Why does alcohol cause OC?

Alcohol Consumption and Breast and Ovarian Cancer Development: Molecular Pathways and Mechanisms

https://tinyurl.com/39h72xhz

A link between alcohol consumption and increased risk of breast cancer is well known. It now is becoming clear that a similar association with ovarian cancer exists albeit less clear cut.

Alcohol abuse is common, it is estimated that alcohol is the cause of 5% of all deaths. The exact mechanism of increased cancer risk remains uncertain. Recent understanding suggests that in the case of ovarian cancer three important mechanisms are responsible. These are; hormonal modulation, DNA damage, and cellular oxidation.

Alcohol is metabolised in the liver, with acetaldehyde as an intermediate product. Both these substances can damage DNA and disrupt repair. The presence of alcohol in the body causes oxidative stress, with an imbalance of free radicals and antioxidants. In good health free radicals, which are oxygen containing molecules with an uneven electron charge, have an important function to control disease. If the balance is disrupted as with alcohol consumption cellular damage may occur.

Hormonal effects of alcohol are due to disruption of  the normal metabolism via aromatase, sometimes causing breast cancer and Low-Grade Ovarian Cancer.  More extensive damaging effect with increased ovarian cancer risk is suspected,

Further understanding will help to determine whether a safe level of alcohol consumption is possible and enable individuals to make their own risk assessment.

Which is best?

The prognostic influence of hospital type, method of first histological confirmation and time to chemotherapy in patients with advanced primary ovarian cancer

https://tinyurl.com/cburpu7d

There is a constant effort to improve the management of ovarian cancer. It is clear that the best chance of complete cure is at the time of the initial surgery. If the cancer can be completely cleared, survival is more likely.

Towards this end a proposed change in management has been developed, with a two-stage process, whereby an initial limited procedure is performed, to obtain a tissue biopsy, prior to complete clearance.

This review of 115 women with ovarian cancer, looks at whether there is any difference in outcome when the two-stage process is used. Also, the hospital type where the first procedure occurred may be significant, in that complete surgery at a centre of excellence has been shown to be advantageous for survival.

Results from the review showed no difference in overall survival, there was a delay in starting chemo for those having two-stage management. A surprising number of women, (10 out of 55 who had two-stage procedures), developed a metastasis at the entry port for the biopsy. Meaning that progression free survival was worse for them.

Is pollution causing OC?

Outdoor Air Pollution Exposure and Ovarian Cancer Incidence in a United States–Wide Prospective Cohort Study

https://tinyurl.com/yjzydbdz

Ever increasing rates of cancer in young patients has raised the concern that this is a consequence of pollution. For the first time evidence supporting this theory in relation to ovarian cancer is available.

Pollution presents mainly in two forms: particulate material such as micro plastics and sulphur, or gaseous such as nitrous dioxide and ozone. Using information from the” Sisters”study, which enrolled more than 50,000 women who had at least one sister with a history of breast cancer, it was possible to show how rates of ovarian cancer varied in relation to different geographic areas, with different pollution levels.

Results from this prospective analysis showed a positive association with increased nitrous dioxide levels but no association with particulate pollution or increased ozone. Nitrous dioxide is found in the atmosphere as the result of combustion mostly from fossil-fuelled transport or internal heating. Elimination of this pollutant would be a good side effect of more use of electric vehicles.

Is it cost-effective?

Cost and Clinical Implications of Utilizing Homologous Recombination Deficiency Status to Guide First-Line Maintenance Therapy Selection in Advanced Ovarian Cancer

https://tinyurl.com/yrydv7t8

With success comes overuse. A typical example of this is the widespread use of enzyme inhibitors, such as PARPi in ovarian cancer, for women who because of their genotype are unlikely to have any benefit.

The current cost in the US to treat 100 women with PARPi for ovarian cancer is just over  $US 62 million for the 5-year treatment course. This imposes a strain on personal and community finances. If these patients are screened using a biomarker guide (BMG), the cost overall is reduced, (by 17.5%), despite the significant cost  of performing BMG on 100 women.

Savings from treatment also include reduced clinical costs due to prolonged survival and better health. For costly treatment such as targeted enzyme inhibition, it is important to ensure it is only used when most cost-effective. This study shows that for each dollar spent on HRD testing, another twenty-six dollars of savings will result.