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Ovarian cancer

Ovarian cancer is a malignant ovarian neoplasm (an abnormal growth located on the ovaries). more...

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Causes

Ovarian cancer is the fourth leading cause of cancer death in women, the leading cause of death from gynecologic malignancies and the second most commonly diagnosed gynecologic malignancy . It is idiopathic, meaning that the exact cause is unknown. The disease is more common in industrialized nations, with the exception of Japan. In the United States, females have a 1.4 % to 2.5 % (1 out of 40-60 women) lifelong chance of developing ovarian cancer.

Older women are at highest risk. More than half of the deaths from ovarian cancer occur in women between 55 and 74 years of age and approximately one quarter of ovarian cancer deaths occur in women between 35 and 54 years of age.

The risk for developing ovarian cancer appears to be affected by several factors. The more children a woman has, the lower her risk of ovarian cancer. Early age at first pregnancy, older ages of final pregnancy, and the use of some oral contraceptive pills have also been shown to have a protective effect. Ovarian cancer is reduced in women after tubal ligation.

The link to the use of fertility medication has been controversial. An analysis in 1991 raised the possibility that use of drugs tation may increase the risk for ovarian cancer. Several cohort studies and case-control studies have been conducted since then without providing conclusive evidence for such a link with the possible exception that prolonged use (> 1 year) of clomiphene citrate should be avoided.1 It will remain a complex topic to study as the infertile population differs in parity from the "normal" population.

There is good evidence that in some women genetic factors are important. Carriers of certain mutations of the BRCA1 or the BRCA2 gene (especially Ashkenazi Jewish women) are at a higher risk of both breast cancer and ovarian cancer, often at an earlier age than the general population. Patients with a personal history of breast cancer, or a family history of breast and/or ovarian cancer, may have an elevated risk. A strong family history of uterine cancer, colon cancer, or other gastrointestinal cancers may indicate the presence of a syndrome known as hereditary non-polyposis colon cancer (HNPCC), which confers a higher risk for developing ovarian cancer. Patients with strong genetic risk for ovarian cancer may consider the use of prophylactic oophorectomy after completion of child-bearing.

Other factors that have been investigated, such as talc use, asbestos exposure, high dietary fat content, and childhood mumps infection, are controversial and have not been definitively proven.

A study funded by American Cancer Society conducted at the H. Lee Moffitt Cancer Center of the University of South Florida has found a correlation between high levels of lysophospholipids (a type of fatty acid) with ovarian cancer patients and low levels of lysophospholipids with healthy women. This potential biomarker can be detected by a simple blood test. The blood test was 93 % accurate as predictor of ovarian cancer with less than 4 % false positives of the 117 women studied. Other indicators of ovarian cancer could be used to increase accuracy to 100 %. 2

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History of endometriosis places women at high risk of ovarian cancer, but pill use remains protective
From Perspectives on Sexual and Reproductive Health, 3/1/05 by D. Hollander

Women who have had endometriosis have an increased likelihood of developing ovarian cancer, but some of the same reproductive factors that lower the odds of cancer for women in general also appear to be protective for this high-risk group. (1) In an analysis based on pooled data from four population-based U.S. studies, the odds of ovarian cancer were 30% higher for women with a history of endometriosis (a condition marked by the presence of endometrial tissue outside the uterine lining) than for others. Regardless of whether women had had endometriosis, the risk of ovarian cancer was reduced among those who had ever used oral contraceptives, and it declined as a woman's number of live births increased.

The analysts pooled data from case-control studies conducted in different regions of the United States between 1993 and 2001. They used chi-square analyses and t-tests to compare characteristics of 2,098 women with ovarian cancer and 2,953 controls, and unconditional logistic regression to examine the factors associated with ovarian cancer. The multivariate analyses were conducted for all women and separately for women with and without endometriosis.

About half of both women with ovarian cancer and controls were in their 40s or 50s, and three-quarters were white; nine in 10 in each group had at least a high school education. Lower proportions of women with cancer than of controls had had a live birth (71% vs. 86%), had been sterilized (16% vs. 28%) and had used oral contraceptives (52% vs. 63%). Most pill users in both groups had taken oral contraceptives for less than 10 years. Four percent of women with ovarian cancer reported a family history of the disease, compared with 2% of controls; 9% and 6%, respectively, had a history of endometriosis.

Regardless of women's cancer status, the proportion who had ever used the pill was higher among those who had had endometriosis than among those with no history of the condition. However, the proportions who had used the pill for 10 or more years did not differ by whether women had had endometriosis.

Analyses controlling for study site, duration of pill use, parity, age, sterilization and family history of ovarian cancer confirmed that women with a history of endometriosis had a higher risk of ovarian cancer than women with no such history (odds ratio, 1.3). The differential was even greater for women who had never given birth (1.8). According to the analysts, the elevated risk among nulliparous women suggests an effect of endometriosis itself, rather than fertility problems caused by the condition.

When all relevant factors were controlled for, women who had ever used oral contraceptives had a reduced risk of ovarian cancer, and the benefit increased with duration of use: Compared with women who had never taken the pill, those who had used it for less than 10 years had 31% lower odds of developing cancer, and longer-term users had 55% lower odds. Similarly, reductions in the odds of ovarian cancer grew with parity (54% for women who had had 1-2 births and 64% for those who had had three or more). Women who had been sterilized had a lower risk than those who had not (odds ratio, 0.6).

Findings generally were similar for women with a history of endometriosis and those who had never had it; the exception was that women who had been sterilized had a reduced risk of ovarian cancer only if they had never had endometriosis. Notably, among women who had had endometriosis, long-term users of oral contraceptives had a markedly lower risk of ovarian cancer than never-users (odds ratio, 0.2); high parity (three or more live births) was associated with a similarly sharp reduction (0.2).

The analysts stress that strategies to reduce the likelihood of ovarian cancer are "critical in all women, but especially in women at an identifiably increased risk," such as those who have had endometriosis. Oral contraceptives are often prescribed as treatment for endometriosis; results of these analyses suggest that women with endometriosis are given the pill at first, but are then switched to other regimens. The analysts observe that such a change could reduce the pill's potential protection against ovarian cancer for these women. They conclude that "when women with endometriosis are being treated, the use of [oral contraceptives,] especially long-term use, should be encouraged."

REFERENCE

(1.) Modugno F et al., Oral contraceptive use, reproductive history, and risk of epithelial ovarian cancer in women with and without endometriosis, American Journal of Obstetrics and Gynecology, 2004, 191(3):733-740.

COPYRIGHT 2005 The Alan Guttmacher Institute
COPYRIGHT 2005 Gale Group

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