Epidemiology and etiology

In 2009, there were an estimated 21,550 new cases of ovarian cancer diagnosed with an associated 14,600 deaths.1 Ovarian cancer remains the number one gynecologic killer and the fifth leading cause of cancer-related death in women. Despite great efforts and extensive research, there has been little change in the mortality rate associated with ovarian cancer over the past three decades. The high mortality associated with ovarian cancer can be attributed to its insidious onset of nonspecific symptoms resulting in the majority of patients not presenting until the cancer has progressed to stage III-IV disease.

As with many other disease states, a significant risk factor associated with ovarian cancer is aging. A woman's risk increases as her age advances from 40 to 79 years, with the mean age at diagnosis being 63, majority of women being diagnosed between 55 and 64 years.

O Ovarian cancer is a sporadic disease, less than 10% of ovarian cancers can be attributed to heredity. Majority of the cases of ovarian cancer occur sporadically, thus making it difficult to screen and prevent. Although hereditary accounts for less than 10% of all ovarian cancer cases, when there is a family history it appears to be

an important risk factor in the development of ovarian cancer in some patients. If one family member has a diagnosis of ovarian cancer, the associated risk is about 9%, but this risk increases to greater than 50% if there are two or more first-degree relatives, that is, mother and sister, with a diagnosis of ovarian cancer or multiple cases of ovarian and breast cancer. Both breast cancer activator gene 1 (BRCA1) and breast cancer activator gene 2 (BRCA2) mutations have been associated with ovarian cancer. However, BRCA1 is more prevalent, being associated with 90% of hereditary and 10% of sporadic cases of ovarian cancer. Hereditary breast and ovarian cancer (HBOC) syndrome is one of the two different forms of hereditary ovarian cancer and is associated with germ-line mutations in BRCA1 and BRCA2.3,4 The hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch syndrome is a familial syndrome with germ-line mutations causing defects in enzymes involved in DNA mismatch repair (MMR), which has been associated with up to 12% of hereditary ovarian cancer cases.4

Although it is not clearly defined, hormones and reproductive history are associated with the risk of developing ovarian cancer. Nulliparity, infertility, early men-arche, or late menopause is associated with an increased risk of ovarian cancer.5,6

Ovarian cancer is associated with certain dietary and environmental factors as well. A diet that is high in galactose and animal fat and meat increases the risk of ovarian

cancer, whereas a vegetable-rich diet is suggested to decrease the risk. ' Although controversial, exogenous factors such as asbestos and talcum powder use on the peri-

neal area have also been suggested to increase the risk of ovarian cancer. '

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