A case control study of carcinoma of the ovary.

Abstract

SUMMARY There is increased concern over the apparent rise in incidence of patients with carcinoma of the ovary, particularly in older women. In an attempt to identify aetiological factors 300 women with cancer of the ovary diagnosed at laparatomy were studied. A questionnaire was administered to these women (Group A) and to two control groups matched by age. The first control group (Group B) comprised patients in a gynaecological ward and the second (Group C) comprised women on the lists of general practitioners living in the same areas as the index cases. Differences were shown in the obstetric history of the three groups. Fewer of the women in Group A had married and fewer had ever been pregnant and the family size was smaller. Significantly fewer of them recollected an attack of mumps, measles, or rubella. In all, only 81 of the whole series of 900 had used oral contraceptives, 19 of Group A and 31 in each of the control groups, a statistically significant deficiency. These findings support those of other investigations and suggest lines of further inquiry.During the past decade there has been increased interest in the epidemiology of cancer of the ovary. This condition causes over 3000 deaths each year in the United Kingdom and is a more common cause of death than cancer of the cervix. Since 1950 the mortality rate both in the United Kingdom and the United States of America has steadily increased. Detailed analysis of the figures for England and Wales (Registrar General) show that the main increase in death rates for carcinoma of the ovary was in those of 65 years and older (Figure), in contrast to cancer of cervix uteri, for which the rates in this age group appear to be declining.West (1966) reported a study of 175 women with ovarian cancer, compared with the same number of patients with non-malignant conditions of the ovary.He commented that the study by Dorn and Cutler (1959) showed that there was a higher morbidity among never-married women. The only positive finding of West was of a lower incidence of mumpsparotitis among the patients with malignant ovarian tumours. Wynder et al. (1969) also studied 150 women with ovarian cancers and compared them with 300 age-matched hospital controls, 25% of whom had cancer of other sites. He did not find a relationship with pregnancy or marital state, but he did find that the women with ovarian cancer had a less frequent history of mumps than his control groups. The women with ovarian cancer more frequently had an earlier menarche, heavier periods, and dysmenorrhoea. But

Risk factors for ovarian cancer: a case-control study

“…Our finding of no overall relationship between hormone replacement therapy and ovarian cancer supports those of other investigators (Newhouse et al, 1977;Hildreth et al, 1981;Weiss et al, 1982). An increased risk associated with the therapy was found among women who reported hysterectomy, but the finding was based on very few cases and may have been due to chance.…”

“…The raised risk for women with a first pregnancy after 35 years persisted (RR = 3.9, 95% CI 1.1-14.2). Results from other studies regarding the risk for women having a first child at relatively older ages are inconclusive, some finding no association (Newhouse et al, 1977;Casagrande et al, 1979;Cramer et al, 1983;Lesher et al, 1985), others an increased risk (Joly et al, 1974;McGowan et al, 1979;Hildreth et al, 1981;Franceschi et al, 1982). Only Franceschi et al (1982) found the increased risk to be statistically significant and independent of parity.…”

“…Age at natural menopause, however, was strongly related to risk. While Hildreth et al (1981), Franceschi et al (1982) and Tzonou et al (1984) also demonstrated that the later the age at menopause the greater the risk, other studies have found no association (West, 1966;Newhouse et al, 1977;Annegers et al, 1979;McGowan et al, 1979;Cramer et al, 1983).…”

Oral contraceptive use and the risk of epithelial ovarian cancer

“…Evidence from several case-control studies conducted mainly in North America (McGowan et al, 1979;Annegers et al, 1979;Hildreth et al, 1981;Weiss et al, 1981;Willett et al, 1981;Rosenberg et al, 1982;Cramer et al, 1982;Casagrande et al, 1983; Centers for Disease Control Cancer and Steroid Hormone Study, 1983; see also Newhouse et al, 1977) suggests that the use of cQmbined oral contraceptives (OCs) reduces the risk of epthelial ovarian cancer. General lifestyle and reproductive characteristics, however, are notoriously different in Italy.…”

Risk factors in ovarian cancer of epithelial origin by pathological diagnosis

“…In most epidemiological reviews, ovarian cancer is considered as one disease, although some recent ones have categorised the cases as epithelial and non-epithelial (Newhouse et al, 1977;Greene et al, 1984). But within those of epithelial origin, different pathological diagnoses can also be analysed separately.…”