Prevention of Ovarian Cancer Roberta B. NessRoberta 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 Hormone replacement therapy

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

Controversies NSAIDS Fertility drugs Androgens Diet: fat, coffee

Ovarian Cancer Risk and Protection

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

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

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

Infertility and Ovarian Cancer Risk Compared to women with 3 or more pregnancies… RISK Women with 0 pregnancies not trying2.1 Women with 0 pregnancies trying4.3

Endometriosis Risk X 1.7 X Brinton Ness Ness

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

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

Talc Use and Ovarian Cancer

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

Pregnancies and Ovarian Cancer

Breast Feeding and Ovarian Cancer

Tubal Ligation

Oophorectomy Cumulative Proportion without Breast or BRCA-Related Gynecologic Cancer Salpingo- oophorectomy (n=98) Months Surveillance (n=72)

Fertility Drugs

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

Tubal Ligation in BRCA Carriers

Aspirin Use Tzonou Cramer Rosenberg Tavani Akhmed Moysich Risk X X X X X X khanov

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

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)

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