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Prevention of Ovarian Cancer. Roberta B. Ness , M.D., M.P.H., Chair of the Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health. What Puts Women at Risk?. Family history of ovarian and breast cancers Infertility Endometriosis Talc use

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prevention of ovarian cancer

Prevention of Ovarian Cancer

Roberta B. Ness, M.D., M.P.H., Chair of the Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health

what puts women at risk
What Puts Women at Risk?
  • Family history of ovarian and breast cancers
  • Infertility
  • Endometriosis
  • Talc use
  • Hormone replacement therapy
does anything prevent ovarian cancer
Does Anything Prevent Ovarian Cancer?
  • Oral contraceptives
  • Pregnancies
  • Breast feeding (long duration)
  • Tubal ligation
  • Oophorectomy and hysterectomy
controversies
Controversies
  • NSAIDS
  • Fertility drugs
  • Androgens
  • Diet: fat, coffee
the legacy of brca
The Legacy of BRCA

BRCA1: Lifetime Risk of Ovarian Cancer:

28-66%

BRCA2: Risk by age 50: <1%

But by age 70: 27%

infertility and ovarian cancer risk
Infertility and Ovarian Cancer Risk

Compared to women with 3 or more pregnancies…

RISK

Women with 0 pregnancies

not trying 2.1

Women with 0 pregnancies

trying 4.3

endometriosis

1.9

X

1.7 1.7

X X

Risk 1.0

Brinton Ness Ness 2000 2002

Endometriosis
hypotheses new
Hypotheses (New)
  • Inflammation:Pelvic inflammation exposes the lining of the ovary to toxic mediators and makes cells quickly turnover. Both may be mutagenic.
etiologic hypotheses new
Etiologic Hypotheses (New)

Androgens and Progestins

• Androgen exposure elevates risk

• Progestins reduce risk

oral contraceptives and ovarian cancer
Oral Contraceptives and Ovarian Cancer
  • Risk 30-40% 
  • Longer use, more protection
  • Protection 20 or more years after last use
  • New OCs protective
  • May be best: low estrogen

high progestin

oophorectomy

1.0

0.9

0.8

0.7

Surveillance (n=72)

0.6

0 12 24 36 48 60 72 84

Oophorectomy

Salpingo-oophorectomy (n=98)

Cumulative Proportion without Breast or BRCA-Related Gynecologic Cancer

Months

oral contraception in women with brca mutations or family history
Oral Contraception in Women with BRCA Mutations or Family History
  • Modan (2001)
  • Women without mutations protected
  • Women with mutations not protected
  • Narod (1998)
  • All women with or without BRCA mutations protected
  • Walker (2002)
  • All women with or without family history protected
aspirin use
Aspirin Use

Risk 1.0

0.90.9

0.75 X X

X 0.7 0.6

0.5 X X

X

Tzonou Cramer Rosenberg Tavani Akhmed Moysich

1984 1998 2000 2000 2001 2001

khanov

time com

health

Thursday March 8, 2001

Time.com

Could a Common Painkiller Cut Your Risk of Ovarian Cancer?

what can you and yours change
What Can You (and Yours) Change?

Anyone

• Oral Contraceptive Use

• Pregnancies and Breast Feeding

• Tubal Ligation

• Don’t Use Talc

• Don’t Use HRT

(except for perimenopausal symptoms)

what can you and yours change1
What Can You (And Yours) Change?
  • Oophorectomy after family size completed
  • Oral contraceptive use
  • Tubal ligation

BRCA Mutation Carriers