Elevated Risk Of Ovarian Cancer Research Articles

Ovarian cancer risk after the use of ovulation-stimulating drugs.

To assess the long-term effects of ovulation-stimulating drugs on the risk of ovarian cancer. A retrospective cohort study of 12,193 eligible study subjects (median age 30 years) who were evaluated for infertility during the period of 1965-1988 at 5 clinical sites identified 45 subsequent ovarian cancers in follow-up through 1999. Standardized incidence ratios compared the risk of cancer among the infertile patients to the general population, whereas analyses within the cohort allowed the derivation of rate ratios for drug usage compared with no usage after adjustment for other ovarian cancer predictors. The infertility patients had a significantly elevated ovarian cancer risk compared with the general population (standardized incidence ratio 1.98, 95% confidence intervals [CI] 1.4, 2.6). When patient characteristics were taken into account and risks assessed within the infertile women, the rate ratios associated with ever usage were 0.82 (95% CI 0.4, 1.5) for clomiphene and 1.09 (95% CI 0.4, 2.8) for gonadotropins. There were higher, albeit nonsignificant, risks with follow-up time, with the rate ratios after 15 or more years being 1.48 (95% CI 0.7, 3.2) for exposure to clomiphene (5 exposed cancer patients) and 2.46 (95% CI 0.7, 8.3) for gonadotropins (3 exposed cancer patients). Although drug effects did not vary by causes of infertility, there was a slightly higher risk associated with clomiphene use among women who remained nulligravid, based on 6 exposed patients (rate ratio 1.75; 95% CI 0.5, 5.7). The results of this study generally were reassuring in not confirming a strong link between ovulation-stimulating drugs and ovarian cancer. Slight but nonsignificant elevations in risk associated with drug usage among certain subgroups of users, however, support the need for continued monitoring of long-term risks. II-2

Awareness and concern about ovarian cancer among women at risk because of a family history of breast or ovarian cancer

Research on women at risk for breast cancer because of family history suggests that a substantial proportion need education and counseling to assist them in their efforts to understand their risk of breast cancer and that some do not get appropriate breast cancer screening. Although women at high genetic risk for breast cancer are at elevated risk for ovarian cancer as well, few studies have examined these women's needs for education and counseling about ovarian cancer risk. This study examined awareness of ovarian cancer, perceived risk of breast and ovarian cancer, interest in genetic testing, and use of screening for breast and ovarian cancer in a population-based sample of women at high risk for breast and ovarian cancer because of a strong family history of cancer at one or both sites. We found that most high-risk women are not getting the information and care they need with respect to their risk for ovarian cancer. Almost 75% have not heard much about their risk for ovarian cancer. More than 90% failed to use 1 or another of 2 possible tests used for ovarian cancer screening regularly.

Awareness and concern about ovarian cancer among women at risk because of a family history of breast or ovarian cancer

Research on women at risk for breast cancer because of family history suggests that a substantial proportion need education and counseling to assist them in their efforts to understand their risk of breast cancer and that some do not get appropriate breast cancer screening. Although women at high genetic risk for breast cancer are at elevated risk for ovarian cancer as well, few studies have examined these women's needs for education and counseling about ovarian cancer risk. This study examined awareness of ovarian cancer, perceived risk of breast and ovarian cancer, interest in genetic testing, and use of screening for breast and ovarian cancer in a population-based sample of women at high risk for breast and ovarian cancer because of a strong family history of cancer at one or both sites. We found that most high-risk women are not getting the information and care they need with respect to their risk for ovarian cancer. Almost 75% have not heard much about their risk for ovarian cancer. More than 90% failed to use 1 or another of 2 possible tests used for ovarian cancer screening regularly.

Occult Ovarian Tumors in Women With BRCA1 or BRCA2 Mutations Undergoing Prophylactic Oophorectomy

To review the findings at prophylactic oophorectomy of a series of women who presented to a familial breast and ovarian cancer clinic. Data from medical charts, operative notes, and pathology reports were collected on women who had undergone prophylactic oophorectomies because of the elevated risk of ovarian cancer. Because only a subset of patients underwent BRCA1 and BRCA2 testing, each patient's risk of hereditary predisposition was calculated using the Berry-Parmigiani model and family history data. From June 1989 to December 1998, 50 women seen at our clinic underwent prophylactic oophorectomy, 33 of whom had a calculated risk of carrying a germline BRCA1 or BRCA2 mutation greater than 25%. Among this group, four incidental tumors were found (four of 33, or 12%); one tumor was noted at the time of surgery and three were noted only in the final pathology. Two patients had microscopic, poorly differentiated serous adenocarcinomas in multiple sites on both ovaries. A third patient had a bilateral serous borderline tumor with micropapillary features. The fourth patient had a microscopic serous borderline ovarian tumor. All four patients had germline BRCA1 or BRCA2 mutations, and three had unremarkable transvaginal ultrasonography examinations within 6 months before prophylactic surgery. Foci of malignant tumor are not uncommon in prophylactic oophorectomies performed in women at very high risk for ovarian cancer and may not be detected on ultrasonograms. Surgeons should have a high suspicion of finding cancer in these women at the time of prophylactic surgery, and careful pathologic assessment of the specimens should be conducted.

Localization of a Breast Cancer Susceptibility Gene, BRCA2 , to Chromosome 13q12-13

A small proportion of breast cancer, in particular those cases arising at a young age, is due to the inheritance of dominant susceptibility genes conferring a high risk of the disease. A genomic linkage search was performed with 15 high-risk breast cancer families that were unlinked to the BRCA1 locus on chromosome 17q21. This analysis localized a second breast cancer susceptibility locus, BRCA2, to a 6-centimorgan interval on chromosome 13q12-13. Preliminary evidence suggests that BRCA2 confers a high risk of breast cancer but, unlike BRCA1, does not confer a substantially elevated risk of ovarian cancer.