A 60-year-old woman, gravida 1, para 1, comes to the office with abdominal distension and decreased appetite. She also has lost 10 pounds (4.5 kg) unintentionally over the past few months. She takes no medications and has received all recommended vaccinations except for the human papilloma vaccine. The patient's mother had BRCA-positive ovarian cancer and died at the age of 55. BMI is 30kg/m². Imaging studies reveal a right-sided ovarian mass and an accumulation of free peritoneal fluid. Her blood work shows a marked elevation of CA-125. Which of the following most likely would have reduced the risk of this patient's condition?

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11ec160b_3acf_f018_9249_4b9a9177d7ce_MD0001_00 This patient's presentation is most likely due to epithelial ovarian cancer (EOC). Common manifestations include abdominal distension, ascites, pleural effusion, bowel obstruction, decreased appetite, weight loss, and an ovarian mass. Patients with EOC often present with advanced disease and increased mortality risk due to the lack of effective screening methods. Cancer antigen 125 (CA-125) is a protein produced by ovarian epithelia and is usually markedly elevated in cancerous ovarian cells compared to normal cells. However, CA-125 is neither sensitive nor specific for early EOC as it can be found in normal tissue and other cancers. Women with BRCA mutations are at significantly increased risk for ovarian cancer. Additional risk factors include repeated ovulation, such as nulliparity (Choice C) or ovarian dysfunction (eg, infertility). These conditions inflict minor trauma to the ovarian surface, therefore rendering the epithelia susceptible to transformation. Protective factors include oral contraceptives, multiparity, and breastfeeding. The common mechanism of these protective factors is less repair at the ovarian surface due to reduced lifetime ovulation frequency. (Choices A and E) Consistent condom use and the human papilloma virus (HPV) vaccine can reduce transmission of high-risk HPV, which in turn can reduce the risk of cervical, vaginal, and vulvar cancer in women. HPV infection is not linked to ovarian cancer. (Choice B) Antioxidants neutralize reactive oxygen species and free radicals, thereby decreasing their damage to cells. However, long-term antioxidant supplementation (eg, vitamin C) has not been proven to decrease the risk of any cancer, including ovarian cancer. Educational objective: The pathogenesis of epithelial ovarian cancer is linked to the frequency of trauma and repair at the ovarian surface. Oral contraceptives, multiparity, and breastfeeding are protective by decreasing the frequency of ovulation. Risk factors include BRCA mutation, nulliparity, and infertility. __________ References: ACOG Practice Bulletin No. 89. Elective and risk reducing salpingo-oophorectomy (http://www.ncbi.nlm.nih.gov/pubmed/18165419) Hormone prevention strategies for breast, endometrial and ovarian cancers. (http://www.ncbi.nlm.nih.gov/pubmed/20471672) Ovarian cancer molecular pathology. (http://www.ncbi.nlm.nih.gov/pubmed/22729278)

A 60-Year-Old Woman, Gravida 1, Para 1, Comes to the Office