Men with testicular cancer continue to be at significantly elevated risk of second malignant neoplasms for more than two decades following initial diagnosis. Patterns of excess second cancers suggest that many factors may be involved, although the precise roles of treatment, natural history, diagnostic surveillance, and other influences are yet to be clarified.

Platinum-based treatment of ovarian cancer increases the risk of secondary leukemia. Nevertheless, the substantial benefit that platinum-based treatment offers patients with advanced disease outweighs the relatively small excess risk of leukemia.

Past treatments for testicular cancer are associated with an increased risk of leukemia, with evidence for dose-response relationships for both radiotherapy and cisplatin-based chemotherapy. Statistically nonsignificant excesses are estimated for current radiotherapy regimens limited to the abdomen and pelvis: Among 10 000 patients given a treatment dose of 25 Gy and followed for 15 years, an excess of nine leukemias is predicted; cisplatin-based chemotherapy (dose, 650 mg) might result in 16 cases of leukemia. The survival advantage provided by current radiotherapy and chemotherapy regimens for testicular cancer far exceeds the small absolute risk of leukemia.

Use of hormone replacement therapy (HRT) has been hypothesized to affect survival of epithelial ovarian cancer (EOC). We studied 5-year survival in patients with invasive EOC and borderline ovarian tumors (BOT) according to HRT use before and after diagnosis in a prospective nation-wide cohort study of 799 women diagnosed with EOC (n 5 649) and BOT (n 5 150) aged 50-74 years in 1993-1995 in Sweden. Cox regression was used to obtain multivariate age-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Multivariate models included indicator variables for age, tumor stage, grade and histological subtype. After 5 years of follow-up, 45% of the patients with EOC and 93% of the patients with BOT were alive. For women with BOT there were no associations between HRT-use pre-or postdiagnosis and survival. There was no overall difference in 5-year EOC survival according to use HRT before diagnosis (multivariate HR 5 0.83, 95% CI 5 0.65-1.08), except for serous EOC (HR 5 0.69, 95% CI 5 0.48-0.98). Analyses of different HRT preparations, duration and recency of use did not reveal any variations in pattern of survival. We observed a better survival for EOC-patients who used HRT after diagnosis (multivariate HR 5 0.57, 95% CI 5 0.42-0.78). We conclude that HRT-use prior to diagnosis of EOC does not affect 5-year survival, except for a possible survival advantage in serous EOC. Women using HRT after diagnosis had a better survival than women with no use, but we cannot rule out that this latter finding may reflect a subtle selection process. ' 2006 Wiley-Liss, Inc.Key words: ovarian cancer; hormonal replacement therapy; survival; mortality; Sweden Hormonal factors are believed to be of fundamental importance in the etiology of ovarian cancer, the 6th most frequent type of female cancer in the world. 1 Ovarian cancer is usually associated with a rather poor prognosis, with overall 5-year survival rates commonly less than 40%. 2 In recent decades in Sweden, HRT has been widely used for relief of climacteric symptoms and to prevent osteoporosis. Progestins without estrogens are mainly used for the treatment of climacteric bleeding irregularities, and for the alleviation of symptoms related to benign appearing ovarian cysts. Estriol can be bought over the counter, and is mostly used for symptomatic treatment of vaginal or urethral atrophy among elderly women. 3,4 While effectively relieving women of climacteric symptoms, use of menopausal hormones has been shown to increase risks of different types of cancer. For breast cancer, there is growing evidence that cyclically combined estrogen-progestin therapy increase risk even more than estrogens alone. 5-8 For endometrial cancer estrogens alone increase risk substantially, as do use of cyclically combined estrogen-progestins. [8][9][10] For epithelial ovarian cancer (EOC) estrogen without progestins, or cyclically combined estrogen-progestins therapy increases risk. 8,11,12 There are few studies on the effects of regimens of estrogens continuously combined to progestins: t...

Ovarian cancer is the leading cause of death from gynecologic malignancies among women worldwide. Little is known about reproductive factors or lifestyle determinants and ovarian cancer prognosis. The objective of this study was to examine whether ovarian cancer survival is influenced by reproductive history, anthropometric characteristics, prediagnostic life-style factors and family history of breast or ovarian cancer. The study population consisted of 635 epithelial ovarian cancer (EOC) cases derived from a nationwide population-based case-control study conducted in Sweden between 1993 and 1995. Exposure data on prediagnostic factors of interest were collected through questionnaires at the beginning of the parent study. Clinical data were abstracted from medical records. Cases were followed-up by means of record linkage to nationwide registers until December 31, 2002. Cox proportional hazard regression model was used to estimate the prognostic effect of each factor in terms of hazard ratios (HR) and 95% confidence intervals (CI), following adjustment for age at diagnosis, FIGO tumor stage and WHO grade of tumor differentiation. Tumor characteristics significantly influenced the risk of death from EOC. After adjustment for these, no clear associations were detected between reproductive history (parity, age at first or last birth, oral contraceptive use, age at menarche or menopause), anthropometric characteristics (body size and shape in different periods of life), lifestyle factors before diagnosis (alcohol consumption, smoking and physical activity over lifetime), nor family history of breast cancer or ovarian cancer and EOC survival. Our findings indicate that these prediagnostic factors do not influence the EOC survival. Nevertheless, among women with early stage disease (FIGO stage I and II), there was some indication that overweight in young adulthood or recent years increased the risk of death, while physical activity in young adult life appeared to reduce the risk of death due to EOC. ' 2008 Wiley-Liss, Inc.Key words: epithelial ovarian cancer; risk factors; survival; prospective study; Sweden Globally, ovarian cancer is the second most common gynecological malignancy and the leading cause of mortality from female reproductive cancer.1,2 Seventy-five percent of women with ovarian cancer present with an advanced disease at the time of diagnosis, and the 5-year survival ratio from ovarian cancer is less than 50% worldwide. Epithelial ovarian tumors constitute the majority (90%) of ovarian malignancies.3 Approximately 85% of epithelial ovarian tumors are invasive, while 15% are borderline ovarian tumors. 4 To date, no firm conclusion can be drawn about the etiology of ovarian cancer.5 Parity and use of oral contraceptives have consistently been shown to reduce the risk of epithelial ovarian cancer (EOC), [6][7][8] while the use of hormone replacement therapy (HRT) and family history of breast and ovarian cancer seem associated with an elevated risk. 5,9 Results are conflicting regarding the etiologic role ...