Epidemiologic correlates of ovarian cortical inclusion cysts (CICs) support a dual precursor pathway to pelvic epithelial cancer

Abstract

ObjectiveMany ovarian carcinomas are presumed to arise within ovarian cortical inclusion cysts (CICs). This study examined the frequency of ovarian CICs in relation to epidemiologic risk factors in women with BRCA1 and BRCA2 (BRCA+) mutations. MethodsBRCA+ women who underwent risk-reducing bilateral salpingo-oophorectomy were studied (n = 74). Fifteen demographic variables (e.g., age at time of surgery, age at first birth, age at menopause, body mass index (BMI), gravidity) from a review of the medical records and three pathologic variables (cystic and atretic follicles, corpora lutea) were recorded. Statistical associations were made using T-test or Chi Square analysis and logistic regression analysis for p-trend. ResultsWomen whose ovaries contained 7 for more CICs were older at first birth (p = 0.034), surgery (p = 0.059), menopause (p = 0.046) and had a higher BMI (p = 0.034) than those with <7 CICs. Regression analysis revealed a significant association between CICs and increasing BMI (p = 0.01). ConclusionsCICs correlate with greater body mass index, similar to low-grade serous and endometrioid tumors and in contrast to high-grade serous carcinoma and its putative precursor in the fallopian tube. A model is presented for ovarian and tubal pathways to pelvic cancer that are linked to different microscopic precursors with distinct epidemiologic correlates.