Ovarian Cancer Incidence Rates Research Articles

Changing trends in Black-White racial differences in surgical menopause: a population-based study

Bilateral oophorectomy before menopause, or surgical menopause, is associated with negative health outcomes, including an increased risk for stroke and other cardiovascular outcomes; however, surgical menopause also dramatically reduces ovarian cancer incidence and mortality rates. Because there are competing positive and negative sequelae associated with surgical menopause, clinical guidelines have not been definitive. Previous research indicates that White women have higher rates of surgical menopause than other racial groups. However, previous studies may have underestimated the rates of surgical menopause among Black women. Furthermore, clinical practice has changed dramatically in the past 15 years, and there are no population-based studies in which more recent data were used. Tracking actual racial differences among women with surgical menopause is important for ensuring equity in gynecologic care. This population-based surveillance study evaluated racial differences in the rates of surgical menopause in all inpatient and outpatient settings in a large, racially diverse US state with historically high rates of hysterectomy. We evaluated all inpatient and outpatient surgeries in North Carolina from 2011 to 2014 for patients aged between 20 and 44 years. Surgical menopause was defined as a bilateral oophorectomy, with or without an accompanying hysterectomy, among North Carolina residents. International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes were used to identify inpatient and outpatient procedures, respectively, and diagnostic indications. We estimated age-, race-, and ethnicity-specific rates of surgical menopause using county-specific population estimates based on the 2010 United States census. We used Poisson regression with deviance-adjusted residuals to estimate the incidence rate ratios in the entire state population. We tested changes in surgery rates over time (reference year, 2011), differences by setting (reference, inpatient), and differences by race and ethnicity (reference, non-Hispanic White). We then described the surgery rates between non-Hispanic White and non-Hispanic Black patients. Between 2011 and 2014, 11,502 surgical menopause procedures for benign indications were performed in North Carolina among reproductive-aged residents. Most (95%) of these surgeries occurred concomitant with a hysterectomy. Over the 4-year study period, there was a 39% reduction in inpatient surgeries (incidence rate ratio, 0.61) and a 100% increase in outpatient surgeries (incidence rate ratio, 2.0). Restricting the analysis to surgeries among non-Hispanic White and Black patients, the increase in outpatient surgeries was significantly higher among non-Hispanic Black women (P<.01) for year-race interaction (reference, 2011 and non-Hispanic White). The overall rates of bilateral oophorectomy for non-Hispanic Black women rose more quickly than for non-Hispanic White women (P<.01). In 2011, the rate of surgical menopause was greater among White women than among Black women (17.7 vs 13.2 per 10,000 women). By 2014, the racial trends were reversed (rate, 24.8 per 10,000 for non-Hispanic White women and 28.4 per 10,000 for non-Hispanic Black women). Our findings suggest that the rates of surgical menopause increased in North Carolina in the early 2010s, especially among non-Hispanic Black women. By 2014, the rates of surgical menopause among non-Hispanic Black women had surpassed that of non-Hispanic White women. Given the long-term health consequences associated with surgical menopause, we propose potential drivers for the racially-patterned increases in the application of bilateral oophorectomy before the age of 45 years.

Uncovering Mitochondrial Determinants of Racial Disparities in Ovarian Cancer

Ovarian cancer (OC) incidence and mortality rates differ between racial groups. Mitochondrial genetic factors are now emerging as determinants of racial disparities in OC. A comprehensive understanding of the role of mitochondria in OC health disparities will help in developing novel therapeutic strategies targeting mitochondria to reduce or eliminate racial health disparities.

Ovarian cancer risk after salpingectomy for ectopic pregnancy or hydrosalpinx: results of the OCASE nationwide population-based database study.

What is the effect of salpingectomy for ectopic pregnancy or hydrosalpinx at a young age on ovarian cancer risk compared to no salpingectomy for any reason? We found no significant reduction in ovarian cancer risk after salpingectomy for ectopic pregnancy or hydrosalpinx. Salpingectomy may reduce ovarian cancer incidence, although the lag-time between intervention and therapeutic effect remains to be elucidated. This nationwide population-based database study uses the Dutch pathology database to identify all women who underwent salpingectomy for ectopic pregnancy or hydrosalpinx between January 1990 and December 2012 and compared ovarian cancer incidence to a control group of women who had a benign dermal nevus removed, matched for age at the time and year of procedure. After selection and manual control of intervention and control group, ovarian cancer incidence was recorded. Hazard ratios (HRs) with 95% CI for the development of ovarian cancer were calculated with Cox regression analyses, both unadjusted and adjusted for age. Subgroup analyses were performed to investigate lag-time between intervention and protective effect. In all, 18961 women were included in the intervention group; 17106 women had a unilateral salpingectomy and 1855 had a bilateral salpingectomy. The control group consisted of 23686 women. With 14 ovarian cancer cases in the intervention group, the incidence rate (IR) of ovarian cancer was 5.4 (95% CI 3.1-8.9) per 100000 person-years. In the control group, there were 24 ovarian cancer cases, resulting in an IR of 7.1 (95% CI 4.7-10.5) per 100000 person-years (P = 0.34). The age-adjusted HR for ovarian cancer was 0.76 (95% CI 0.39-1.47) after salpingectomy. Unilateral salpingectomy resulted in an age-adjusted HR of 0.81 (95% CI 0.41-1.59) and bilateral salpingectomy resulted in an age-adjusted HR of 0.43 (95% CI 0.06-3.16) based on one case. None of our subgroup analysis for lag-time resulted in a significant difference in ovarian cancer incidence between intervention and control group. The difference in ovarian cancer incidence appeared largest in women with at least 8 years of follow-up (P = 0.08). Due to the young population, ovarian cancer incidence is low, even at the end of follow-up. Furthermore, due to the anonymous nature of the pathology registry, we were unable to adjust for confounding factors. Although results did not reach statistical significance, they add to the available data on ovarian cancer incidence after salpingectomy. Our subgroup analysis suggests there may be no benefit in the first years following salpingectomy. None. N/A.

Dietary Inflammatory Index and Epithelial Ovarian Cancer in Southern Chinese Women: A Case-Control Study.

The association between inflammatory properties of diet and ovarian cancer risk has been investigated in some Western populations. However, little evidence is available from Asian women whose ovarian cancer incidence rates are low and dietary and lifestyle patterns are very different from their Western counterparts. We aimed to examine whether more pro-inflammatory diets, as indicated by higher dietary inflammatory index (DII®) scores, are associated with increased odds of epithelial ovarian cancer in southern China. A case-control study was conducted during 2006-2008 in Guangzhou, Guangdong Province. Energy-adjusted DII (E-DII) scores were calculated based on dietary intake assessed by a validated food frequency questionnaire administered to 500 incident epithelial ovarian cancer patients and 500 hospital-based controls. Logistic regression models were used to assess the relationship between E-DII scores and odds of ovarian cancer. Positive associations were observed between higher E-DII scores and ovarian cancer odds, using both continuous DII scores (odds ratio (OR) 1.87; 95% confidence interval (CI) 1.65, 2.13) and by DII tertiles (ORtertile3vs1 7.04, 95% CI: 4.70, 10.54, p for trend < 0.001). Likewise, a more pro-inflammatory diet was associated with a higher chance of serous and mucinous ovarian tumors. Our results suggest that a pro-inflammatory diet was associated with increased odds of developing epithelial ovarian cancer in southern Chinese women. The findings add to epidemiological evidence for the role of dietary inflammatory potential in ovarian cancer development.

Racial/Ethnic Differences in Ovarian Cancer Risk: Results from the Multiethnic Cohort Study.

Incidence rates of epithelial ovarian cancer (EOC) vary across racial/ethnic groups, yet little is known about the impact of hormone-related EOC risk factors in non-Whites. Among 91,625 female Multiethnic Cohort Study participants, 155 incident EOC cases were diagnosed in Whites, 93 in African Americans, 57 in Native Hawaiians, 161 in Japanese Americans, and 141 in Latinas. We used Cox proportional hazards regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for associations between race/ethnicity and EOC risk and between hormone-related factors and EOC risk across racial/ethnic groups. Compared with Whites, African Americans and Japanese Americans had a lower multivariable-adjusted EOC risk; Native Hawaiians had a suggestive higher risk. Parity and oral contraceptive (OC) use were inversely associated with EOC risk (P int race/ethnicity ≥ 0.43); associations were strongest among Japanese Americans (e.g., ≥4 vs. 0 children; HR = 0.45; CI, 0.26-0.79). Age at natural menopause and postmenopausal hormone (PMH) use were not associated with EOC risk in the overall population, but were positively associated with risk in Latinas (e.g., ≥5 years vs. never PMH use; HR = 2.13; CI, 1.30-3.49). We observed strong associations with EOC risk for parity and OC use in Japanese Americans and PMH use and age at natural menopause in Latinas. However, differences in EOC risk among racial/ethnic groups were not fully explained by established hormone-related risk factors. Our study indicates there are racial/ethnic differences in EOC risk and risk factors, and could help improve prevention strategies for non-White women.

Abstract A02: Pediatric ovarian cancer in the United States: Incidence trends over four decades

Abstract Objectives: Ovarian cancer is rare in children, accounting for 1% of childhood cancers. However, it is the most common cancer of the female genital tract in adolescents. Due to the rarity of the disease and the histologic and prognostic differences between pediatric and adult cases, there is a paucity of data describing incidence trends of pediatric ovarian cancer in the United States. It is unknown whether pediatric ovarian cancer has increased in incidence over time. The aim of the current study was to examine incidence and trends in pediatric ovarian cancer in the last four decades in the United States. Methods: We queried the Surveillance, Epidemiology, and End Results 9 database from 1975-2016 for age-adjusted ovarian cancer incidence rates for pediatric cases, aged 0 to 19 years. We used Joinpoint regression analyses to examine incidence trends stratified by race (white, blacks, and others, which included Hispanics, American Indians/Alaskan Natives, and Asian Pacific Islanders), histology (carcinoma, germ cell tumor, others), and age groups (0-14, and 15-19 years). Results: There were 897 pediatric ovarian cancer cases in the study. Whites accounted for 71.3% of tumors, and 75.6% of tumors were germ cell. Overall, there was a 46% increase in the incidence of pediatric ovarian tumors in (12.59 per 100,000 in 1975 vs. 18.38 per 100,000 in 2016). Average annual percent change (AAPC) was 0.9 (p &amp;lt; 0.05), and APC from 1975 to 1977 was 5.1 (p = 0.5), from 1977 to 2006 APC was 0.5 (p &amp;lt; 0.05), and from 2006 to 2016, APC was 1.3 (p &amp;lt; 0.05). There was an upward trend in tumor incidence in all racial groups, and age-adjusted incidence rate was highest among whites (18.95 per 100,000). Among whites, APC changed significantly between 1981 and 2016 (APC = 0.8, p &amp;lt; 0.05); however, among blacks, APC increased between 1997 and 2016 (APC = 1.3, p &amp;lt; 0.05); and among other races, it increased between 1975 and 1997 (APC=1.1, p&amp;lt;0.05) and between 2000 and 2016 (APC = 1.9 p &amp;lt; 0.05). Conclusions: In the past four decades, there has been a steady increase in the age-adjusted incidence rate of pediatric ovarian tumors, and while overall incidence is highest among whites, there has been a sharp increase in incidence among blacks and other minority populations, especially in the last two decades. This surveillance information may be relevant to issues germane to survivors of pediatric cancers, such as oncofertility issues. Citation Format: Kara M. Christopher, Eric Adjei Boakye, Justin M. Barnes, Matthew C. Simpson, Brittany J. Kline, Katherine Mass, Theresa L. Schwartz, Shannon Grabosch, Nosayaba Osazuwa-Peters. Pediatric ovarian cancer in the United States: Incidence trends over four decades [abstract]. In: Proceedings of the AACR Special Conference on the Advances in Pediatric Cancer Research; 2019 Sep 17-20; Montreal, QC, Canada. Philadelphia (PA): AACR; Cancer Res 2020;80(14 Suppl):Abstract nr A02.

Abstract B41: Racial/ethnic disparities in epithelial ovarian cancer and its risk factors: The Multiethnic Cohort Study

Abstract Background: Age-adjusted incidence rates of epithelial ovarian cancer (EOC) are highest rates in White and Hispanic women, and lower in African American and Asian/Pacific Islander women. We investigated the extent to which reproductive and lifestyle factors explain racial/ethnic differences in EOC risk among White, African American, Native Hawaiian, Japanese American, and Hispanic women in the Multiethnic Cohort (MEC) Study. Methods: The study included 91,682 participants who completed a baseline questionnaire on hormone-related and other lifestyle factors. Incident invasive EOC cases were identified from tumor registries. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between (1) race/ethnicity and EOC risk and (2) hormone-related factors and EOC risk across racial/ethnic groups. Exposures included parity, ages at first birth, menarche, and natural menopause, menopausal status, exogenous hormone use, and body mass index. Models were adjusted for age, menopausal status, parity, and oral contraceptive (OC) use. Results: During a median of 20 years of follow-up, 155 EOC cases occurred among Whites, 93 among African Americans, 57 among Native Hawaiians, 161 among Japanese Americans, and 141 among Latinas. Compared to Whites, African Americans and Japanese Americans had a lower EOC risk (HR 0.74 [CI 0.57-0.97] and HR 0.79 [CI 0.63-0.99], respectively) while Native Hawaiians had a suggestive higher risk (HR 1.36 [CI 0.99-1.85]). EOC risk in Latinas did not differ from that in Whites (HR 0.97 [CI 0.76-1.22]). Parity and OC use were significantly inversely associated with EOC risk in the full population. These risk patterns were observed across race/ethnicity (pint ≥0.43), with the strongest inverse associations among Japanese Americans (≥4 vs. 0 children, HR 0.45 [CI 0.26-0.79], ptrend &amp;lt;0.01; ≥5 years vs. never OC use, HR 0.35 [CI 0.16-0.78]). Though there was no association in the full population, age at natural menopause (≥55 vs. ≤45 years, HR 2.60 [CI 1.24-5.42]) and postmenopausal hormone use (≥5 years vs. never, HR 2.13 [CI 1.30-3.49]) were positively associated with EOC risk among Latinas. There were no significant associations among White, African American, or Native Hawaiian women for any of the risk factors tested. Conclusion: Our results suggest that differences in risk among ethnic groups were not fully explained by established risk factors and differences in risk remained, with increased risk observed in Native Hawaiians and lower risk in Latinas and Japanese Americans, compared to Whites. EOC is a rare disease, and case numbers limited our ability to further explore associations across the racial/ethnic groups in the MEC study. Citation Format: Danja Sarink, Song Yi Park, Loic Le Marchand, Kami White, Brenda Hernandez, Lynne Wilkens, V. Wendy Setiawan, Anna Wu, Melissa A. Merritt. Racial/ethnic disparities in epithelial ovarian cancer and its risk factors: The Multiethnic Cohort Study [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research; 2019 Sep 13-16, 2019; Atlanta, GA. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(13_Suppl):Abstract nr B41.

Incidence and Survival Rates of Gynecological Malignancies in The United States Before and After the HPV Vaccine

Intoduction: Gynecological malignancies are one of the most common cancers in women and have high mortality rates in the United States. In this study, we aimed to analyze the incidence and mortality rates of gynecological malignancies in 2011-2015 and compare these data with the corresponding parameters of 2001-2005. We chose these intervals of years for contrasting, as HPV vaccines have been actively used since 2006. HPV vaccine is known to prevent cervical cancer but has unknown impact on other gynecological malignancies. The aim of the is study is to check if incidence and survival of gynecological malignancies has changed before and after application of HPV vaccine Material and Methods: The Surveillance, Epidemiology and End Results (SEER) cancer registry 2005-2011 and 2011-2015 database was investigated and patients with gynecological malignancy were identified. Data were obtained using SEER*Stat version 8.3.5. A statistical analysis on the incidence rate and mortality rate was performed. Data were exported using case-listing session in SEER*Stat and were analyzed using SPSS version 25. Results: Overall 125,357 cases with a gynecological malignancy were identified in 2011-2015 in comparison with 102,534 cases in the period of 2001-2005. The incidence of cervical cancer decreased in the period of 2011-2015 compared with the period from 2001 to 2005 (median incidence rates 3.9 and 4.3 per 100.000 persons, respectively, p &lt; 0.05), while incidence of uterine (15.3 and 12.0 per 100.000 persons persons, respectively) and vulvar (1.55 and 1.86 per 100.000 persons, respectively) has increased ( p &lt; 0.05). There was no change in the incidence rate of ovarian cancer (7.28 and 7.19 per 100.000 persons). Survival rates for cervix, uterine, ovarian and vulva cancer have increased. However, zero time error couldn’t be avoided in statistical analysis. Conclusion: As a result of widespread screening with Pap smear test and availability of human papilloma virus vaccine the incidence of cervix cancer has declined. Increase in vulvar and uterine cancer incidence may be attributed to lack of effective screening program for early detection of these type of cancers and most probably HPV vaccine has no effect on their incidence. Survival of gynecological malignancies has increased over years which may be explained by better treatment options or earlier detection.

Comment on: Wiser et al. Ovarian cancer in Switzerland: incidence and treatment according to hospital registry data. Swiss Med Wkly.2018;148:w14647

Wieser and colleagues, in a study published in Swiss Medical Weekly in July 2018, compared incidence rates of ovarian cancer derived from the cantonal cancer registries (CCRs) as published by the National Institute for Cancer Epidemiology and Registration (NICER) with those derived from the hospital discharge data compiled by the Swiss Federal Statistical Office. The authors observed a substantial difference between these two estimates. The average age-adjusted ovarian cancer incidence rate was 14.6 per 100,000 women per year over the period 2004–2012 compared with a rate of 11.3 per 100,000 women per year reported by NICER for the same period [1]. The authors argue that the figure provided by NICER is probably an underestimation of the true figure because cancer registry data are based on voluntary information on new cases from clinicians.With our response, we show that this conclusion is not correct and the observed high rate of ovarian cancer in hospital discharge data is an artefact, probably arising from incorrect coding of non-malignant ovarian tumours. Further, we explain the purpose of epidemiological cancer registries and their difference from routinely collected discharge data.

Ovarian Cancer Incidence in the Multi-Ethnic Asian City-State of Singapore 1968-2012.

Purpose:We investigate ovarian cancer incidence between 1968 and 2012 in Singapore, a multiethnic Asian city state. Methods:Aggregated data of ovarian epithelial cancer numbers and estimated person-years from 1968 to 2012 were obtained from Singapore Cancer Registry. Age-Period-Cohort modelling was performed. Results:The age-standardised incidence rate of ovarian cancer increased from 5.8 to 12.5 per 100,000 per year between 1968 and 2012, while the age-standardised mortality rate has remained stable. This increase was higher among Malays (5.1 to 14.0 per 100,000 per year), compared to Chinese and Indians. Serous carcinoma showed the greatest increase in incidence from 0.4 to 3.4 per 100,000 per year. Period effects were seen in the ovarian cancer incidence trend in Chinese women, but not Malay and Indian women. Clear cell and mucinous carcinoma subtypes were more common in Chinese than in Malay and Indian women. Stage at diagnosis for the years 2003-2010 differed by subtype, and the majority of patients with serous carcinomas presented at a later stage compared to those with clear cell or mucinous carcinomas. Conclusion:Ovarian cancer incidence rates have doubled in 40 years in Singapore. There were ethnic differences in incidence rates and ovarian cancer subtypes.

Hysterectomy with opportunistic salpingectomy versus hysterectomy alone.

Hysterectomy with opportunistic salpingectomy versus hysterectomy alone.

Geographic Co-Occurrence of Mesothelioma and Ovarian Cancer Incidence.

Background: Asbestos is an established cause of several cancers, including mesothelioma and ovarian cancer. Incidence of mesothelioma, the sentinel asbestos-associated cancer, varies by state, likely reflecting different levels of asbestos exposure. We hypothesized that states with high mesothelioma incidence may also have high ovarian cancer incidence. Materials and Methods: Using data from the Centers for Disease Control and Prevention National Program for Cancer Registries and the National Cancer Institute Surveillance, Epidemiology, and End Results Program, we examined the geographic co-occurrence of mesothelioma and ovarian cancer incidence rates by U.S. state for 2003-2015. Results: By state, mesothelioma incidence ranged from 0.5 to 1.3 cases per 100,000 persons and ovarian cancer incidence ranged from 9 to 12 cases per 100,000 females. When states were grouped by quartile of mesothelioma incidence, the average ovarian cancer incidence rate was 10% higher in states with the highest mesothelioma incidence than in states with the lowest mesothelioma incidence. Ovarian cancer incidence tended to be higher in states with high mesothelioma incidence (Pearson correlation r = 0.54; p < 0.0001). Conclusions: Data from state cancer registries show ovarian cancer incidence was positively correlated with mesothelioma incidence, suggesting asbestos may be a common exposure. The potential for asbestos exposure has declined since the 1970s because fewer products contain asbestos; however, some products, materials, and buildings may still release asbestos and thousands of workers may be exposed. Ensuring that people are protected from exposure to asbestos in their workplaces, homes, schools, and communities may reduce the risk of several cancers.

Clear differences in ovarian cancer incidence and trends by ethnicity among Asian Americans

BackgroundAcross major races in the United States (U.S.), ovarian cancer incidence is low among Asian American women. However, this observation aggregates Asian Americans as a single group despite their heterogeneity. Disaggregating the ethnic Asian population will produce more useful information to better understand ovarian cancer incidence among Asian women in the U.S. MethodsData from the Surveillance, Epidemiology, and End Results Program from 1990 to 2014 were used to compare age-adjusted incidence rates (AAIRs, per 100,000 women) for ovarian cancer for the six largest U.S. Asian ethnicities (Asian Indian/Pakistani, Chinese, Filipino, Japanese, Korean, Vietnamese) to non-Hispanic whites (NHWs). The race/ethnicity-specific AAIRs were calculated by time period and histotype. We examined the magnitude and direction of AAIR trends using average annual percent change (AAPC) statistics. ResultsAll Asian ethnicities had significantly lower ovarian cancer incidence rates than NHWs. However, among Asian ethnicities, Asian Indians/Pakistanis had the highest rate of ovarian cancer (AAIR = 10.51, 95% CI: 9.65–11.42) while Koreans had the lowest (AAIR = 7.23, 95% CI: 6.62–7.88). Clear cell ovarian cancer had significantly higher incidence rates among Chinese, Filipino, and Japanese women than NHW women (incidence rate ratio (IRR) = 1.49, 95% CI: 1.29–1.72, IRR = 1.30, 95% CI: 1.12–1.51, IRR = 1.64, 95% CI: 1.36–1.97, respectively). Incidence trends also differed by Asian ethnicity with significant decreases only observed for Chinese (AAPC = −1.49, 95% CI: −2.22 to −0.74) and Japanese (AAPC = −1.75, 95% CI: −2.57 to −0.92). ConclusionsExamining Asian Americans as a single group results in missed ethnic-specific disparities in ovarian cancer, hence disaggregating this heterogeneous population in future research is warranted.

Ovarian Cancer in Women of African Ancestry (OCWAA) consortium: a resource of harmonized data from eight epidemiologic studies of African American and white women.

Although the incidence rate of epithelial ovarian cancer (EOC) is somewhat lower in African American (AA) than white women, survival is worse. The Ovarian Cancer in Women of African Ancestry (OCWAA) consortium will overcome small, study-specific sample sizes to better understand racial differences in EOC risk and outcomes. We harmonized risk factors and prognostic characteristics from eight U.S. the North Carolina Ovarian Cancer Study (NCOCS), the Los Angeles County Ovarian Cancer Study (LACOCS), the African American Cancer Epidemiology Study (AACES), the Cook County Case-Control Study (CCCCS), the Black Women's Health Study (BWHS), the Women's Health Initiative (WHI), the Multiethnic Cohort Study (MEC), and the Southern Community Cohort Study (SCCS). Determinants of disparities for risk and survival in 1,146 AA EOC cases and 2,922 AA controls will be compared to 3,368 white EOC cases and 10,270 white controls. Analyses include estimation of population-attributable risk percent (PAR%) by race. OCWAA is uniquely positioned to study the epidemiology of EOC in AA women compared with white women to address disparities. Studies of EOC have been underpowered to address factors that may explain AA-white differences in the incidence and survival. OCWAA promises to provide novel insight into disparities in ovarian cancer.

The influence of birth cohort and calendar period on global trends in ovarian cancer incidence.

Ovarian cancer is the eighth most common cancer in women worldwide and incidence rates vary markedly by world region. Our study provides a comprehensive overview of ovarian cancer incidence trends globally, examining the influence of birth cohort and period of diagnosis on changing risk. We presented current patterns and trends of ovarian cancer incidence until 2012 using data from successive volumes of Cancer Incidence in Five Contents. The incidence of ovarian cancer is highest in northern and eastern European countries and in northern America. Declining trends were observed in most countries with the exception of a few central and eastern Asian countries. Marked declines were seen in Europe and North America for women aged 50-74 where rates have declined up to 2.4% (95% CI: -3.9, -0.9) annually in Denmark (DNK) over the last decade. Additionally, declines in the incidence rate ratio (IRR) were observed for generations born after the 1930s, with an additional strong period effect seen around 2000 in United States and DNK. In contrast, IRRs increased among younger generations born after the 1950s in Japan and Belarus. Overall, the favorable trends in ovarian cancer incidence is likely due to the increase use of oral contraceptive pills, and changes in the prevalence of other reproductive risk and protective factors for ovarian cancer over the years studied. Changes in disease classifications and cancer registry practices may also partially contribute to the variation in ovarian cancer incidence rates. Thus, continuous cancer surveillance is essential to detect the shifting patterns of ovarian cancer.

Theaflavin-3,3'-Digallate Suppresses Human Ovarian Carcinoma OVCAR-3 Cells by Regulating the Checkpoint Kinase 2 and p27 kip1 Pathways.

Theaflavin-3,3′-digallate (TF3) is a unique polyphenol in black tea. Epidemiological studies have proved that black tea consumption decreases the incidence rate of ovarian cancer. Our former research demonstrated that TF3 inhibited human ovarian cancer cells. Nevertheless, the roles of checkpoint kinase 2 (Chk2) and p27 kip1 (p27) in TF3-mediated inhibition of human ovarian cancer cells have not yet been investigated. In the current study, TF3 enhanced the phosphorylation of Chk2 to modulate the ratio of pro/anti-apoptotic Bcl-2 family proteins to initiate intrinsic apoptosis in a p53-independent manner and increased the expression of death receptors to activate extrinsic apoptosis in OVCAR-3 human ovarian carcinoma cells. In addition, TF3 up-regulated the expression of p27 to induce G0/G1 cell cycle arrest in OVCAR-3 cells. Our study indicated that Chk2 and p27 were vital anticancer targets of TF3 and provided more evidence that TF3 might be a potent agent to be applied as adjuvant treatment for ovarian cancer.

The risk of breast and gynecological cancer in women with a diagnosis of infertility: a nationwide population-based study

Some studies have suggested that infertility is a risk factor for endometrial, ovarian and breast cancer. The study aimed to create a comprehensive picture of the association between infertility and the risk of ovarian, endometrial and breast cancer, and whether any association could be explained by ovulatory disturbances, endometriosis or nulliparity. In a population-based cohort of 2,882,847 women, cox regression analysis was used to investigate cancer incidence among infertile women. Overall, infertility was associated with a higher incidence rate of ovarian (adjusted hazard ratio [aHR] 1.53, 95% confidence interval [CI] 1.38–1.71) and endometrial cancer (aHR 1.25, 95% CI 1.11–1.40), but not of breast cancer (aHR 0.96, 95% CI 0.92–1.01). Ovarian cancer incidence was higher in women diagnosed with endometriosis, and in nulliparous women with ovulatory disturbances, compared to women with none of the diagnoses. Endometrial cancer incidence was higher in women with ovulatory disturbances, but not in women with endometriosis. These findings suggest that infertility could have long-term consequences of importance to physicians and public health workers.

Diagnostic accuracy of gynecology imaging reporting and data system in evaluation of adnexal lesions.

Background:Considering the increasing incidence rate of ovarian cancer in worldwide and the utility of Gynecologic Imaging Reporting and Data System (GI-RADS) in diagnosing malignant adnexal lesions such as ovarian cancer, we aimed to evaluate the diagnostic performance of this reporting system in differentiating between malignant and benign adnexal lesions.Materials and Methods:In this cross-sectional study, women with suspected adnexal lesions were enrolled. For differentiating of malignant adnexal lesions, Grade II and III of GI-RADS system were classified as low risk for malignancy and Grades IV and V as high risk. Results of histopathologic diagnosis were compared with the results of the mentioned GI-RADS system classification, and the diagnosed accuracy of the system was determined. Patients who did not have histopathologic diagnosis were followed up.Results:In this study, 197 women with suspected adnexal lesions were evaluated. Frequency of GI-RADS II, III, IV, and V were 34.5% (69 cases), 38.0% (76 cases), 19.5% (39 cases), and 6.5% (13 cases), respectively. According to the low- and high-risk classification of GI-RADS, 72.5% were classified as GI-RADS II and III and 26% as GI-RADS IV and V, respectively. Definitive histopathologic diagnosis was reported for 158 cases. Histopathologic evaluation indicated that 12 (7.6%) of the masses were malignant and 146 (92.6%) were benign. Comparing with the histopathologic diagnosis, the GI-RADS system sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio (LR), and negative LR were 91.6%, 80.82%, 28.2%, 99.1%, 4.77, and 0.10, respectively. The accuracy of the scoring system was 81.64%.Conclusion:Our findings indicated that using GI-RADS, we could quantify the risk of malignancy by such a structured as well as simple reporting system so that the system could be useful for clinicians for performing an appropriate clinical management.

The Cost-Effectiveness of Multigene Panel Testing for Hereditary Breast and Ovarian Cancer in Norway.

Background. Expansion of routine genetic testing for hereditary breast and ovarian cancer from conventional BRCA testing to a multigene test could improve diagnostic yield and increase the opportunity for cancer prevention in both identified carriers and their relatives. We use an economic decision model to assess whether the current knowledge on non-BRCA mutation prevalence, cancer risk, and patient preferences justifies switching to a multigene panel for testing of early-onset breast cancer patients. Methods. We evaluated routine testing by BRCA testing, a 7-gene panel, and a 14-gene panel using individual-level simulations of annual health state transitions over a lifetime perspective. Breast and ovarian cancer incidence is reduced and posttreatment survival is improved when high-risk mutations are detected and risk-reducing treatment offered. Most model inputs were synthesized from published literature. Intermediate health outcomes included breast and ovarian cancer incidence rates, along with organ-specific cancer mortality. Cost-effectiveness outcomes were health sector costs and quality-adjusted life years. Results. Intermediate health outcomes improved by testing with multigene panels. At a cost-effectiveness threshold of $77,000, a 7-gene panel test with five non-BRCA genes was the optimal strategy with an incremental cost-effectiveness ratio of $53,310 per quality-adjusted life year compared to BRCA-only testing. Limitations. Unable to stratify carriers to specific mutations within genes, we can only make predictions on the gene level, with combined risk estimates for known variants. As mutation prevalence is the absolute upper bound of returns to more expansive testing, the rarity of modelled mutations makes analysis outcomes sensitive to model implementation. Conclusions. A 7-gene panel to diagnose hereditary breast and ovarian cancer in early-onset breast cancer patients can be a cost-effective alternative to current BRCA-only testing in Norway.

Comparison of gynecologic cancer risk factors, incidence and mortality trends between South Korea and Israel, 1999-2013.

To discuss possible causes of disparities in incidence and mortality rates of ovarian cancer, uterine cancer and cervical cancer between two diverse populations from east and west Asia. Incidence and mortality data from 1999 to 2013 were extracted from Korean and Israeli cancer registries. Age-standardized rates and annual percent changes were calculated. Trends were analyzed using Joinpoint analysis and discussed with respect to risk factor exposure. Age-standardized rate of ovarian cancer significantly increased in Korea (annual percent change 1.7%) but decreased among Jews (annual percent change -2.15%). Age-standardized rate of uterine cancer increased among both Koreans and Israeli Jews (annual percent changes 5.8 and 1.17%, respectively). Incidence of cervical cancer significantly decreased in Korea (annual percent change -3.8%) while remained stable on Israel. Mortality trends paralleled incidence trends with a significant increase in ovarian cancer and uterine cancer mortality in Korea (annual percent changes 1.2 and 4.6%, respectively) and a drop in cervical cancer mortality from 2002 (annual percent change -5.8%). Among Israeli Jews, uterine cancer mortality increased (annual percent change 1.01%), while ovarian cancer mortality decreased (annual percent change -0.58%). Uterine cancer mortality among Arabs declined (annual percent change -0.5%), while cervical cancer mortality remained unchanged. Gynecologic malignancies show different incidence trends in Korea and Israel. Uterine cancer is rising in both countries and is correlated to changing trends in obesity and dietary habits. Ovarian cancer is rising in Korea but declining among Israeli Jews along with changes in parity, childbearing age, contraceptive use and increasing awareness to BRCA gene carriers and risk reduction salpingo-oophorectomy. Cervical cancer is declining in Korea along with an effective screening program implemented. Mortality trends follow incidence trends in both countries.