Environmental Factors

A host of environmental exposures have been examined for their effect on ovarian cancer risk, although evidence is mixed. The introduction of chemical carcinogens, such as talc and asbestos, into the peritoneal cavity through retrograde migration from the vulva and vagina has been theorized to be associated with development of ovarian cancer. Venter et al. (54) used technetium Tc 99m-labeled human albumin microspheres to prove that particles in the lower genital tract could migrate to the ovaries. Although, talc particles have been found in both benign and malignant ovarian tumors (55,56) and occupational exposure to asbestos appears to confer a higher rate of intra-abdominal carcinomatosis (57,58), several studies have failed to find an association between these agents and the development of ovarian cancer (59-61). Modest increases in relative risk for ovarian cancer among women using perineal talc ranges from 1.6 to 1.9 (62,63).

The effect of radiation exposure is controversial. Although, Annegers et al. (27) reported an increase in relative risk by 1.8 for women exposed to radiation, others have noted no difference (58). The effect of viral infection on ovarian cancer risk is also controversial. Both rubella and influenza have been noted to play a role (9) and mumps has been the focus of more attention. Some investigators have noted mumps infection to exert a protective effect (64), whereas others have described a harmful effect (65,66). On one hand, authors have speculated that women exposed to mumps are more likely to be born into larger families with more children, and in turn, produce more children themselves, thereby lowering their risk for ovarian cancer (46,67). On the other hand, others have suggested that patients with subclinical mumps infection may suffer early ovarian failure, with associated elevation of gonadotropin levels, which may stimulate ovarian epithelial growth, leading to an elevated risk (65,66). The effect of mumps infection is not likely to be of future clinical concern in most industrialized nations given the low incidence with nearly universal vaccination programs (68,69), but mumps remains endemic in many parts of the developing world (70).

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