Current Ovarian Cancer Prevention Strategies

Epithelial ovarian cancer has the highest fatality-to-case ratio of all the gynecologic malignancies,because more than two-thirds of patients have advanced disease at diagnosis.High-grade serouscarcinomas, which are the most common, are now believed to be related etiologically to fallopian tubeand peritoneal cancer and most appear to arise from the fimbria of the fallopian tube.Ovarian cancer has been associated with low parity and infertility .Although there has been a varietyof epidemiologic variables correlated with ovarian cancersuch as increased risk with talc use,galactose consumption, and decreased risk with tubal ligation and the oral contraceptive pill usage—none has been so strongly correlated as prior reproductive history and duration of the reproductivecareer.Early menarche and late menopause increase the risk of ovarian cancer.In a cohort study ofmore than 1.1 million Norwegian women, a positive association was found between body mass index(BMI), height, and risk of ovarian cancernulliparity(compared with multiparity greater than 4) carrieda RR of 2.42, andinfertility per se for 5 years or longer (compared with shorter than 1 year) carried aRR of 2.7.Womenwho had received estrogen replacement therapy only for more than 10 years without progestin were atincreased risk. By 20 years, the relative risk was 3.2-fold.Western countries, including the UnitedStates and the United Kingdom,have an incidence of ovarian cancer that is three to seven timesgreater than in Japan, where epithelial ovarian tumors are considered rare.