THE EPIDEMIOLOGY OF OVARIAN-CARCINOMA AND THE CURRENT STATUS OF TUMOR-MARKERS TO DETECT DISEASE

被引:56
作者
HERBST, AL
机构
[1] Chicago, Illinois
关键词
EPIDEMIOLOGY; OVARIAN CANCER; TUMOR MARKERS; CA; 125; PROPHYLACTIC OOPHORECTOMY;
D O I
10.1016/S0002-9378(94)70104-0
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
OBJECTIVES: The objectives of this manuscript are to review the epidemiologic characteristics of ovarian cancer and to summarize the current status of tumor markers to detect disease. STUDY DESIGN: A review of the pertinent literature was done. RESULTS: In general, ovarian cancer is most frequent in industrialized countries, with dietary fat and possible use of talc as additive factors. Ovulation appears to increase the risk as does family history, increasing age, infertility, and possibly the use of ovulatory drugs. Pregnancy and the use of oral contraceptives, as well as possibly breast-feeding, lower the risk. Tubal ligation or hysterectomy with ovarian preservation also lowers the risk. The lifetime risk is about 1.4% in the United States, and the risk increases with age. If one first-degree relative has ovarian cancer, the lifetime risk appears to rise to 5%, but this pooled estimate may be affected by self-reporting bias in some studies. CA 125, the most widely used marker, is nonspecific, being elevated in about 80% of cases of ovarian epithelial cancer but also elevated in a number of benign conditions, which reduces its potential effectiveness as a screening tool. CONCLUSIONS: No single cause of ovarian cancer has been uncovered. Overall > 90% of ovarian cancers occur sporadically. Those with the hereditary ovarian cancer syndrome (multiple generations of breast and ovarian cancer) have a 50% risk and an autosomal dominant inheritance, but they constitute < 1% of cases. No ideal tumor marker for ovarian cancer screening is currently available. Further evaluation is needed to see whether the use of multiple tumor markers and/or vaginal ultrasonography might produce an acceptable cost-effective screening model. Current data do not support the utilization of prophylactic oophorectomy in women with one first-degree relative with ovarian cancer as a general strategy to prevent ovarian cancer. It is appropriate strategy for those with hereditary ovarian cancer syndrome.
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收藏
页码:1099 / 1107
页数:9
相关论文
共 43 条
[1]   AGE AT ONSET FOR FAMILIAL EPITHELIAL OVARIAN-CANCER [J].
AMOS, CI ;
SHAW, GL ;
TUCKER, MA ;
HARTGE, P .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1992, 268 (14) :1896-1899
[2]   A RADIOIMMUNOASSAY USING A MONOCLONAL-ANTIBODY TO MONITOR THE COURSE OF EPITHELIAL OVARIAN-CANCER [J].
BAST, RC ;
KLUG, TL ;
STJOHN, E ;
JENISON, E ;
NILOFF, JM ;
LAZARUS, H ;
BERKOWITZ, RS ;
LEAVITT, T ;
GRIFFITHS, CT ;
PARKER, L ;
ZURAWSKI, VR ;
KNAPP, RC .
NEW ENGLAND JOURNAL OF MEDICINE, 1983, 309 (15) :883-887
[3]   HEREDITARY OVARIAN-CANCER - A CLINICOPATHOLOGICAL STUDY [J].
BEWTRA, C ;
WATSON, P ;
CONWAY, T ;
READHIPPEE, C ;
LYNCH, HT .
INTERNATIONAL JOURNAL OF GYNECOLOGICAL PATHOLOGY, 1992, 11 (03) :180-187
[4]   CANCER STATISTICS, 1991 [J].
BORING, CC ;
SQUIRES, TS ;
TONG, T .
CA-A CANCER JOURNAL FOR CLINICIANS, 1991, 41 (01) :19-36
[5]  
Cancer and Steroid Hormone Study of the Centers for Disease Control and the National Institute of Child Health and Human Development, 1987, N Engl J Med, V316, P650
[6]  
CASAGRANDE JT, 1979, LANCET, V2, P170
[7]   SCREENING FOR OVARIAN-CANCER - THE ROLE OF NONINVASIVE IMAGING TECHNIQUES [J].
COHEN, C ;
JENNINGS, TS .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1994, 170 (04) :1088-1094
[8]  
COLE LA, 1989, YALE J BIOL MED, V62, P367
[9]  
CRAMER DW, 1984, OBSTET GYNECOL, V63, P833
[10]   SCREENING IN OVARIAN-CANCER [J].
CREASMAN, WT ;
DISAIA, PJ .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1991, 165 (01) :7-10