Epithelial ovarian cancer and type of peritoneal insult: a case-control study

Objective: To evaluate the association between different types of peritoneal insults and the development of sporadic epithelial ovarian cancer (EOC) subtypes in the general population.

Study design: Hospital based case control study comparing sporadic cases of EOC with age matched control group between 2003 and 2008. Medical, surgical, and gynecological histories were compared between 208 women with histological diagnosis of EOC and 224 women in the control group matched for age at presentation for well woman examination.

Results: 18% patients in the study population and 5% patients in the control group had history of diverticulosis (OR 7.3, 95% CI 2.8-19.1). 10% patients in the study populations and 39% patients in the control group had history of diabetes mellitus (OR 0.41, 95% CI 0.23-0.75). Sub classification of EOC into type 1 and type 2 further revealed 12% patients (OR 0.44, 95% CI 0.22-0.87) in type 1 group, 35% patients (OR 0.43, 95% CI 0.27-0.69) in type 2 group, and 71% patients in the control group had no prior surgical history. Furthermore, 3% patients (OR 0.27; 95% CI 0.08-0.9) in the type 1 group, 48% patients (OR 2.0, CI 95% 1.24-3.24) in the type 2 group, and 41% patients in the control group had history of bilateral tubal ligation (BTL).

Conclusion: A significant association was found between diverticulosis, hysterectomy and endometriosis increasing the likelihood of type 1 EOC; while diverticulosis, exploratory laparotomy and hysterectomy increased the likelihood of type 2 EOC. BTL was significantly associated with decreasing the likelihood of type 1 EOC, but increasing the likelihood of type 2 EOC. Diabetes mellitus and no prior surgical history were found to significantly decrease the likelihood of all EOC.