Hoskins W J
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
J Cell Biochem Suppl. 1995;23:189-99. doi: 10.1002/jcb.240590926.
In 1995, an estimated 26,600 women in the United States will be diagnosed with ovarian cancer. During that same year, approximately 14,500 women will die from the disease. Although ovarian cancer accounts for only 33% of the gynecologic cancers and only 5% of all cancers affecting women in the United States, it results in 55% of the deaths from gynecologic cancer and 6% of the cancer deaths in women. The cure rate for ovarian cancer by stage at diagnosis is not significantly different from other gynecologic cancers. Ovarian cancer confined to the ovary (Stage I) can be cured in 90% of cases. Survival for patients with advanced disease (Stage III and IV) is 21%. Unfortunately, while 73% of endometrial cancers, 55% of breast cancers, and 50% of cervical cancers are diagnosed as Stage I, only 23% of ovarian cancers are diagnosed as Stage I. Thus, five-year survival for all endometrial cancer is 85%, for all breast cancer, 82%, for cervical cancer, 70%, and for ovarian cancer, only 42%. The lack of early symptoms and the absence of any proven method of screening for early ovarian cancer results in over 70% of women being diagnosed after the disease has spread beyond the ovary. Also, unlike breast, cervical, and endometrial cancer, there is no known premalignant phase for ovarian cancer; therefore, diagnosis and treatment of a premalignant condition to prevent the development of ovarian cancer is not possible. Theories to explain the development of ovarian cancer are based on observation that ovulation inhibition through pregnancy, oral contraceptive use, and a shorter ovulatory period (late menarche or early menopause) result in a decreased incidence of ovarian cancer. The incessant disruption of the ovarian capsule followed by repair may provide the opportunity for aberrant growth. Finally, therapy of women with ovarian cancer usually requires multiple surgical procedures, multiple courses of chemotherapy, and results in significant morbidity and health care costs. For most with the disease, the end result will still be a slow, painful death by starvation. There should be little doubt based on the above statistics that every effort should be directed towards prevention of ovarian cancer. Possible strategies in the prevention of ovarian cancer should be directed toward determining if a premalignant condition exists, developing screening tools to detect premalignant disease or disease confined to the ovary, and developing interventions to prevent the development of the disease. It is well established that use of oral contraceptives for five or more years can result in up to a 50% reduction in the occurrence of epithelial ovarian cancer. Given the low complication rates from oral contraception use, this medication should be considered as a method of prevention, especially in high-risk groups. In addition, this is a realistic starting point for research into the development of preventive regimens.
1995年，据估计美国有26,600名女性将被诊断出患有卵巢癌。同年，约14,500名女性将死于该疾病。尽管卵巢癌仅占美国妇科癌症的33%，在所有影响女性的癌症中仅占5%，但其导致的死亡占妇科癌症死亡人数的55%，占女性癌症死亡人数的6%。卵巢癌按诊断时的分期计算的治愈率与其他妇科癌症并无显著差异。局限于卵巢的卵巢癌（I期）90%的病例可治愈。晚期疾病（III期和IV期）患者的生存率为21%。不幸的是，73%的子宫内膜癌、55%的乳腺癌和50%的宫颈癌在诊断时为I期，而只有23%的卵巢癌在诊断时为I期。因此，所有子宫内膜癌的五年生存率为85%，所有乳腺癌为82%，宫颈癌为70%，而卵巢癌仅为42%。缺乏早期症状以及没有任何经过验证的早期卵巢癌筛查方法导致超过70%的女性在疾病扩散到卵巢以外后才被诊断出来。此外，与乳腺癌、宫颈癌和子宫内膜癌不同，卵巢癌不存在已知的癌前阶段；因此，不可能通过诊断和治疗癌前病变来预防卵巢癌的发生。解释卵巢癌发生的理论基于这样的观察结果：通过怀孕、使用口服避孕药以及较短的排卵周期（初潮晚或绝经早）抑制排卵会导致卵巢癌发病率降低。卵巢包膜持续受到破坏然后修复可能为异常生长提供机会。最后，卵巢癌女性的治疗通常需要多次手术、多疗程化疗，且会导致严重的发病率和医疗费用。对于大多数患有这种疾病的人来说，最终结果仍将是缓慢、痛苦的饥饿死亡。基于上述统计数据，毫无疑问应该尽一切努力预防卵巢癌。预防卵巢癌的可能策略应旨在确定是否存在癌前病变，开发筛查工具以检测癌前疾病或局限于卵巢的疾病，并开发预防疾病发生的干预措施。众所周知，使用口服避孕药五年或更长时间可使上皮性卵巢癌的发生率降低多达50%。鉴于使用口服避孕药的并发症发生率较低，这种药物应被视为一种预防方法，尤其是在高危人群中。此外，这是研究预防性方案的一个现实起点。
