Clinics (Sao Paulo).2019;74:e1343.
Ovarian Cancer Previvors: How to manage these patients?
The origin of precursor lesions and ovarian cancer
High-grade serous ovarian carcinoma (HGSC), the most frequent and aggressive histological type of ovarian cancer, originates in fimbrial cells that are secondarily implanted in the ovary (). This type of carcinoma can start in the fallopian tubes and implant and grow in the ovary at an early stage, or it can originate in normal tubal cells implanted in the ovulatory wound during ovulation (). The origin of cancer depends on local factors and/or host fragility (,). Women with mutations in the BRCA genes carry conditions that favor the development of HGSC in the tubal epithelium (). It is therefore reasonable to consider that efforts to prevent ovarian cancer should focus on intervention in the fimbriae to prevent cell implantation in the ovaries, and thus, cancer development.
Factors that prevent fimbrial cell implantation in the ovary, such as the prolonged use of anovulatory contraceptives and salpingectomy for any reason, have been shown to significantly reduce the incidence of ovarian cancer (,). The implantation of fimbrial cells in the ovary begins with the onset of ovulation. The amount of ovulation occurring over a woman’s lifetime is closely related to the incidence rate of ovarian cancer (,). It is reasonable to suppose that earlier interruptions of fimbrial cell implantation will have a greater benefit in the prevention of ovarian cancer.