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JNCI Journal of the National Cancer Institute 1998 90(23):1774-1786; doi:10.1093/jnci/90.23.1774
© 1998 by Oxford University Press
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Journal Of The National Cancer Institute, Vol 90, 1774-1786, Copyright © 1998 by Oxford University Press


REVIEWS

Hormonal etiology of epithelial ovarian cancer, with a hypothesis concerning the role of androgens and progesterone

HA Risch
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06520-8034, USA.

In the United States, ovarian cancer is the fourth most frequent cause of cancer death among women, following lung, breast, and colorectal cancers. Each year, approximately 26,000 women are diagnosed with ovarian cancer and 14,000 die of it. Germline mutations in BRCA1, BRCA2, or other genes have been implicated in a small fraction of cases. However, it has been suggested that, for the great majority of patients, the risk of epithelial ovarian cancer could be related to "incessant ovulation" (i.e., to the chronically repeated formation of stromal epithelial clefts and inclusion cysts following ovulation) or to some type of hormonal stimulation of ovarian epithelial cells, either on the surface of the ovary or within ovarian inclusion cysts, possibly mediated through excessive gonadotropin secretion. From the evidence to date, the relative importance of these two hypotheses-- incessant ovulation and gonadotropin stimulation--cannot be distinguished. While either or both may play a role in the development of ovarian cancer, it appears that an additional major factor must also be involved. The purpose of this review is to evaluate evidence for and against the incessant ovulation and gonadotropin hypotheses, as well as to consider the possibility that risk of ovarian cancer may be increased by factors associated with excess androgenic stimulation of ovarian epithelial cells and may be decreased by factors related to greater progesterone stimulation. Many features of the evidence bearing on the pathophysiology of ovarian cancer appear to support a connection with androgens and progesterone.
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J. Chubak, S. S. Tworoger, Y. Yasui, C. M. Ulrich, F. Z. Stanczyk, and A. McTiernan
Associations between Reproductive and Menstrual Factors and Postmenopausal Sex Hormone Concentrations
Cancer Epidemiol. Biomarkers Prev., August 1, 2004; 13(8): 1296 - 1301.
[Abstract] [Full Text] [PDF]


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J. Clin. Endocrinol. Metab.Home page
K.-Y. Kim, K.-C. Choi, S.-H. Park, C.-S. Chou, N. Auersperg, and P. C. K. Leung
Type II Gonadotropin-Releasing Hormone Stimulates p38 Mitogen-Activated Protein Kinase and Apoptosis in Ovarian Cancer Cells
J. Clin. Endocrinol. Metab., June 1, 2004; 89(6): 3020 - 3026.
[Abstract] [Full Text] [PDF]


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Cancer Epidemiol. Biomarkers Prev.Home page
L. M. Hannan, M. F. Leitzmann, J. V. Lacey Jr., L. H. Colbert, D. Albanes, A. Schatzkin, and C. Schairer
Physical Activity and Risk of Ovarian Cancer: A Prospective Cohort Study in the United States
Cancer Epidemiol. Biomarkers Prev., May 1, 2004; 13(5): 765 - 770.
[Abstract] [Full Text] [PDF]


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JCOHome page
A. Scorilas, C. A. Borgono, N. Harbeck, J. Dorn, B. Schmalfeldt, M. Schmitt, and E. P. Diamandis
Human Kallikrein 13 Protein in Ovarian Cancer Cytosols: A New Favorable Prognostic Marker
J. Clin. Oncol., February 15, 2004; 22(4): 678 - 685.
[Abstract] [Full Text] [PDF]


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Am J EpidemiolHome page
F. Modugno
Ovarian Cancer and Polymorphisms in the Androgen and Progesterone Receptor Genes: A HuGE Review
Am. J. Epidemiol., February 15, 2004; 159(4): 319 - 335.
[Abstract] [Full Text] [PDF]


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Am J EpidemiolHome page
S. Y. Pan, K. C. Johnson, A.-M. Ugnat, S. W. Wen, and Y. Mao
Association of Obesity and Cancer Risk in Canada
Am. J. Epidemiol., February 1, 2004; 159(3): 259 - 268.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
C. M. Cottreau, R. B. Ness, F. Modugno, G. O. Allen, and M. T. Goodman
Endometriosis and Its Treatment with Danazol or Lupron in Relation to Ovarian Cancer
Clin. Cancer Res., November 1, 2003; 9(14): 5142 - 5144.
[Abstract] [Full Text] [PDF]


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JAMAHome page
G. L. Anderson, H. L. Judd, A. M. Kaunitz, D. H. Barad, S. A. A. Beresford, M. Pettinger, J. Liu, S. G. McNeeley, and A. M. Lopez
Effects of Estrogen Plus Progestin on Gynecologic Cancers and Associated Diagnostic Procedures: The Women's Health Initiative Randomized Trial
JAMA, October 1, 2003; 290(13): 1739 - 1748.
[Abstract] [Full Text] [PDF]


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Am J EpidemiolHome page
K.-H. Tung, M. T. Goodman, A. H. Wu, K. McDuffie, L. R. Wilkens, L. N. Kolonel, A. M. Y. Nomura, K. Y. Terada, M. E. Carney, and L. H. Sobin
Reproductive Factors and Epithelial Ovarian Cancer Risk by Histologic Type:A Multiethnic Case-Control Study
Am. J. Epidemiol., October 1, 2003; 158(7): 629 - 638.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
A. J. Li, R. L. Baldwin, and B. Y. Karlan
Short Androgen Receptor Allele Length Is a Poor Prognostic Factor in Epithelial Ovarian Carcinoma
Clin. Cancer Res., September 1, 2003; 9(10): 3667 - 3673.
[Abstract] [Full Text] [PDF]


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JNCI J Natl Cancer InstHome page
A. Engeland, S. Tretli, and T. Bjorge
Height, Body Mass Index, and Ovarian Cancer: A Follow-Up of 1.1 Million Norwegian Women
J Natl Cancer Inst, August 20, 2003; 95(16): 1244 - 1248.
[Abstract] [Full Text] [PDF]


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JCOHome page
G. M. Yousef, A. Scorilas, D. Katsaros, S. Fracchioli, L. Iskander, C. Borgono, I. A. Rigault de la Longrais, M. Puopolo, M. Massobrio, and E. P. Diamandis
Prognostic Value of the Human Kallikrein Gene 15 Expression in Ovarian Cancer
J. Clin. Oncol., August 15, 2003; 21(16): 3119 - 3126.
[Abstract] [Full Text] [PDF]


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Cancer Res.Home page
A. Evangelou, M. Letarte, I. Jurisica, M. Sultan, K. J. Murphy, B. Rosen, and T. J. Brown
Loss of Coordinated Androgen Regulation in Nonmalignant Ovarian Epithelial Cells with BRCA1/2 Mutations and Ovarian Cancer Cells
Cancer Res., May 15, 2003; 63(10): 2416 - 2424.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
Y. Dong, A. Kaushal, M. Brattsand, J. Nicklin, and J. A. Clements
Differential Splicing of KLK5 and KLK7 in Epithelial Ovarian Cancer Produces Novel Variants with Potential as Cancer Biomarkers
Clin. Cancer Res., May 1, 2003; 9(5): 1710 - 1720.
[Abstract] [Full Text] [PDF]


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Exp. Biol. Med.Home page
A. C. McDonnel, E. A. Van Kirk, D. D. Isaak, and W. J. Murdoch
Inhibitory Effects of Progesterone on Plasma Membrane Fluidity and Tumorigenic Potential of Ovarian Epithelial Cancer Cells
Experimental Biology and Medicine, March 1, 2003; 228(3): 308 - 314.
[Abstract] [Full Text] [PDF]


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Am J EpidemiolHome page
L. J. Schouten, R. A. Goldbohm, and P. A. van den Brandt
Height, Weight, Weight Change, and Ovarian Cancer Risk in the Netherlands Cohort Study on Diet and Cancer
Am. J. Epidemiol., March 1, 2003; 157(5): 424 - 433.
[Abstract] [Full Text] [PDF]


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Am J EpidemiolHome page
F. Lubin, A. Chetrit, L. S. Freedman, E. Alfandary, Y. Fishler, H. Nitzan, A. Zultan, and B. Modan
Body Mass Index at Age 18 Years and during Adult Life and Ovarian Cancer Risk
Am. J. Epidemiol., January 15, 2003; 157(2): 113 - 120.
[Abstract] [Full Text] [PDF]


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Cancer Epidemiol. Biomarkers Prev.Home page
D. C. Whiteman, V. Siskind, D. M. Purdie, and A. C. Green
Timing of Pregnancy and the Risk of Epithelial Ovarian Cancer
Cancer Epidemiol. Biomarkers Prev., January 1, 2003; 12(1): 42 - 46.
[Abstract] [Full Text] [PDF]


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Ann OncolHome page
L. S. A. Augustin, J. Polesel, C. Bosetti, C. W. C. Kendall, C. La Vecchia, M. Parpinel, E. Conti, M. Montella, S. Franceschi, D. J. A. Jenkins, et al.
Dietary glycemic index, glycemic load and ovarian cancer risk: a case-control study in Italy
Ann. Onc., January 1, 2003; 14(1): 78 - 84.
[Abstract] [Full Text] [PDF]


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Biol. Reprod.Home page
K.-C. Choi, C.-J. Tai, C.-R. Tzeng, N. Auersperg, and P. C.K. Leung
Adenosine Triphosphate Activates Mitogen-Activated Protein Kinase in Pre-Neoplastic and Neoplastic Ovarian Surface Epithelial Cells
Biol Reprod, January 1, 2003; 68(1): 309 - 315.
[Abstract] [Full Text] [PDF]


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EndocrinologyHome page
S. B. Rulli, A. Kuorelahti, O. Karaer, L. J. Pelliniemi, M. Poutanen, and I. Huhtaniemi
Reproductive Disturbances, Pituitary Lactotrope Adenomas, and Mammary Gland Tumors in Transgenic Female Mice Producing High Levels of Human Chorionic Gonadotropin
Endocrinology, October 1, 2002; 143(10): 4084 - 4095.
[Abstract] [Full Text] [PDF]


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Cancer Epidemiol. Biomarkers Prev.Home page
C. Rodriguez, E. E. Calle, D. Fakhrabadi-Shokoohi, E. J. Jacobs, and M. J. Thun
Body Mass Index, Height, and the Risk of Ovarian Cancer Mortality in a Prospective Cohort of Postmenopausal Women
Cancer Epidemiol. Biomarkers Prev., September 1, 2002; 11(9): 822 - 828.
[Abstract] [Full Text] [PDF]


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Am J EpidemiolHome page
T. Riman, P. W. Dickman, S. Nilsson, N. Correia, H. Nordlinder, C. M. Magnusson, and I. R. Persson
Risk Factors for Invasive Epithelial Ovarian Cancer: Results from a Swedish Case-Control Study
Am. J. Epidemiol., August 15, 2002; 156(4): 363 - 373.
[Abstract] [Full Text] [PDF]


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JAMAHome page
J. V. Lacey Jr, P. J. Mink, J. H. Lubin, M. E. Sherman, R. Troisi, P. Hartge, A. Schatzkin, and C. Schairer
Menopausal Hormone Replacement Therapy and Risk of Ovarian Cancer
JAMA, July 17, 2002; 288(3): 334 - 341.
[Abstract] [Full Text] [PDF]


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CA Cancer J ClinHome page
M. N. Barnes, W. E. Grizzle, C. J. Grubbs, and E. E. Partridge
Paradigms for Primary Prevention of Ovarian Carcinoma
CA Cancer J Clin, July 1, 2002; 52(4): 216 - 225.
[Abstract] [Full Text] [PDF]


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J. Clin. Endocrinol. Metab.Home page
K.-C. Choi, S. K. Kang, C.-J. Tai, N. Auersperg, and P. C. K. Leung
Follicle-Stimulating Hormone Activates Mitogen-Activated Protein Kinase in Preneoplastic and Neoplastic Ovarian Surface Epithelial Cells
J. Clin. Endocrinol. Metab., May 1, 2002; 87(5): 2245 - 2253.
[Abstract] [Full Text] [PDF]


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JNCI J Natl Cancer InstHome page
V. Syed, G. Ulinski, S. C. Mok, and S.-M. Ho
Reproductive Hormone-Induced, STAT3-Mediated Interleukin 6 Action in Normal and Malignant Human Ovarian Surface Epithelial Cells
J Natl Cancer Inst, April 17, 2002; 94(8): 617 - 629.
[Abstract] [Full Text] [PDF]


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JNCI J Natl Cancer InstHome page
T. Riman, P. W. Dickman, S. Nilsson, N. Correia, H. Nordlinder, C. M. Magnusson, E. Weiderpass, and I. R. Persson
Hormone Replacement Therapy and the Risk of Invasive Epithelial Ovarian Cancer in Swedish Women
J Natl Cancer Inst, April 3, 2002; 94(7): 497 - 504.
[Abstract] [Full Text] [PDF]


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JNCI J Natl Cancer InstHome page
J. M. Schildkraut, B. Calingaert, P. A. Marchbanks, P. G. Moorman, and G. C. Rodriguez
Impact of Progestin and Estrogen Potency in Oral Contraceptives on Ovarian Cancer Risk
J Natl Cancer Inst, January 2, 2002; 94(1): 32 - 38.
[Abstract] [Full Text] [PDF]


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JNCI J Natl Cancer InstHome page
G. C. Rodriguez, N. P. Nagarsheth, K. L. Lee, R. C. Bentley, D. K. Walmer, M. Cline, R. S. Whitaker, P. Isner, A. Berchuck, R. K. Dodge, et al.
Progestin-Induced Apoptosis in the Macaque Ovarian Epithelium: Differential Regulation of Transforming Growth Factor-{beta}
J Natl Cancer Inst, January 2, 2002; 94(1): 50 - 60.
[Abstract] [Full Text] [PDF]


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Cancer Epidemiol. Biomarkers Prev.Home page
A. B. Spurdle, J. L. Hopper, X. Chen, G. S. Dite, M. R. E. McCredie, G. G. Giles, D. J. Venter, M. C. Southey, D. M. Purdie, and G. Chenevix-Trench
The Steroid 5{alpha}-Reductase Type II TA Repeat Polymorphism Is Not Associated with Risk of Breast or Ovarian Cancer in Australian Women
Cancer Epidemiol. Biomarkers Prev., December 1, 2001; 10(12): 1287 - 1293.
[Abstract] [Full Text] [PDF]


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Cancer Res.Home page
V. Syed, G. Ulinski, S. C. Mok, G. K. Yiu, and S.-M. Ho
Expression of Gonadotropin Receptor and Growth Responses to Key Reproductive Hormones in Normal and Malignant Human Ovarian Surface Epithelial Cells
Cancer Res., September 1, 2001; 61(18): 6768 - 6776.
[Abstract] [Full Text] [PDF]



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