Surgical Recommendations for Black Women Compared to White Women With Ovarian Cancer in the US

Objective: To evaluate racial disparities in surgical treatment recommendations for Black and White women diagnosed with ovarian cancer in the United States. Methods: We conducted a retrospective cohort study using SEER data from 2001 to 2021. The primary outcome was a recommendation for surgical treatment. We employed inverse probability weighting (IPW) with propensity scores to estimate the average treatment effect (ATE) of race on surgical recommendation. Covariates included age group, tumor grade, income quartile, marital status, metro residence, and histologic subtype. The analysis adjusted for SEER registry (state) and year fixed effects to account for geographic and temporal differences. Multiple imputation with chained equations was used to address missing data and improve the precision. Results: Among 145,304 women diagnosed with ovarian cancer, 11% were Black, and 89% were White. Compared to White women, Black women were more likely to be younger, unmarried, and reside in large metropolitan areas. Overall, 77.4% of patients received a surgical recommendation, with lower rates among Black women (69.5%) than White women (78.5%). After adjustment for covariates and imputation, IPW analysis revealed that Black women had a 6.8% lower probability of receiving a surgical recommendation compared to White women (ATE = -0.068; 95% CI: -0.080 to -0.057; p < 0.001). Conclusion: Black women with ovarian cancer are significantly less likely to receive a recommendation for curative surgery than White women, even after adjusting for clinical and sociodemographic factors. These findings underscore the need for systemic interventions to promote equity in oncologic care.