ABSTRACT
OBJECTIVE: Ovarian cancer in Black women is common in many West African countries but is relatively rare in North America. Black women have worse survival outcomes when compared to White women. Ovarian cancer histotype, diagnosis, and age at presentation are known prognostic factors for outcome. We sought to conduct a preliminary comparative assessment of these factors across the African diaspora. METHODS: Patients diagnosed with ovarian cancer (all histologies) between June 2016-December 2019 in Departments of Pathology at 25 participating sites in Nigeria were identified. Comparative population-based data, inclusive of Caribbean-born Blacks (CBB) and US-born Blacks (USB), were additionally captured from the International Agency for Research on Cancer and Florida Cancer Data Systems. Histology, country of birth, and age at diagnosis data were collected and evaluated across the three subgroups: USB, CBB and Nigerians. Statistical analyses were done using chi-square and student's t-test with significance set at p<0.05. RESULTS: Nigerians had the highest proportion of germ cell tumor (GCT, 11.5%) and sex-cord stromal (SCST, 16.2%) ovarian cancers relative to CBB and USB (p=0.001). CBB (79.4%) and USB (77.3%) women were diagnosed with a larger proportion of serous ovarian cancer than Nigerians (60.4%) (p<0.0001). Nigerians were diagnosed with epithelial ovarian cancers at the youngest age (51.7± 12.8 years) relative to USB (58.9 ± 15.0) and CBB (59.0± 13.0,p<0.001). Black women [CBB (25.2 ± 15.0), Nigerians (29.5 ± 15.1), and USB (33.9 ± 17.9)] were diagnosed with GCT younger than White women (35.4 ± 20.5, p=0.011). Black women [Nigerians (47.5 ± 15.9), USB (50.9 ± 18.3) and CBB (50.9 ± 18.3)] were also diagnosed with SCST younger than White women (55.6 ± 16.5, p<0.01). CONCLUSION: There is significant variation in age of diagnosis and distribution of ovarian cancer histotype/diagnosis across the African diaspora. The etiology of these findings requires further investigation.
ABSTRACT
The 2020 Atlantic hurricane season was notable for a record-setting 30 named storms while, contemporaneously, the COVID-19 pandemic was circumnavigating the globe. The active spread of COVID-19 complicated disaster preparedness and response actions to safeguard coastal and island populations from hurricane hazards. Major hurricanes Eta and Iota, the most powerful storms of the 2020 Atlantic season, made November landfalls just two weeks apart, both coming ashore along the Miskito Coast in Nicaragua's North Caribbean Coast Autonomous Region. Eta and Iota bore the hallmarks of climate-driven storms, including rapid intensification, high peak wind speeds, and decelerating forward motion prior to landfall. Hurricane warning systems, combined with timely evacuation and sheltering procedures, minimized loss of life during hurricane impact. Yet these protective actions potentially elevated risks for COVID-19 transmission for citizens sharing congregate shelters during the storms and for survivors who were displaced post-impact due to severe damage to their homes and communities. International border closures and travel restrictions that were in force to slow the spread of COVID-19 diminished the scope, timeliness, and effectiveness of the humanitarian response for survivors of Eta and Iota. Taken together, the extreme impacts from hurricanes Eta and Iota, compounded by the ubiquitous threat of COVID-19 transmission, and the impediments to international humanitarian response associated with movement restrictions during the pandemic, acted to exacerbate harms to population health for the citizens of Nicaragua.
