Pregnancy duration and ovarian cancer risk: A 50-year nationwide cohort study

Validity of self-reported number of pregnancies and maternal age at first birth among females attending organized mammographic screening

AIMS

Reproductive history conveys information about potential health risks later in adulthood. This study aimed to examine the validity of self-reported number of pregnancies and maternal age at first birth (AFB) among females attending BreastScreen Norway.

METHODS

Participants were identified through the Janus Serum Bank cohort in Norway and were eligible for this cross-sectional validation study if they participated in a health survey issued by BreastScreen Norway between 2006 and 2015. Retrospective self-reported survey information on number of pregnancies and AFB in years was validated against prospectively collected information from the Medical Birth Registry of Norway (MBRN) using the Spearman rank (rs) and intraclass correlation coefficients (ICC) with 95% confidence intervals (CI).

RESULTS

After exclusions, 51,598 subjects were included in the analysis on number of pregnancies and 46,919 in the analysis on AFB. On average, study subjects were 59-60 years old when completing the health survey and had become first-time mothers roughly 36 years earlier. Survey-based information about number of pregnancies was highly correlated and demonstrated high agreement with the registry data (rs=0.967, 95% CI 0.964-0.969; ICC=0.884, 95% CI 0.882-0.885). Survey-based information about AFB demonstrated even higher correlation and very high agreement with the registry data (rs=0.975, 95% CI 0.973-0.976; ICC=0.974, 95% CI 0.974-0.975).

CONCLUSIONS

Retrospectively recalled survey-based information about number of pregnancies and AFB was highly accurate when validated against prospectively collected information in the MBRN. These survey-based data are valuable for future epidemiological research, and linkage to the MBRN may not be required when these data are available.

Global epidemiology of epithelial ovarian cancer

Globally, ovarian cancer is the eighth most common cancer in women, accounting for an estimated 3.7% of cases and 4.7% of cancer deaths in 2020. Until the early 2000s, age-standardized incidence was highest in northern Europe and North America, but this trend has changed; incidence is now declining in these regions and increasing in parts of eastern Europe and Asia. Ovarian cancer is a very heterogeneous disease and, even among the most common type, namely epithelial ovarian cancer, five major clinically and genetically distinct histotypes exist. Most high-grade serous ovarian carcinomas are now recognized to originate in the fimbrial ends of the fallopian tube. This knowledge has led to more cancers being coded as fallopian tube in origin, which probably explains some of the apparent declines in ovarian cancer incidence, particularly in high-income countries; however, it also suggests that opportunistic salpingectomy offers an important opportunity for prevention. The five histotypes share several reproductive and hormonal risk factors, although differences also exist. In this Review, we summarize the epidemiology of this complex disease, comparing the different histotypes, and consider the potential for prevention. We also discuss how changes in the prevalence of risk and protective factors might have contributed to the observed changes in incidence and what this might mean for incidence in the future.

Underpinnings of the Halachic Approach to BRCA Screening and Intervention: Facilitating Provider Counseling for Observant Jewish Populations

BACKGROUND

Halacha is the corpus of Jewish law which serves as a life blueprint for observant Jewish individuals. Health professionals counseling halachically observant populations at risk for breast cancer gene (BRCA) mutations should be well informed of the halachic approach to screening for BRCA mutations and subsequent interventions.

AIM

To address the intersection of halacha with ethical norms and current medical evidence-based data as they relate to potential and identified BRCA mutation carriers at their various stages of decision-making.

RESULTS

Halacha, ethics, and medicine have much in common, but there are specific principles which guide halacha; decision-making in light of halacha is complex and varies with respect to the multi-faceted aspects of screening and intervention. Halacha encourages the exercise of autonomy regarding situations in which beneficence is not clear-cut and dependent on subjective perceptions.

CONCLUSIONS

Health professionals knowledgeable of halacha are better equipped to counsel the observant Jewish population at risk of BRCA mutations or identified as mutation carriers, enabling them to present targeted questions to halachic authorities and thus achieve optimal decision-making.

Association Between Germline BRCA1/2 Gene Variants and Clinicopathological Features of Ovarian Cancer

Objective

To investigate the relationship between BRCA1/2 gene mutation and clinicopathological features in ovarian cancer patients, so as to develop precise individualized treatment plan for patients.

Methods

Patients diagnosed with ovarian cancer between January 2018 and July 2023 who underwent BRCA1/2 genetic testing were retrospectively analyzed. The clinicopathological characteristics (age, body mass index (BMI), family history of ovarian cancer, pregnancy history, menopause status, tumor size, histopathology, Federation of Gynecology and Obstetrics (FIGO) staging, and ascites) of non-carriers and BRCA1/2 variant carriers were compared. Logistic regression analysis was used to explore the relationship between BRCA1/2 variants and clinicopathological characteristics of ovarian cancer.

Results

A total of 284 ovarian cancer patients were collected, and the subjects were divided into two groups, 197 non-carriers and 87 BRCA1/2 variants carriers. The proportion of serous ovarian carcinoma in BRCA1/2 variant carriers is higher than that in non-BRCA variant carriers (78.2% vs 60.9%, p=0.015). There were 51 patients with BRCA pathogenic or likely pathogenic variant, 22 patients with BRCA likely benign variant, and 14 patients with BRCA variants of uncertain significance (VUS). The proportion of serous ovarian carcinoma in patients with BRCA pathogenic/likely pathogenic variant is higher than that in patients with BRCA likely benign variant and BRCA VUS (94.1% vs 50.0% and 64.3%. p<0.001). There were no statistically significant differences in BMI, family history of ovarian cancer, pregnancy history, menopause status, maximum diameter of the tumor lesion, FIGO stage, and ascites among patients with different grades of variants. Multivariate logistic regression analysis showed that serous ovarian carcinoma was related to BRCA mutation (Serous carcinoma vs non-serous carcinoma: OR 2.145, 95% CI: 1.044-4.407) (p=0.038).

Conclusion

Patients with BRCA1 variant develop ovarian cancer at a younger age than those with the BRCA2 variant. The proportion of FIGO stage III-IV in patients with BRCA pathogenic + likely pathogenic variant was significantly higher than those in patients with other variants. Germline BRCA1/2 variants were most frequently identified in serous ovarian carcinoma patients.

Proteomic characterization of epithelial ovarian cancer delineates molecular signatures and therapeutic targets in distinct histological subtypes

Clear cell carcinoma (CCC), endometrioid carcinoma (EC), and serous carcinoma (SC) are the major histological subtypes of epithelial ovarian cancer (EOC), whose differences in carcinogenesis are still unclear. Here, we undertake comprehensive proteomic profiling of 80 CCC, 79 EC, 80 SC, and 30 control samples. Our analysis reveals the prognostic or diagnostic value of dysregulated proteins and phosphorylation sites in important pathways. Moreover, protein co-expression network not only provides comprehensive view of biological features of each histological subtype, but also indicates potential prognostic biomarkers and progression landmarks. Notably, EOC have strong inter-tumor heterogeneity, with significantly different clinical characteristics, proteomic patterns and signaling pathway disorders in CCC, EC, and SC. Finally, we infer MPP7 protein as potential therapeutic target for SC, whose biological functions are confirmed in SC cells. Our proteomic cohort provides valuable resources for understanding molecular mechanisms and developing treatment strategies of distinct histological subtypes.

Burden of ovarian cancer in China from 1990 to 2030: A systematic analysis and comparison with the global level

Introduction

Ovarian cancer (OC) is one of the major diseases threatening women's health and life. Estimating the burden trends and risk factors of OC can help develop effective management and prevention measures. However, there is a lack of comprehensive analysis concerning the burden and risk factors of OC in China. In this study, we aimed to assess and predict the burden trends of OC in China from 1990 to 2030, and make a comparison with the global level.

Methods

We extracted prevalence, incidence, mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) data from the Global Burden of Disease Study 2019 (GBD 2019) and characterized OC burden in China by year and age. OC epidemiological characteristics were interpreted by conducting joinpoint and Bayesian age-period-cohort analysis. We also described risk factors, and predicted OC burden from 2019 to 2030 using Bayesian age-period-cohort model.

Results

In China, there were about 196,000 cases, 45,000 new cases and 29,000 deaths owing to OC in 2019. The age-standardized rates (ASRs) of prevalence, incidence and mortality have increased by 105.98%, 79.19%, and 58.93% respectively by 1990. In the next decade, OC burden in China will continue to rise with a higher rate than the global level. The OC burden in women under 20 years of age is slowing down, while the burden in women over 40 years of age is getting more severe, especially in postmenopausal and older women. High fasting plasma glucose is the major factor contributing the most to OC burden in China, and high body-mass index has surpassed occupational exposure to asbestos to be the second risk factor. OC burden from 2016 to 2019 in China has increased faster than ever before, indicates an urgent need to develop effective interventions.

Conclusion

The burden of OC in China has shown an obvious upward trend in the past 30 years, and the increase rate accelerated significantly in recent 5 years. In the next decade, OC burden in China will continue to rise with a higher rate than the global level. Popularizing screening methods, optimizing the quality of clinical diagnosis and treatment, and promoting healthy lifestyle are critical measures to improve this problem.

Understanding How Pregnancy Protects Against Ovarian and Endometrial Cancer Development: Fetal Antigens May Be Involved

It is well known that many factors, including infertility, obesity, type 2 diabetes, and family history of cancer, increase the risk of developing endometrial and ovarian cancer. However, multiparous women are known to have a lower risk of developing either ovarian or endometrial cancer than nonparous women. The lack of ovulation and shifting of sex hormonal balance, with decreased estrogen levels and increased progesterone levels during pregnancy, has traditionally been thought to be the major contributor to this decreased risk. However, in reality, the mechanisms underlying this phenomenon are relatively unknown. Increasing evidence suggests that endocrine factors are unlikely to completely explain the protective effect of pregnancies, and that multiple other nonendocrine mechanisms including fetal antigens and the newly proposed dormant cells hypothesis may also be involved. In this review, we summarize recent evidence and describe the potential underlying mechanisms that may explain how pregnancy protects against the development of ovarian and endometrial cancers in women's later life.