The epidemiology of ovarian carcinoma and the current status of tumor markers to detect disease

Abstract

OBJECTIVES: The objectives of this manuscript are to review the epidemiologic characteristics of ovarian cancer and to summarize the current status of tumor markers to detect disease. STUDY DESIGN: A review of the pertinent literature was done. RESULTS: In general, ovarian cancer is most frequent in industrialized countries, with dietary fat and possible use of talc as additive factors. Ovulation appears to increase the risk as does family history, increasing age, infertility, and possibly the use of ovulatory drugs. Pregnancy and the use of oral contraceptives, as well as possibly breast-feeding, lower the risk. Tubal ligation or hysterectomy with ovarian preservation also lowers the risk. The lifetime risk is about 1.4% in the United States, and the risk increases with age. If one first-degree relative has ovarian cancer, the lifetime risk appears to rise to 5%, but this pooled estimate may be affected by self-reporting bias in some studies. CA 125, the most widely used marker, is nonspecific, being elevated in about 80% of cases of ovarian epithelial cancer but also elevated in a number of benign conditions, which reduces its potential effectiveness as a screening tool. CONCLUSIONS: No single cause of ovarian cancer has been uncovered. Overall >90% of ovarian cancers occur sporadically. Those with the hereditary ovarian cancer syndrome (multiple generations of breast and ovarian cancer) have a 50% risk and an autosomal dominant inheritance, but they constitute <1% of cases. No ideal tumor marker for ovarian cancer screening is currently available. Further evaluation is needed to see whether the use of multiple tumor markers and/or vaginal ultrasonography might produce an acceptable cost-effective screening model. Current data do not support the utilization of prophylactic oophorectomy in women with one first-degree relative with ovarian cancer as a general strategy to prevent ovarian cancer. It is appropriate strategy for those with hereditary ovarian cancer syndrome. (AM J OBSTET GYNECOL 1994; 170:1099-107.)