DESCRIPTION: In the United States in 1995, there were about 26,000 new
cases of cancer of the ovary, and approximately 14,500 women died from it,
making it the most lethal of the gynecological malignancies. Over the
lifetime, close to 2 percent of women are affected. Ovarian cancer is
difficult to treat because it is typically asymptomatic until advanced
stages, and patients frequently present late in the disease course. The
established risk factors do not clearly account for a large fraction of
disease incidence, and the possible ovulatory or hormonal mechanisms by
which these factors affect risk of developing ovarian cancer are not well
understood. The application suggests a new hormonal hypothesis regarding
the aetiology of ovarian cancer, and demonstrates a substantial body of
pathologic, endocrinologic and epidemiologic evidence in support of this
hypothesis. A population-based, case-control study to examine this
hypothesis is proposed to be conducted in the State of Connecticut. The
study will examine a collection of factors related to hormonal expression
during and after the reproductive years. In total, about 500 non-mucinous
and 80 mucinous ovarian-cancer cases, aged 35-79 years, will be identified
prospectively in the state through the Rapid Case Ascertainment Shared
Resource of the Yale Cancer Center. Approximately 1,000 randomly-selected
population controls will be frequency-matched to the cases in three age
groups. Controls will be identified using random-digit dialing for those
under 65 years of age, and randomly chosen from rosters, provided by the
Health Care Financing Administration for those 65 years and over. All of
the subjects will be interviewed at home by trained interviewers, using a
standardized, structured questionnaire which will include medical and
reproductive history, and approximations of the various hormone-related
factors. Univariate and multivariate analyses will be used to estimate
relative risks for comparison of the cases with the controls. In general,
the hormonal factors to be examined have received only a little attention
with respect to ovarian cancer, and the proposed study will be the first to
evaluate them systematically in a rigorous, large-scale study which will
integrate all of the factors within a coherent aetiologic framework.
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