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Prevention of Ovarian Cancer

Prevention of Ovarian Cancer. Roberta B. Ness , M.D., M.P.H., Chair of the Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health. What Puts Women at Risk?. Family history of ovarian and breast cancers Infertility Endometriosis Talc use

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Prevention of Ovarian Cancer

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  1. Prevention of Ovarian Cancer Roberta B. Ness, M.D., M.P.H., Chair of the Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health

  2. What Puts Women at Risk? • Family history of ovarian and breast cancers • Infertility • Endometriosis • Talc use • Hormone replacement therapy

  3. Does Anything Prevent Ovarian Cancer? • Oral contraceptives • Pregnancies • Breast feeding (long duration) • Tubal ligation • Oophorectomy and hysterectomy

  4. Controversies • NSAIDS • Fertility drugs • Androgens • Diet: fat, coffee

  5. Ovarian Cancer Risk and Protection

  6. Probability of a 50 yo Non-Jewish Woman with Ovarian Cancer Carrying a BRCA1 Mutation

  7. Probability of a 50 yo Jewish Woman with Ovarian Cancer Carrying a BRCA1 Mutation

  8. The Legacy of BRCA BRCA1: Lifetime Risk of Ovarian Cancer: 28-66% BRCA2: Risk by age 50: <1% But by age 70: 27%

  9. Infertility and Ovarian Cancer Risk Compared to women with 3 or more pregnancies… RISK Women with 0 pregnancies not trying 2.1 Women with 0 pregnancies trying 4.3

  10. 1.9 X 1.7 1.7 X X Risk 1.0 Brinton Ness Ness 2000 2002 Endometriosis

  11. Hypotheses (New) • Inflammation:Pelvic inflammation exposes the lining of the ovary to toxic mediators and makes cells quickly turnover. Both may be mutagenic.

  12. Etiologic Hypotheses (New) Androgens and Progestins • Androgen exposure elevates risk • Progestins reduce risk

  13. Talc Use and Ovarian Cancer

  14. Oral Contraceptives and Ovarian Cancer • Risk 30-40%  • Longer use, more protection • Protection 20 or more years after last use • New OCs protective • May be best: low estrogen high progestin

  15. Pregnancies and Ovarian Cancer

  16. Breast Feeding and Ovarian Cancer 0 6 12 18 24

  17. Tubal Ligation

  18. 1.0 0.9 0.8 0.7 Surveillance (n=72) 0.6 0 12 24 36 48 60 72 84 Oophorectomy Salpingo-oophorectomy (n=98) Cumulative Proportion without Breast or BRCA-Related Gynecologic Cancer Months

  19. FertilityDrugs

  20. Oral Contraception in Women with BRCA Mutations or Family History • Modan (2001) • Women without mutations protected • Women with mutations not protected • Narod (1998) • All women with or without BRCA mutations protected • Walker (2002) • All women with or without family history protected

  21. Tubal Ligation in BRCA Carriers

  22. Aspirin Use Risk 1.0 0.90.9 0.75 X X X 0.7 0.6 0.5 X X X Tzonou Cramer Rosenberg Tavani Akhmed Moysich 1984 1998 2000 2000 2001 2001 khanov

  23. health Thursday March 8, 2001 Time.com Could a Common Painkiller Cut Your Risk of Ovarian Cancer?

  24. What Can You (and Yours) Change? Anyone • Oral Contraceptive Use • Pregnancies and Breast Feeding • Tubal Ligation • Don’t Use Talc • Don’t Use HRT (except for perimenopausal symptoms)

  25. What Can You (And Yours) Change? • Oophorectomy after family size completed • Oral contraceptive use • Tubal ligation BRCA Mutation Carriers

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