1. 1 Epidemiology and clinical relevance

2. 2 World (thousands) cases: 204 Deaths 125 Europe cases: 63 Deaths 40

3. 3 La Vecchia et al, Ann Oncol 2010 Age standardized mortality rates, UE _____ all ages ………35-64 years

4. Temporal trends of incidence and mortality rates, Italy 4 AIRTUM, Epidemiologia e prevenzione 2006

5. Incidence and mortality rates in strata of age, Italy 5 AIRTUM, Epidemiologia e prevenzione 2006

6. 6 High incidence area High/low incidence areas incidence ratio Low incidence area Cervical cancer Columbia15Israel Breast cancer Canada, Columbia Britannica 7Israel, not Jewish women Endometrial cancer USA, California 30Japan Ovarian cancer Denmark6Japan

7. Serous 40 percent of all ovarian cancers; most common ovarian cancer Endometrioid 20 percent of all ovarian cancers; 15 percent of endometrioid carcinomas coexist with endometriosis; 40 percent bilateral Mucinous 25 percent of all ovarian cancers; origin unclear; may occur in association with endometriosis; associated with pseudomyxoma peritonei

8. Main factors associated with ovarian cancer risk Increased risk Early menarche/late menopause Endometriosis Estrogen replacement therapy Family history Genetic syndromes High-fat diet Low parity Decreased risk Early menopause/late menarche Multiparity Hysterectomy Low-fat diet Oral contraceptive use

9. 9 Relative riskAttributable risk Nulliparity2.05 Menarche 50y 1.810 OC use. (>24 months) 0.512 Familiarity2.12 Histerectomy0.73

10. 10 HRT use and hystologic subtypes SerousMucinousEndometriosis Risch et al., 19961.40.71.9 Purdie et al., 19992.6 Parazzini et al., 20011.31.41.5

11. 11 Ron et al., 1987 Shu et al., 1989 Brinton et al., 1989 Whittemore et al., 1992 Harris et al., 1992 Rossing et al., 1994 Risch et al., 1994 Franceschi et al., 1994 Venn et al., 1995 Purdie et al., 1995 Shushan et al., 1996 Parazzini et al., 1997 Mosgaard et al., 1997 Published studies on the relation between fertility treatments and ovarian cancer risk Glud et al., 1998 Modan et al., 1998 Nugent et al., 1998 Cramer et al., 1998 Parazzini et al., 1998 Potashnik et al., 1999 Venn et al., 1999 Klip et al., 2000 Ness et al., 2000 Parazzini et al., 2001 Goodman et al., 2001 Ness et al., 2002 Lerner geva 2010

12. 12 Casi Controlli N. % N. % OR (95% CI) Total No 101698.5% 2385 98.9%1.0 yes 15 1.5% 26 1.1%1.3 (0.7-2.5) Nulliparae No 18198.4% 370 97.1%1.0 Yes 3 1.6% 11 2.9%0.6 (0.1-2.0) Parae No 83598.6% 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

13. 13 Cases Controls Adj OR 95% C.I. Clomiphene No89210701.0 1-3 m 17 250.9(0.5 - 1.7) 4-12 16 290.8(0.4 - 1.4) > 12 9 101.2(0.5 - 3.0) Gonadotropin No91611101.0 1-3m 10 101.5(0.6 - 3.6) 4-12 6 130.6(0.2 - 1.6) > 12 3 14.5(0.5 - 44.1) Ness et al., 2002

14. Incidence of ovarian cancer among patents with endometrioiss and the general Swedish population (Melin et al, 2006) 14

15. 15 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)

16. grazie 16