Risk factors and increasing protective factors may help prevent cancer

Avoiding cancer risk factors may help prevent certain cancers. Risk factors include smoking, being overweight, and not getting enough exercise. Increasing protective factors such as quitting smoking and exercising may also help prevent some cancers. Talk to your doctor or other health care professional about how you might lower your risk of cancer.

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What are risk factors for ovarian, fallopian tube, and primary peritoneal cancer?

A woman who has had breast cancer has an increased risk of ovarian cancer.

Family history of ovarian, fallopian tube, and primary peritoneal cancer

A woman whose mother or sister had ovarian cancer has an increased risk of ovarian cancer. A woman with two or more relatives with ovarian cancer also has an increased risk of ovarian cancer.

Inherited risk

The risk of ovarian cancer is increased in women who have inherited certain changes in the BRCA1, BRCA2, or other genes.

The risk of ovarian cancer is also increased in women who have certain inherited syndromes that include:

• Familial site-specific ovarian cancer syndrome.
• Familial breast/ovarian cancer syndrome.
• Hereditary nonpolyposis colorectal cancer (HNPCC; Lynch syndrome).

Hormone replacement therapy

There is a slightly increased risk of ovarian cancer in women who are taking hormone replacement therapy (HRT) after menopause. There is also an increased risk of ovarian cancer in women who have recently used HRT, even if they used it for less than 5 years. The risk of ovarian cancer is the same for HRT with estrogen only or with combined estrogen and progestin. When HRT is stopped, the risk of ovarian cancer decreases over time. The risk of ovarian cancer is not affected by the age of the woman when taking HRT.

Weight and height

Being overweight or obese during the teenage years is linked to an increased risk of ovarian cancer. Being obese is linked to an increased risk of death from ovarian cancer. Being tall (5’8″ or taller) may also be linked to a slight increase in the risk of ovarian cancer.

Endometriosis

Women who have endometriosis have an increased risk of ovarian cancer.

The following are protective factors for ovarian, fallopian tube, and primary peritoneal cancer:

Oral contraceptives

Taking oral contraceptives (“the pill”) lowers the risk of ovarian cancer. The longer oral contraceptives are used, the lower the risk may be. The decrease in risk may last up to 30 years after a woman has stopped taking oral contraceptives.

Taking oral contraceptives increases the risk of blood clots. This risk is higher in women who also smoke.

Tubal ligation
The risk of ovarian cancer is decreased in women who have a tubal ligation (surgery to close both fallopian tubes).

Giving birth
Women who have given birth have a decreased risk of ovarian cancer compared to women who have not given birth. Giving birth to more than one child further decreases the risk of ovarian cancer.

Salpingectomy
Some studies have shown that salpingectomy (surgery to remove one or both fallopian tubes) is linked with a decreased risk of ovarian cancer. When both fallopian tubes are removed, the risk of ovarian cancer is lowered more than when one fallopian tube is removed.

Breastfeeding
Breastfeeding is linked to a decreased risk of ovarian cancer. The longer a woman breastfeeds, the lower her risk of ovarian cancer. Women who breastfeed for at least 8 to 10 months have the greatest decrease in risk of ovarian cancer.

Risk-reducing salpingo-oophorectomy

Some women who have a high risk of ovarian cancer may choose to have a risk-reducing salpingo-oophorectomy (surgery to remove the fallopian tubes and ovaries when there are no signs of cancer). This includes women who have inherited certain changes in the BRCA1 and BRCA2 genes or have an inherited syndrome. (See the Risk-reducing salpingo-oophorectomy section in the PDQ health professional summary on Genetics of Breast and Gynecologic Cancers for more information.)

It is very important to have a cancer risk assessment and counseling before making this decision. These and other factors may be discussed:

• Infertility.
• Early menopause: The drop in estrogen levels caused by removing the ovaries can cause early menopause. Symptoms of menopause include the following:
  • Hot flashes.
  • Night sweats.
  • Trouble sleeping.
  • Mood changes.
  • Decreased sex drive.
  • Heart disease.
  • Vaginal dryness.
  • Frequent urination.
  • Osteoporosis (decreased bone density).

These symptoms may not be the same in all women. Hormone replacement therapy (HRT) may be used to lessen these symptoms.

• Risk of ovarian cancer in the peritoneum: Women who have had a risk-reducing salpingo-oophorectomy continue to have a small risk of ovarian cancer in the peritoneum (thin layer of tissue that lines the inside of the abdomen). This is rare, but may occur if ovarian cancer cells had already spread to the peritoneum before the surgery or if some ovarian tissue remains after surgery.

It is not clear whether the following affect the risk of ovarian, fallopian tube, and primary peritoneal cancer:

• Diet
  • Studies of dietary factors have not found a strong link to ovarian cancer.
• Alcohol
  • Studies have not shown a link between drinking alcohol and the risk of ovarian cancer.
• Aspirin and non-steroidal anti-inflammatory drugs
  • Some studies of aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) have found a decreased risk of ovarian cancer and others have not.
• Talcum powder (Talc)
  • Studies of women who used talcum powder (talc) dusted on the perineum (the area between the vagina and the anus) have not found clear evidence of an increased risk of ovarian cancer.
• Infertility treatment
  • Overall, studies in women using fertility drugs have not found clear evidence of an increased risk of ovarian cancer. The risk of invasive ovarian cancer may be higher in women who do not get pregnant after taking fertility drugs.

Cancer prevention clinical trials are used to study ways to prevent cancer.

Cancer prevention clinical trials are used to study ways to lower the risk of developing certain types of cancer. Some cancer prevention trials are conducted with healthy people who have not had cancer but who have an increased risk for cancer. Other prevention trials are conducted with people who have had cancer and are trying to prevent another cancer of the same type or to lower their chance of developing a new type of cancer. Other trials are done with healthy volunteers who are not known to have any risk factors for cancer.

The purpose of some cancer prevention clinical trials is to find out whether actions people take can prevent cancer. These may include eating fruits and vegetables, exercising, quitting smoking, or taking certain medicines, vitamins, minerals, or food supplements.

New ways to prevent ovarian, fallopian tube and primary peritoneal cancer are being studied in clinical trials.

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