Ambient air pollution and survival among Black women with epithelial ovarian cancer across diverse geographical regions of the United States

Background: Ovarian cancer is a leading cause of gynecologic cancer mortality, with Black women experiencing 5-year survival rates of only 41%. Disproportionate air pollution exposure may impact survival. We evaluated associations of fine particulate matter (PM 2.5 ) and nitrogen dioxide (NO 2 ) exposure with survival among Black women with epithelial ovarian cancer using data from the California Cancer Registry (CCR, n = 540) and the multi-state African American Cancer Epidemiology Study (AACES, n = 766). Methods: Annual PM 2.5 and NO 2 levels were estimated at a 1 km resolution using well-validated ensemble-based prediction models derived from the Socioeconomic Data and Application Center and assigned to the participants’ residential addresses per their year of diagnosis (2004−2016). Weibull accelerated failure time models with participant-level frailty were used to assess air pollutant exposure associations with overall survival. Results: Average PM 2.5 and NO 2 exposures were 11.3 μg/m³ and 25.8 ppb in CCR and 9.7 μg/m³ and 17.5 ppb in AACES. There was little evidence of an association between air pollution exposures and survival, with event time ratios (> 1 indicate longer survival) in CCR of 1.08 (95% CI = 0.97, 1.20) per 1 μg/m³ PM 2.5 and 1.07 (95% CI = 0.99, 1.15) per 10 ppb NO 2 , and in AACES of 1.00 (95% CI = 0.93, 1.07) per 1 μg/m³ PM 2.5 and 1.04 (95% CI = 0.91, 1.19) per 10 ppb NO 2 . Conclusions: Findings were modest and consistent across both cohorts and sensitivity analyses, supported by the use of advanced exposure modeling. Future research should use time-varying, long-term exposure data and examine interactions with occupation, physical activity, and neighborhood stressors.