Newly diagnosed and relapsed epithelial ovarian cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up

Incidence an Epidemiology

Epithelial ovarian cancer (EOC) represents a heterogeneous spectrum of disease entities at a clinical, pathological and molecular level. Ovarian cancer is the second most lethal gynaecological malignancy worldwide behind cervical cancer and the first in developed countries, with ∼200 000 women dying globally in 2020.1 A study of epidemiological trends from 1990 to 2019 showed that highly developed regions had the highest burden and mortality.2

Infertility or nulliparity, estrogen hormone treatment and obesity have been reported as risk factors for EOC and could account for the rising incidence of the disease in developed countries.3 Oral contraceptive use, especially over longer periods, and breastfeeding can reduce incidence.4 A recent large study revealed significant heterogeneity of associations for 14 EOC risk factors across histological subtypes.3 Higher parity, younger age at menopause and tubal ligation were most strongly associated with reduced risk in endometrioid carcinomas (ECs) and clear-cell carcinomas (CCCs), while endometriosis was associated with an increased risk in both EOC subtypes.3 Serous and poorly differentiated carcinomas had modest associations with parity and menopausal hormonal therapy use and stronger associations with a family history of ovarian cancer.3 Deleterious germline BRCA1/2 mutations (gBRCA1/2-mut) are associated with a 16%-65% increased risk of EOC, predominantly of high-grade serous histology.5 Women with mutations in mismatch repair genes (Lynch syndrome) have a 10%-12% lifetime risk of developing EOC, which tends to be of either EC or CCC subtype.6

CITA DEL ARTÍCULO  Ann Oncol. 2023 Aug 10;S0923-7534(23)00797-4. doi: 10.1016/j.annonc.2023.07.011