Epithelial ovarian cancer: testing the 'androgens hypothesis'

Area of Science:

• Gynecologic Oncology
• Endocrinology
• Epidemiology

Background:

• Risch's 1998 hypothesis suggested androgens stimulate ovarian epithelial cell proliferation, potentially increasing cancer risk.
• Direct evidence supporting the androgen hypothesis for ovarian cancer pathogenesis remains limited.
• Hyperandrogenism is clinically associated with conditions like polycystic ovary syndrome (PCOS), hirsutism, and acne.

Purpose of the Study:

• To investigate the association between androgen-related factors and epithelial ovarian cancer risk.
• To evaluate the role of polycystic ovary syndrome (PCOS), hirsutism, and acne in ovarian cancer development.
• To examine the impact of testosterone supplement and Danazol use on ovarian cancer risk.

Main Methods:

• A population-based case-control study was conducted across Australia.
• Cases included 1276 women with invasive epithelial ovarian cancer and 315 with borderline tumours (aged 18-79).
• Controls (n=1508) were selected from the National Electoral Roll; data on medical history and medication use were self-reported.

Main Results:

• No significant association was found between PCOS, acne, or hirsutism and overall ovarian cancer risk or most subtypes.
• A positive association was observed between a history of PCOS and serous borderline ovarian tumours (OR 2.6; 95% CI 1.0-6.1).
• Ever use of testosterone supplements was linked to increased ovarian cancer risk (OR 3.7; 95% CI 1.1-12.0), while Danazol use showed no increased risk (OR 1.0; 95% CI 0.4-2.9).

Conclusions:

• The study's findings do not support the hypothesis that common androgen-related disorders increase the risk of epithelial ovarian cancer.
• Testosterone supplement use may represent a risk factor for ovarian cancer, requiring further research.
• Specific androgen-related conditions like PCOS may have differential associations with ovarian cancer subtypes, such as borderline tumours.