Where Women Live May Influence Ovarian Cancer Survival in Black Women

Black women with epithelial ovarian cancer had a 45% higher risk of death than White women. Neighborhood vulnerability accounted for 40.3% of this difference, with the widest gap seen among Black women living in the most vulnerable areas. The findings, published in JAMA Network Open, were based on cancer registry records from 2,544 women treated at the University of Alabama at Birmingham and suggest that neighborhood conditions may contribute to the survival gap even among women treated at the same cancer center.

"We expected residential context to influence outcomes, but what surprised us was how much stronger the impact was for Black women," said senior author Francesmary Modugno, professor at the University of Pittsburgh.

How did neighborhoods affect ovarian cancer survival for Black and White women?

There were 1,736 deaths among the 2,544 women, including 358 Black women and 1,378 White women. After accounting for age, cancer stage, tumor type and decade of diagnosis, Black women had a 45% higher risk of death than White women.

Women living in high-vulnerability neighborhoods had a 20% higher risk of death than those in less vulnerable areas. The difference was greatest among Black women in high-vulnerability neighborhoods, who had a 77.1% higher risk of death than White women in low-vulnerability neighborhoods. This was greater than the difference associated with race or neighborhood vulnerability alone.

Of the 358 deaths among Black women, 201 (56.1%) occurred among women living in high-vulnerability neighborhoods. Among White women, 260 (18.9%) of 1,378 deaths occurred in these neighborhoods. Differences in neighborhood vulnerability explained 40.3% of the higher risk of death among Black women.

What did the ovarian cancer study measure with the Social Vulnerability Index?

Researchers looked back at records on women treated at the O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham and diagnosed between Jan. 1, 2000, and May 31, 2023, with follow-up through June 30, 2024. Of 3,140 women identified, the analysis excluded 412 women with nonepithelial tumors, 170 women with borderline tumors, meaning growths that are not clearly cancer and rarely spread, and 14 women missing neighborhood information. That left 509 Black women and 2,035 White women, with median ages of 62 and 63 years.

Each woman's address at diagnosis was matched to the 2020 Social Vulnerability Index, a Centers for Disease Control and Prevention (CDC) measure that scores neighborhoods on poverty, housing, transportation access, education and other conditions. Neighborhoods in the top quarter nationally counted as high vulnerability. Black women's neighborhoods scored higher, with a median of 0.78 compared with 0.48 for White women.

Black women were more likely to be diagnosed at an advanced stage, meaning cancer that had spread beyond the ovary (68.0% versus 62.6%). They were less likely to have high-grade serous tumors, the most common and fastest-growing form of the disease (50.3% versus 53.2%). Neighborhood economic conditions alone carried a 17% higher risk of death.

What are the limitations of the ovarian cancer neighborhood study?

Only Black and White women were included, so the results do not extend to women of other races. All were treated at a single cancer center in Alabama, which limits how far the findings travel. The index leaves out green space, pollution and access to healthy food. Registry records carried no information on tumor mutations, treatment regimens, income, education or housing.

Why does the ovarian cancer survival gap between Black and White women matter?

Epithelial ovarian cancer is the most lethal gynecologic cancer, according to Cancer Statistics, 2026, a report the study cites rather than a finding of its own. Five-year survival sits at 50% overall and at 40% for Black women, the lowest figure among all races. The findings will need to be repeated in other parts of the country and in other racial and ethnic groups according to researchers.

"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, associate professor at the University of Alabama at Birmingham.

Patient navigation, transportation assistance, childcare support and survivorship resources are among the services that can help women finish treatment. Women can ask their care team which of those services their cancer center offers.

References

1. Modugno F, et al. "Residential Context and Survival Disparities in Black and White Women With Ovarian Cancer." JAMA Network Open. Published August 10, 2026.
2. Siegel RL, et al. "Cancer statistics, 2026." CA: A Cancer Journal for Clinicians. Published 2026.
3. "Where women live may influence ovarian cancer survival, especially among Black women." News release. University of Pittsburgh. August 10, 2026.

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