Lindstrom, B.S., Warner Huh, M.D. all of Pitt; Teresa Boitano, M.D., , Charles Leath III, M.D., M.S.P.H., Haller Smith, M.D., Michael Toboni, M.D., MPH, Michael Straughn, M.D., and Rebecca Arend, M.D., MSPH, all of the University of Alabama at Birmingham; Cai Chao, Ph.D., of the University of South Carolina; Nicolina Sciaraffa, Ph.D., and Claudia Coronnello, Ph.D., both of the Ri.MED Foundation; and Lyse Norian, Ph.D., and Justin Xavier Moore, Ph.D., MPH, both of the University of Kentucky.
Funding for this work was provided by the National Institutes of Health (5P50CA098252, P50CA272218, R21CA267050, R21CA301113, UG1CA233330), the Congressionally Directed Medical Research Program (W81XWH2110338), and the Janet Burroughs Ovarian Cancer Foundation.
