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Reducing Ovarian Cancer Risks: Prevention Strategies & Controversies

Learn about factors that influence ovarian cancer risk, prevention methods, and controversies surrounding NSAIDS, fertility drugs, and diet. Find out the impact of BRCA mutations, infertility, and endometriosis on risk levels. Discover preventive measures such as oral contraceptives, pregnancies, and oophorectomy. Stay informed on talc use, hormone replacement therapy, and the potential benefits of aspirin. Empower yourself with knowledge to reduce ovarian cancer risks effectively.

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Reducing Ovarian Cancer Risks: Prevention Strategies & Controversies

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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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