Ovarian Cancer: The Fallopian Tube as the Site of Origin and Opportunities for Prevention

open access
 May 2, 2016

 .....High-grade serous carcinoma (HGSC) is the most common and aggressive histotype of epithelial ovarian cancer (EOC), and it is the predominant histotype associated with hereditary breast and ovarian cancer syndrome (HBOC). Mutations in BRCA1 and BRCA2 are responsible for most of the known causes of HBOC, while mutations in mismatch repair genes (Lynch Syndrome) and several genes of moderate penetrance are responsible for the remaining known hereditary risk.....This review discusses the site of origin of EOC, the rationale for risk-reducing salpingectomy in the high-risk population, and opportunities for salpingectomy in the low-risk population.

 ....However, recent studies of different immigrant populations in the United States and in their respective countries of origin have identified pockets of women who bare a similarly high genetic burden as the Ashkenazi Jewish population. Women of Bahamian heritage, for example, are estimated to have 27.1% of breast cancer cases due to BRCA mutations (10, 11). The ovarian cancer burden in these isolated high-risk populations is still unclear, but likely to be as high as those women of Ashkenazi descent.....

....A report from the Nurses’ Health Study concluded that compared with ovarian conservation, bilateral oophorectomy at the time of hysterectomy for benign disease was associated with a decreased risk of breast and ovarian cancer but an increased risk of all-cause mortality (81, 82); therefore, one can stipulate that salpingectomy alone may be sufficient in the genetically “low-risk” population, while the overall benefit versus harm of these approaches requires close attention in the genetically high-risk population. Specifically, oophorectomy offers protection against breast cancer even after menopause and improves survival in those with breast cancer (83). As these prevention modalities are implemented, it is important that the goal of decreasing the incidence and burden of ovarian cancer is not at the expense of worsening the incidence and mortality of breast cancer in women who are at increased risk due to co-morbidities.