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Epidemiology and clinical relevance

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World (thousands) cases: 204 Deaths 125Europe cases: 63 Deaths 40

3La Vecchia et al, Ann Oncol 2010

Age standardized mortality rates, UE

_____ all ages………35-64 years

Temporal trends of incidence and mortality rates, Italy

4AIRTUM, Epidemiologia e prevenzione 2006

Incidence and mortality rates in strata of age, Italy

5AIRTUM, Epidemiologia e prevenzione 2006

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High incidence

area

High/low incidence areas incidence ratio

Low incidence

area

Cervical cancer

Columbia 15 Israel

Breast cancer

Canada, Columbia Britannica

7 Israel, not Jewish women

Endometrial cancer

USA, California

30 Japan

Ovarian cancer

Denmark 6 Japan

Serous 40 percent of all ovarian cancers; most common ovarian cancer

Endometrioid 20 percent of all ovarian cancers; 15 percent of endometrioid carcinomas coexist withendometriosis; 40 percent bilateral

Mucinous 25 percent of all ovarian cancers; origin unclear; may occur in association withendometriosis; associated with pseudomyxoma peritonei

Main factors associated with ovarian cancer risk

Increased riskEarly menarche/late

menopauseEndometriosis

Estrogen replacement therapy

Family historyGenetic syndromes

High-fat dietLow parity

Decreased riskEarly menopause/late

menarcheMultiparity

HysterectomyLow-fat diet

Oral contraceptive use

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Relative risk Attributable risk

Nulliparity 2.0 5

Menarche<11y and menopause >50y

1.8 10

OC use. (>24 months)

0.5 12

Familiarity 2.1 2

Histerectomy 0.7 3

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HRT use and hystologic subtypes

Serous Mucinous Endometriosis

Risch et al., 1996 1.4 0.7 1.9

Purdie et al., 1999 2.6

Parazzini et al., 2001 1.3 1.4 1.5

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Ron et al., 1987Shu et al., 1989Brinton et al., 1989Whittemore et al., 1992Harris et al., 1992Rossing et al., 1994Risch et al., 1994Franceschi et al., 1994Venn et al., 1995Purdie et al., 1995Shushan et al., 1996Parazzini et al., 1997Mosgaard et al., 1997

Published studies on the relation between fertility treatments and ovarian cancer risk

Glud et al., 1998Modan et al., 1998Nugent et al., 1998Cramer et al., 1998Parazzini et al., 1998Potashnik et al., 1999Venn et al., 1999Klip et al., 2000Ness et al., 2000Parazzini et al., 2001Goodman et al., 2001Ness et al., 2002Lerner geva 2010

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Casi Controlli N. % N. % OR (95% CI)

Total No 1016 98.5% 2385 98.9% 1.0 yes 15 1.5% 26 1.1% 1.3 (0.7-2.5)

Nulliparae No 181 98.4% 370 97.1% 1.0 Yes 3 1.6% 11 2.9% 0.6 (0.1-2.0)

Parae No 835 98.6% 2015 99.3% 1.0 Yes 12 1.4% 15 0.7% 1.9 (0.9-4.1)

Parazzini et al., 2001

Fertility treatments od risk of ovarian cancer

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Cases Controls Adj OR 95% C.I.

ClomipheneNo 892 1070 1.01-3 m 17 25 0.9 (0.5 - 1.7)4-12 16 29 0.8 (0.4 - 1.4)> 12 9 10 1.2 (0.5 - 3.0)

GonadotropinNo 916 1110 1.01-3m 10 10 1.5 (0.6 - 3.6)4-12 6 13 0.6 (0.2 - 1.6)> 12 3 1 4.5 (0.5 -

44.1)

Ness et al., 2002

Incidence of ovarian cancer among patents with endometrioiss and the general Swedish population

(Melin et al, 2006)

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Diet and ovarian cancer

• Cases-controls studies have shown a positive association between fat consumption and risk of ovarian cancer

• Cases-controls studies have shown a negative association between fat vitamin A,C, E and risk of ovarian cancer

• The women Health Initiative Dietary Modification Randomized Controlled Study has shown a decreased risk of ovarian cancer after 4 years of low fat diet(Prentice et al, 2007)

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