Prevention of Ovarian Cancer among High-Risk Women

Ovarian cancer is highly lethal malignancy diagnosed at the late stage because of generalized non-specific symptoms. Exact etiology of ovarian cancer is complex and not known completely. Most prominent risk factor is family history of the ovary and breast cancer. 5-15% of ovarian cancers are associated with mutations of BRCA1, BRCA2 and mismatch repair genes. Some possible protective factors are the use of oral contraceptives for prolonged duration, pregnancy, tubal ligation and hysterectomy. Identification of high-risk women for development of ovarian malignancy is difficult because of scarcity of knowledge about early ovary carcinogenesis and any premalignant condition. Serum CA-125 estimation and trans-vaginal ultrasound (TVUS) have been tried for screening purpose, but they are not reliable tests.
Chemoprevention and prophylactic surgery are emerging as potential preventive measures to reduce the risk of ovarian cancer. High-risk women, who have not satisfied parity, cannot opt primary prevention of ovarian cancer by bilateral oophorectomy. Oral contraceptives, fenretinide, non-steroidal anti-inflammatory drugs and some natural compounds are under evaluation as chemopreventive agents with controversial reports. To achieve acceptable benefit to risk ratio, identification of women at high-risk of ovarian cancer and providing them chemoprevention with minimal adverse effects is challenging task.

Keywords: ovarian cancer, risk factors, chemoprevention.