To examine whether exposure to ambient ozone, particulate matter with diameter less than 2.5 μm (PM), nitrogen dioxide (NO), and distance to major roadways (DTR) impact ovarian cancer-specific survival, while considering differences by stage, race/ethnicity, and socioeconomic status.
Women diagnosed with epithelial ovarian cancer from 1996 to 2014 were identified through the California Cancer Registry and followed through 2016. Women’s geocoded addresses were linked to pollutant exposure data and averaged over the follow-up period. Pollutants were considered independently and in multi-pollutant models. Cox proportional hazards models assessed hazards of disease-specific death due to environmental exposures, controlling for important covariates, with additional models stratified by stage at diagnosis, race/ethnicity and socioeconomic status.
PM and NO, but not ozone or DTR, were significantly associated with survival in univariate models. In a multi-pollutant model for PM, ozone, and DTR, an interquartile range increase in PM (Hazard Ratio [HR], 1.45; 95% Confidence Interval [CI], 1.41-1.49) was associated with worse prognosis. Similarly, in the multi-pollutant model with NO, ozone, and DTR, women with higher NO exposures (HR for 20.0-30.0 ppb, 1.30; 95% CI, 1.25-1.36 and HR for >30.0 ppb, 2.48; 95% CI, 2.32-2.66) had greater mortality compared to the lowest exposed (<20.0 ppb). Stratified results show the effects of the pollutants differed by race/ethnicity and were magnified among women diagnosed in early stages.
Our analyses suggest that greater exposure to NO and PM may adversely impact ovarian cancer-specific survival, independent of sociodemographic and treatment factors. These findings warrant further study.

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