Risk Factors For Ovarian Cancer Research Articles

Reproductive Factors Do Not Influence Survival with Ovarian Cancer.

Previous studies on the association between reproductive factors and ovarian cancer survival are equivocal, possibly due to small sample sizes. Using data on 11,175 people diagnosed with primary invasive epithelial ovarian, fallopian tube, or primary peritoneal cancer (ovarian cancer) from 16 studies in the Ovarian Cancer Association Consortium (OCAC), we examined the associations between survival and age at menarche, combined oral contraceptive use, parity, breastfeeding, age at last pregnancy, and menopausal status using Cox proportional hazard models. The models were adjusted for age at diagnosis, race/ethnicity, education level, and OCAC study and stratified on stage and histotype. During the mean follow-up of 6.34 years (SD = 4.80), 6,418 patients passed away (57.4%). There was no evidence of associations between the reproductive factors and survival among patients with ovarian cancer overall or by histotype. This study found no association between reproductive factors and survival after an ovarian cancer diagnosis. Reproductive factors are well-established risk factors for ovarian cancer, but they are not associated with survival after a diagnosis of ovarian cancer.

Is Pregnancy Characteristic Associated with Ovarian Cancer? A Review of the Available Evidence

Numerous epidemiological studies examining the etiology of ovarian cancer and the role of pregnancy related factors in ovarian cancer has been one of the topics of interest to many researchers. Various articles have only mentioned the link between some risk factors and ovarian cancer, but no study has addressed the various dimensions of this issue to this day. Therefore, due to the important position of ovarian cancer among gynecological cancers, this study was conducted to investigate the pregnancy-related risk factors for ovarian cancer. To determine the relationship between pregnancy characteristic and ovarian cancer, a comprehensive search was carried out in English databases such as; Medline, Web of Science Core Collection, and Scopus using keywords; pregnancy, ovarian cancer (or 'carcinoma of the ovary' or 'ovarian neoplasm' or 'ovarian tumor'), risk factor, pregnancy characteristic terms and a combination of these terms. Full-text, English language, and original articles were included in this study. In total, 35 articles were entered into the study. The relationship between pregnancy related factors and ovarian cancer were studied. Although there was a weak association between some factors such as preterm birth and the risk of ovarian cancer, only the strong protective effect of parity was seen in the articles. The results of this study did not show that pregnancy related factors increase the risk of ovarian cancer. In summary, the findings are inadequate regarding some risk factors such as gender of fetus, multiple pregnancy, placental and fetal weight, parity, miscarriage, preeclampsia, and gestational diabetes, and raised questions for future research. Keywords: Ovarian cancer, pregnancy, risk factor

A review on mechanisms of resistance to PARP inhibitors.

Standard therapy for advanced ovarian cancer (OC) consists of radical debulking cytoreductive surgery followed by adjuvant chemotherapy. An important risk factor for OC is genetic predisposition, with BRCA1 or BRCA2 mutations accounting for the majority of hereditary OC. Mutation in BRCA ultimately causes accumulation of genetic alterations because of the failure of cells to arrest and repair DNA damage or to undergo apoptosis, resulting in tumorigenesis. Poly (ADP-ribose) polymerase (PARP) inhibitors have emerged as a promising approach for managing BRCA-associated cancers, especially high-grade OC and breast cancers. They lead to synthetic lethality in BRCA-mutated cells by stalling the replication forks in homologous recombination-deficient (HR) cells. Four PARP inhibitors (olaparib, niraparib, rucaparib, and talazoparib) are currently approved by the Food and Drug Administration for OC, breast, and pancreatic cancer indications and are being evaluated for other BRCA-associated cancers. Despite their clinical efficacy, cancer cells generally develop resistance to them through several mechanisms. Understanding these mechanisms is crucial for developing strategies to counter resistance and identify the basic mechanisms of DNA damage response. This review focuses on the mechanism of action of PARP inhibitors, understanding various causes of resistance, and building strategies to overcome PARP inhibitor resistance.

BRCA1 and Metastasis: Outcome of Defective DNA Repair.

Simple SummaryBRCA1 has critical functions in accurately repairing double stand breaks in the DNA through a process known as homologous recombination. BRCA1 also has various functions in other cellular processes that safeguard the genome. Thus, mutations or silencing of this tumor suppressor significantly increases the risk of developing breast, ovarian, and other cancers. Metastasis refers to the spread of cancer to other parts of the body and is the leading cause of cancer-related deaths. In this review, we discuss the mechanisms by which BRCA1 mutations contribute to the metastatic and aggressive nature of the tumor cells.Heritable mutations in BRCA1 and BRCA2 genes are a major risk factor for breast and ovarian cancer. Inherited mutations in BRCA1 increase the risk of developing breast cancers by up to 72% and ovarian cancers by up to 69%, when compared to individuals with wild-type BRCA1. BRCA1 and BRCA2 (BRCA1/2) are both important for homologous recombination-mediated DNA repair. The link between BRCA1/2 mutations and high susceptibility to breast cancer is well established. However, the potential impact of BRCA1 mutation on the individual cell populations within a tumor microenvironment, and its relation to increased aggressiveness of cancer is not well understood. The objective of this review is to provide significant insights into the mechanisms by which BRCA1 mutations contribute to the metastatic and aggressive nature of the tumor cells.

PREVENTION OF OVARIAN CANCER

Ovarian cancer is a gynecological malignancy that in Indonesia still ranks third after cervical cancer and uterine corpus cancer 1. In the United States, ovarian cancer is the second most common gynecologic cancer and the leading cause of death from gynecological cancer. Clinically, its development is different from cervical cancer. Namely, ovarian cancer does not have apparent initial clinical symptoms, so that it is difficult to detect early. As a result, 65-75% of ovarian cancer are diagnosed at an advanced stage. Symptoms of ovarian cancer are non-specific, easy to miss in the early stages; symptoms are often seen in advanced stages (stage III or stage IV) a combination of a full stomach, bloating, nausea, abdominal distension, early satiety, fatigue, changes in bowel movements, urinary symptoms, back pain, dyspareunia, and weight loss. Preventive and promotive efforts in reducing the incidence of ovarian cancer are identified risk factors for ovarian cancer.

Awareness of Toxicological Impact and Risk of using Talcum Powder as a Factor for Ovarian Cancer among Women in three Metropolitan Cities of Southwestern States, Nigeria


 
 
 This study evaluated the public awareness level on the toxicological nature of talcum powder and the perceived risk of ovarian cancer among women in order to design effective interventions that will ultimately improve public health among all women in Nigeria. A risk perception survey was developed to capture the public awareness level about talcum powder as an emerging contaminant and risk of ovarian cancer, inquiring whether risk is viewed positively or negatively and the extent of worry or concern. A total of 300 questionnaires were administered and returned, analyzed and interpreted for policy decision making. Each questionnaire contains mostly Likert type questions featuring a set of risks with fixed response alternatives. Basic descriptive statistics was considered for explanatory variables: age, educational attainment and generalized risk sensitivity. Majority of respondents use talcum powder for different purposes. 28% of respondents use talcum powder for genital hygiene, out of which 42.86% use this cosmetic product on a daily basis. Poor level of awareness was generally observed as most respondents do not know whether talcum powder could be considered a potential risk factor for ovarian cancer. Majority (66.43%) were very concerned about the risk of ovarian cancer but perceived less risk for ovarian cancer when asked to compare risk with their respective age groups. Notably, poor level of awareness about the toxicological nature of talc and the relatively high level of perceived risk of developing ovarian cancer due to previous talc exposure was evident among respondents in our study.
 
 

Pelvic inflammatory disease is associated with ovarian cancer development in women with endometriosis: A cohort study in Taiwan.

Endometriosis and pelvic inflammatory disease are considered to be risk factors for ovarian cancer, as dysbiosis probably contributes to ovarian cancer development via chronic inflammation and immune response alteration. Therefore, we hypothesized thatpelvic inflammatory disease predisposes to ovarian cancer development in women with endometriosis. We selected patients who were diagnosed with endometriosis or pelvic inflammatory disease between January 1, 2000 and December 31, 2015, in a 2million longitudinal health and welfare database in Taiwan with cancer and death registries. Patients were divided into five groups: (1) those with endometriosis, (2) those with pelvic inflammatory disease, (3) those with endometriosis diagnosed before pelvic inflammatory disease, (4) those with pelvic inflammatory disease diagnosed before endometriosis, and (5) healthy women. Propensity score matching with inverse probability of treatment weighting was used to adjust for covariates across the study groups. The risk of ovarian cancer was significantly higher in women with endometriosis and subsequent pelvic inflammatory disease than in those with endometriosis alone (hazard ratio 8.07; 95% confidence interval 4.53-14.37; P<0.001). The same result was found for ovarian cancer incidence per 1000 person-years. Our data show that pelvic inflammatory disease is associated with cancer development in women with pre-existing endometriosis.

Disease Burden and Attributable Risk Factors of Ovarian Cancer From 1990 to 2017: Findings From the Global Burden of Disease Study 2017.

Aim: We aimed to estimate the disease burden and risk factors attributable to ovarian cancer, and epidemiological trends at global, regional, and national levels.Methods: We described ovarian cancer data on incidence, mortality, and disability-adjusted life-years as well as age-standardized rates from 1990 to 2017 from the Global Health Data Exchange database. We also estimated the risk factors attributable to ovarian cancer deaths and disability-adjusted life-years. Measures were stratified by region, country, age, and socio-demographic index. The estimated annual percentage changes and age-standardized rates were calculated to evaluate temporal trends.Results: Globally, ovarian cancer incident, death cases, and disability-adjusted life-years increased by 88.01, 84.20, and 78.00%, respectively. However, all the corresponding age-standardized rates showed downward trends with an estimated annual percentage change of −0.10 (−0.03 to 0.16), −0.33 (−0.38 to −0.27), and −0.38 (−0.32 to 0.25), respectively. South and East Asia and Western Europe carried the heaviest disease burden. The highest incidence, deaths, and disability-adjusted life-years were mainly in people aged 50–69 years from 1990 to 2017. High fasting plasma glucose level was the greatest contributor in age-standardized disability-adjusted life-years rate globally as well as in all socio-demographic index quintiles and most Global Disease Burden regions. Other important factors were high body mass index and occupational exposure to asbestos.Conclusion: Our study provides valuable information on patterns and trends of disease burden and risk factors attributable to ovarian cancer across age, socio-demographic index, region, and country, which may help improve the rational allocation of health resources as well as inform health policies.

Obesity Promotes Tumor Immune Evasion in Ovarian Cancer Through Increased Production of Myeloid-Derived Suppressor Cells via IL-6.

BackgroundObesity is defined as a chronic, low-grade inflammatory disease that can cause obesity-associated disorders, such as cancer. Obesity has traditionally been thought to be a risk factor for ovarian cancer. Few reports have focused on the specific pathogenesis of obesity-related ovarian cancer. When considering the correlation between obesity and the relative risk of death from ovarian cancer, we investigated whether obesity promotes tumor immune escape in ovarian cancer.ResultsIn the present study, obese mice were found to have higher rates of tumor growth and tumor infiltration than mice of normal weight. Obesity increased the proportion of myeloid-derived suppressor cells (MDSCs) in peripheral blood compared with mice of normal weight. In addition, the levels of CCL25, CD40L, GM-CSF, IL-5, IGFBP2, IL-6, MMP3, and MMP9 in the peripheral blood, bone marrow, and ovarian tissue of obese mice were higher than in mice of normal weight. Moreover, IL-5 and IL-6 significantly enhanced the expression levels of S100A8 and S100A9 in MDSCs. When compared with the levels in mice of normal weight, the expression levels of S100A8 and S100A9 in the MDSCs of OB/OB mice were also higher within the tumor microenvironment. The infiltration of MDSCs in ovarian cancer was found to be positively correlated with the expression levels of IL-6. The IL-6 expression levels in ovarian cancer tissue are positively correlated with the expression levels of S100A8 and S100A9, which is consistent with the results of previous animal experiments. Finally, we found that LMT28 can suppress the tumor growth by inhibiting IL-6.ConclusionObesity promotes the expression of the MDSC-related immunosuppressive genes S100A8 and S100A9 by upregulating IL-6, thus promoting tumor immune evasion and metastasis in ovarian cancer.

Weight Gain and the Risk of Ovarian Cancer in BRCA1 and BRCA2 Mutation Carriers.

Weight gain and other anthropometric measures on the risk of ovarian cancer for women with BRCA mutations are not known. We conducted a prospective analysis of weight change since age 18, height, body mass index (BMI) at age 18, and current BMI and the risk of developing ovarian cancer among BRCA1 and BRCA2 mutation carriers. In this prospective cohort study, height, weight, and weight at age 18 were collected at study enrollment. Weight was updated biennially. Cox proportional hazards models were used to estimate the hazard ratio (HR) and 95% confidence intervals (CI) for ovarian cancer. This study followed 4,340 women prospectively. There were 121 incident cases of ovarian cancer. Weight gain of more than 20 kg since age 18 was associated with a 2-fold increased risk of ovarian cancer, compared with women who maintained a stable weight (HR, 2.00; 95% CI, 1.13-3.54; P = 0.02). Current BMI of 26.5 kg/m2 or greater was associated with an increased risk of ovarian cancer in BRCA1 mutation carriers, compared with those with a BMI less than 20.8 kg/m2 (Q4 vs. Q1 HR, 2.13; 95% CI, 1.04-4.36; P = 0.04). There were no significant associations between height or BMI at age 18 and risk of ovarian cancer. Adult weight gain is a risk factor for ovarian cancer in women with a BRCA1 or BRCA2 mutation. These findings emphasize the importance of maintaining a healthy body weight throughout adulthood in women at high risk for ovarian cancer.

The Prevent Ovarian Cancer Program (POCP): Identification of Women at Risk for Ovarian Cancer Using Complementary Recruitment Approaches

(Abstracted from Gynecol Oncol 2021;162:97–106) High-grade serous ovarian cancer (HGSOC) accounts for 70% of ovarian cancer cases and is the deadliest subtype of ovarian cancer. Approximately 20% of ovarian cancers are hereditary, and the greatest single risk factor for ovarian cancer is the inheritance of a pathogenic variant (PV) such as BRCA1 or BRCA2.

Four Prognosis-Associated lncRNAs Serve as Biomarkers in Ovarian Cancer.

Long non-coding RNAs (lncRNAs) play crucial roles in ovarian cancer (OC) development. However, prognosis-associated lncRNAs (PALs) for OC have not been completely elucidated. Our study aimed to identify the PAL signature of OC. A total of 663 differentially expressed lncRNAs were identified in the databases. According to the weighted gene coexpression analysis, the highly correlated genes were clustered into seven modules related to the clinical phenotype of OC. A total of 25 lncRNAs that were significantly related to overall survival were screened based on univariate Cox regression analysis. The prognostic risk model constructed contained seven PALs based on the parameter λmin, which could stratify OC patients into two risk groups. The results showed that the risk groups had different overall survival rates in both The Cancer Genome Atlas (TCGA) and two verified Gene Expression Omnibus (GEO) databases. Univariate and multivariate Cox regression analyses confirmed that the risk model was an independent risk factor for OC. Gene enrichment analysis revealed that the identified genes were involved in some pathways of malignancy. The competitive endogenous RNA (ceRNA) network included five PALs, of which four were selected for cell function assays. The four PALs were downregulated in 33 collected OC tissues and 3 OC cell lines relative to the control. They were shown to regulate the proliferative, migratory, and invasive potential of OC cells via Cell Counting Kit-8 (CCK-8) and transwell assays. Our study fills the gaps of the four PALs in OC, which are worthy of further study.

Barriers to healthcare seeking, beliefs about ovarian cancer and the role of socio-economic position. A cross-sectional multilevel study in Dubai, a multicultural society.

Background: Studies have shown that public awareness of ovarian cancer is weak, and women are often diagnosed at late stages when treatment is difficult. This study aimed to determine the barriers for seeking early medical care and level of knowledge and awareness among women regarding ovarian cancer.Design and methods: A structured questionnaire was designed and adapted from the validated cancer awareness measure.Results: The recognition level of ovarian cancer symptoms among women in this study varied from 12-51%, and the most alarming ones, back pain, eating difficulties, and persistent abdominal pain, were missed by most of the surveyed women. The most recognized ovarian cancer risk factors were never being pregnant, having a history of infertility, and going through menopause, while the least recognized was having personal or family history of breast cancer. Non-UAE nationals women with higher educational levels had better knowledge of ovarian cancer compared to their peers.Conclusions:A change or implementation model is highly recommended in order to improve women’s awareness of ovarian cancer symptoms. Strengthening education among women with regards to risk factors, early symptoms, and the need to seek early medical help should help to increase ovarian cancer awareness and reduce a delay in the diagnosis. Significance for public health In the absence of effective screening, "appropriate clinical suspicion" of the signs and symptoms of the ovarian cancer is currently the best strategy to detect the disease. To reduce the diagnostic interval, several countries have implemented referral guidelines and organizational changes. Most of these guidelines suggest that individuals presenting with symptoms indicative of cancer (alarm symptoms) should be urgently referred to specialized investigative trajectories. However, many studies worldwide have shown that public awareness levels of ovarian cancer are poor, therefore women are often diagnosed at late stages when treatment is difficult. Our findings demonstrate that the overall level of recognition of risk factors and symptoms of ovarian cancer among women in the UAE is indeed low and within a critical level. Thus, strengthening education among women with regards to risk factors, early symptoms, and the need to seek early medical will be helpful in increasing ovarian cancer awareness and reducing the delay in diagnosis.

A recurrent pathogenic BRCA2 exon 5-11 duplication in the Christian Arab population in Israel.

Germline pathogenic variants (PVs) in BRCA1/BRCA2 are well-established risk factors for breast cancer (BC) and/or ovarian cancer (OC). Founder PVs have been described in BRCA1/ BRCA2 in several genetic isolates. The Christian Arab population in the Middle East is a relatively isolated ethnic group, yet founder, or recurrent BRCA1/BRCA2 PVs have not been reported in this population. In this study we describe PVs detected in cancer susceptibility genes among a cohort of Christian Arabs from Israel. We reviewed patient records from the Oncogenetic clinic at Rambam Health Care Campus during the years 2013- mid 2020. Thirty-five unrelated Christian Arab patients, with personal or family history of BC and/or OC underwent BRCA1/BRCA2 (14/35) testing or cancer gene panel testing (21/35) as part of their diagnostic workup. Three clinically significant variants in BRCA2, CHEK2 and RAD51C were found in 7/35 patients (20%). A recurrent duplication of the BRCA2 genomic region, encompassing exons 5-10 and the 5' portion of exon 11, was found in 5/33 (15.2%) patients for whom copy number variants (CNVs) analysis was performed. We identified a recurrent pathogenic BRCA2 duplication in Christian Arab patients with a personal/ family history of BC and/or OC. Our findings emphasize the importance of inclusion of CNVs analysis in BRCA1/BRCA2 genetic testing, and specifically for Christian Arab patients suspected of hereditary BC and/or OC.

EP551 - Weight gain and the risk of ovarian cancer in BRCA1 and BRCA2 mutation carriers

Background: Weight gain and other anthropometric measures on the risk of ovarian cancer for women with BRCA mutations are not known. We conducted a prospective analysis of weight change since age 18, height, body mass index (BMI) at age 18, and current BMI and the risk of developing ovarian cancer among BRCA1 and BRCA2 mutation carriers. Methods: In this prospective cohort study, height, weight, and weight at age 18 were collected at study enrollment. Weight was updated biennially. Cox proportional hazards models were used to estimate the hazard ratio (HR) and 95% confidence intervals (CI) for ovarian cancer. Results: This study followed 4,340 women prospectively. There were 121 incident cases of ovarian cancer. Weight gain of more than 20 kg since age 18 was associated with a 2-fold increased risk of ovarian cancer, compared with women who maintained a stable weight (HR, 2.00; 95% CI, 1.13–3.54; P = 0.02). Current BMI of 26.5 kg/m2 or greater was associated with an increased risk of ovarian cancer in BRCA1 mutation carriers, compared with those with a BMI less than 20.8 kg/m2 (Q4 vs. Q1 HR, 2.13; 95% CI, 1.04–4.36; P = 0.04). There were no significant associations between height or BMI at age 18 and risk of ovarian cancer. Conclusions: Adult weight gain is a risk factor for ovarian cancer in women with a BRCA1 or BRCA2 mutation. Impact: These findings emphasize the importance of maintaining a healthy body weight throughout adulthood in women at high risk for ovarian cancer.

The association of resistance training with risk of ovarian cancer.

ABSTRACTBackgroundIncreasing evidence, including multiple putative inflammatory risk factors (e.g., c‐reactive protein, and adiposity), supports that inflammation plays an important role in ovarian carcinogenesis. Resistance training (RT) is associated with lower levels of circulating inflammatory markers, independent of physical activity.MethodsWe evaluated the relationship between RT and risk of ovarian cancer accounting for other physical activity (e.g., walking) in two large prospective cohorts, the Nurses’ Health Study (NHS) and NHSII.Key ResultsIn total, analyses included 42,005 NHS participants (2000–2016) and 67,289 NHSII participants (2001–2017) with RT assessed every 4 years. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of RT with ovarian cancer risk overall and by tumor subtype, adjusting for known and putative ovarian cancer risk factors. We identified a total of 609 cases over 1,748,884 person‐years. No association was observed with overall ovarian cancer risk (RT ≥60 vs 0 min/wk, HR = 0.95, 95%CI: 0.74–1.22) or by histotype (comparable HR = 0.86 and 0.98 for type I and II tumors, respectively). Results did not differ by body mass index (Pinteraction = 0.97), or other physical activity (Pinteraction = 0.31).Conclusions & InferencesWe observed no evidence that moderate levels of RT were associated with risk of ovarian cancer. Further investigations are required to confirm these findings.

Prospective Analyses of Lifestyle Factors Related to Energy Balance and Ovarian Cancer Risk by Infiltration of Tumor-Associated Macrophages.

Lifestyle factors related to energy balance have been associated with ovarian cancer risk and influence the tumor immune microenvironment, including tumor-associated macrophages (TAM). However, no studies have assessed whether these factors differentially impact ovarian cancer risk by TAM densities. We conducted a prospective analysis in the Nurses' Health Studies to examine the associations of physical activity, sitting time, and a food-based empirical dietary inflammatory pattern (EDIP) score with invasive epithelial ovarian cancer risk by TAM density assessed by immunohistochemistry. We considered density of CD68 (marker of total TAMs) and CD163 (marker of pro-carcinogenic M2-type TAMs), and their ratios. We used multivariable Cox proportional hazards regression to calculate hazard ratios (HR) and 95% confidence intervals (CI) of exposures with risk of ovarian tumors with high versus low TAMs, including analyses stratified by body mass index. Analyses included 312 incident ovarian cancer cases with TAM measurements. Physical activity, sitting time, and EDIP score were not differentially associated with ovarian cancer risk by TAM densities (P heterogeneity > 0.05). Among overweight and obese women, higher EDIP score was associated with increased risk of CD163 low-density tumors (HR comparing extreme tertiles, 1.57; 95% CI, 0.88-2.80; P trend = 0.01), but not CD163 high-density tumors (comparable HR, 1.16; 95% CI, 0.73-1.86; P trend = 0.24), though this difference was not statistically significant (P heterogeneity = 0.22). We did not observe differential associations between lifestyle factors and ovarian cancer risk by TAM densities. Future investigations examining the interplay between other ovarian cancer risk factors and the tumor immune microenvironment may help provide insight into ovarian cancer etiology.

Risk Factors for Ovarian Cancer among Libyan Women

Ovarian cancer is the third type of gynecologic cancer in terms of prevalence after cervical and uterinecancer. The disease is known as the silent killer as it is slowly spread without a diagnosis, which leads to theworst prognosis and high mortality rate. Libya shows low disease incidence while the high mortality rate isseen in developed countries due to a lack of proper diagnostic and treatment options. This research aims tounderstand the various risk factors of ovarian cancer among the women in Libya. A questionnaire is usedin a quantitative research methodology using stratified random sample over the population is divided in twoclasses namely healthy and diseased, based on earlier diagnosis and ovarian cancer care. The diseased andhealthy women were targeted in a written survey in different hospitals and clinics in Libya. The data analysisis done in four stages. The first stage is cleaning and coding of the data. The second step is the demographicprofile of the respondents. The third stage. Frequency distribution of the data in order to compare the healthyand diseased women. The fourth stage is the linear logistic regression in order to determine the risk factorsfor ovarian cancer and test the research hypotheses. The logistic regression analysis indicated good fit of themodel. The model was able to correctly predicted 81.4 % of the cases which is 19.6 % increase over the nullmodel. The logistic regression analysis was also used to indicate the predictors namely family history, levelof obesity, ovulation information, use of birth control and breast feeding unlike awareness, nature of dietwhich was not predictor in the model.

Risk Factors for Ovarian Cancer: A Literature Review

Ovarian cancer is the third type of gynecologic cancer in terms of prevalence after cervical and uterinecancer. The disease is known as the silent killer as it is slowly spread without a diagnosis, which leads tothe worst prognosis and high mortality rate. Libya shows low disease incidence while the high mortalityrate is seen in developed countries due to a lack of proper diagnostic and treatment options. This researchaims to understand the various risk factors of ovarian cancer described in literature. Based on the literaturereview related to various factors which are the demographic, reproductive history, hormonal factors, geneticfactors, lifestyle such as diet and BMI. Various controversial in literature exist on the effect of these factorsand their association with risk factors.

Searching the PDF Haystack: Automated Knowledge Discovery in Scanned EHR Documents.

Clinicians express concern that they may be unaware of important information contained in voluminous scanned and other outside documents contained in electronic health records (EHRs). An example is "unrecognized EHR risk factor information," defined as risk factors for heritable cancer that exist within a patient's EHR but are not known by current treating providers. In a related study using manual EHR chart review, we found that half of the women whose EHR contained risk factor information meet criteria for further genetic risk evaluation for heritable forms of breast and ovarian cancer. They were not referred for genetic counseling. The purpose of this study was to compare the use of automated methods (optical character recognition with natural language processing) versus human review in their ability to identify risk factors for heritable breast and ovarian cancer within EHR scanned documents. We evaluated the accuracy of the chart review by comparing our criterion standard (physician chart review) versus an automated method involving Amazon's Textract service (Amazon.com, Seattle, Washington, United States), a clinical language annotation modeling and processing toolkit (CLAMP) (Center for Computational Biomedicine at The University of Texas Health Science, Houston, Texas, United States), and a custom-written Java application. We found that automated methods identified most cancer risk factor information that would otherwise require clinician manual review and therefore is at risk of being missed. The use of automated methods for identification of heritable risk factors within EHRs may provide an accurate yet rapid review of patients' past medical histories. These methods could be further strengthened via improved analysis of handwritten notes, tables, and colloquial phrases.