Epidemiology, etiology, and fertility drugs in ovarian epithelial carcinoma: where are we today?

Our plain-English summary of Epidemiology, etiology, and fertility drugs in ovarian epithelial carcinoma: where are we today?, by Z. Shoham (Fertility and Sterility, 1994).

The study

• Author: Z. Shoham
• Journal: Fertility and Sterility
• Published: 1994;62(3):433-48
• Type of article: Review
• Cited by: 78 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: To review studies that have examined the epidemiology and etiology of the development of epithelial carcinoma of the ovary.

Data Identification: Important published studies related to the topic were identified through a computerized bibliography search.

Conclusion: A review of the literature reveals that the etiology of epithelial ovarian cancer is probably multifactorial and that genetic, environmental, hormonal, and viral factors appear to be directly or indirectly related to the development of the disease. An attempt to implicate specific agents has not produced conclusive results. However, based on large epidemiologic studies, it seems that there is a clear trend of decreasing risk with increasing number of pregnancies, deliveries, use of oral contraceptives, and the duration of breast feeding. An increased risk was found to be associated with ovarian dysfunction leading to infertility and exposure to asbestos and talc. The recent observation that infertile women who used fertility drugs might experience an increased risk for the development of epithelial ovarian cancer should be examined very carefully because of the small number of patients in the study, lack of appropriate information about the type of infertility, drugs used, dosage, and duration of treatment. Because there are no screening tests that are consistently accurate enough to detect ovarian cancer at an early stage, translating the current information into disease prevention requires careful clinical evaluation with a routine follow-up of patients at risk.

In plain English

This article reviewed published studies, found by computerized bibliography search, on the causes and epidemiology of epithelial ovarian cancer. Risk factors were grouped as genetic, environmental and hormonal. Among environmental factors, the author described work on a possible link with materials of the talc-asbestos group. One study found talc-like particles in ovaries with carcinoma and produced ovarian tumors in guinea pigs given asbestos. Another found a slightly elevated frequency of ovarian carcinoma in female asbestos workers. A case-control study reported a relative risk of 1.92 for regular perineal use of talc powder. Studies linking more pregnancies, oral contraceptives and breastfeeding with lower risk were also summarized. In a pooled analysis of U.S. studies in white women, infertile women who had used fertility drugs had an odds ratio of 2.8 (95% CI 1.3 to 6.1) for invasive epithelial ovarian cancer versus women with no history of infertility. Thirty-one women in that analysis had such a history; the drugs and doses were not known. The author concluded that the cause is probably multifactorial and that no specific agent had been conclusively implicated.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Literature review (no new data collected by the author)
• Who was studied: Published studies on epithelial ovarian cancer, identified through a computerized bibliography search; no study population of the author's own
• Exposure: Suspected risk factors reviewed: genetic, environmental (including materials of the talc-asbestos group, and diet), hormonal and reproductive factors, infertility, and fertility drugs
• Main results:
  • Reviewed study (Graham and Graham): particles similar to talc were found in ovaries with ovarian carcinoma, and ovarian neoplasms were induced in guinea pigs with asbestos
  • Reviewed study (Newhouse et al.): a slightly elevated frequency of ovarian carcinoma was found in female asbestos workers
  • Reviewed case-control study (Cramer et al.): 42.8% of ovarian cancer patients regularly used talc powder in the perineal area, compared with 28.4% of controls, giving a relative risk of 1.92 (P < 0.003)
  • Across large epidemiologic studies, the author described a trend of decreasing risk with more pregnancies and deliveries, use of oral contraceptives, and longer breastfeeding. In one reviewed pooled European analysis, women with four or more births had a relative risk of 0.6 (95% CI 0.4 to 0.8) compared with women who had never given birth
  • The reviewed pooled analysis by Whittemore et al. covered invasive epithelial tumors in white women, using data from 12 U.S. case-control studies
  • In that pooled analysis, infertile women who had received fertility drugs had an odds ratio of 2.8 (95% CI 1.3 to 6.1) for invasive epithelial ovarian cancer, compared with women who had no history of infertility
  • In that analysis, 31 women had any history of fertility drug use, and the specific drugs, dosage, duration of therapy and type of infertility treatment were not known
• The authors' conclusion: The author concluded that the cause of epithelial ovarian cancer is probably multifactorial and that attempts to implicate specific agents had not produced conclusive results. The author also concluded that the reported increased risk with fertility drugs should be examined very carefully.
• Limitations the authors state:
  • The author states that the review did not set out to assess the methods, statistical analysis or results of the Whittemore et al. study

Topics

The National Library of Medicine indexes this study under subjects our site covers: Ovarian cancer.

Medical terms in this study, explained in our Lexicon: Epidemiology, Etiology, Carcinoma, Ovarian Cancer, Talc.

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