Possible role of ovarian epithelial inflammation in ovarian cancer

Ovarian cancer is a commonly fatal disease for which prevention strategies have been limited, in part because of a lack of understanding of the underl ying biology, This paper reviews the epidemiologic literature in the Englis h language on risk factors and protective factors for ovarian cancer and pr oposes a novel hypothesis that a common mechanism underlying this disease i s inflammation. Previous hypotheses about the causes of ovarian cancer have attributed risk to an excess number of lifetime ovulations or to elevation s in steroid hormones, Inflammation may underlie ovulatory events because a n inflammatory reaction is induced during the process of ovulation, Additio nal risk factors for ovarian cancer, including asbestos and talc exposure, endometriosis (i.e., ectopic implantation of uterine lining tissue), and pe lvic inflammatory disease, cannot be directly linked to ovulation or to hor mones but do cause local pelvic inflammation, On the other hand, tubal liga tion and hysterectomy act as protective factors, perhaps by diminishing the likelihood that the ovarian epithelium will be exposed to environmental in itiators of inflammation. Inflammation entails cell damage, oxidative stres s, and elevations of cytokines and prostaglandins, all of which may be muta genic. The possibility that inflammation is a pathophysiologic contributor to the development of ovarian cancer suggests a directed approach to future research.