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Contraception as chemoprevention of ovarian cancer in BRCA1 and BRCA2 women

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Ovarian cancer is the seventh most common cancer in women in the world, with an estimated worldwide mortality of over 207′000 women every year. This cancer, due to the current lack of adequate screening techniques, is commonly diagnosed late and has a poor prognosis. The oral contraceptive pill is considered the most effective prevention strategy for ovarian cancer in the general population, being associated with a decreased incidence while also having a substantial positive impact on the mortality rate, which is reduced by up to 50%. BRCA1 and BRCA2 germline mutated women have an augmented risk of ovary and breast cancer: despite international guidelines that consider prophylactic surgery as the gold standard for ovarian cancer prevention, there are currently no effective non-invasive preventive methods. In BRCA1\2 mutated patients, clinicians should weigh the benefits of contraceptive pills against the risk of long-term thromboembolic side effects and hormonal malignancies such as breast and cervical cancer. A multidisciplinary team should counsel patients on the most appropriate risk-reduction strategy tailored to their needs and expectations, proposing the oral contraceptive pill to selected patients after balancing the risks of adverse effects and the benefits on both contraception and chemoprevention.

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Abbreviations

OC:

Ovarian cancer

oCP:

Oral contraceptive pill

BRCA1:

Breast cancer type 1 susceptibility protein

BRCA2:

Breast cancer type 2 susceptibility protein

HBOC:

Autosomal dominant hereditary-breast-ovarian cancer syndrome

NCCN:

National Comprehensive Cancer Network

RRSO:

Risk-reducing bilateral salpingo-oophorectomy

BC:

Breast cancer

CC:

Cervical cancer

OR:

Odds ratio

HR:

Hazard ratio

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Authors and Affiliations

  1. S.S.D. Ginecologia Oncologica Clinicizzata, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy

    Vera Loizzi

  2. Dipartimento Di Biomedicina Traslazionale E Neuroscienze (DiBraiN), University of Bari “Aldo Moro”, 70124, Bari, Italy

    Vera Loizzi

  3. Obstetrics and Gynecology Unit, University of Bari, Bari, Italy

    Marco Cerbone & Gianluca Raffaello Damiani

  4. Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, 70124, Bari, Italy

    Francesca Arezzo, Ettore Cicinelli & Gennaro Cormio

  5. Oncology Unit IRCSS Istituto Tumori “Giovanni Paolo II”, 70124, Bari, Italy

    Erica Silvestris & Gennaro Cormio

  6. Section of Molecular Pathology, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70124, Bari, Italy

    Gerardo Cazzato

Authors
  1. Vera Loizzi
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  2. Marco Cerbone
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  3. Francesca Arezzo
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  4. Erica Silvestris
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  5. Gianluca Raffaello Damiani
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  7. Ettore Cicinelli
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  8. Gennaro Cormio
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Contributions

The authors confirm their contribution to the paper as follows: study conception and design: Vera Loizzi (VL), Gennaro Cormio (GC), and Ettore Cicinelli (EC); data collection: Marco Cerbone (MC), Francesca Arezzo (FA), and Erica Silvestris (ES); analysis and interpretation of results: MC, FA, ES, Gianluca Raffaello Damiani (GRD), Gerardo Cazzato (GeC), and VL; draft manuscript preparation: MC, VL, FA, GRD, GeC, GC, and EC; writing—review & editing of the manuscript: MC, VL, FC, ES, GC, GeC, GRD, GC, and EC. All authors reviewed the results and approved the final version of the manuscript.

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Correspondence to Marco Cerbone.

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Loizzi, V., Cerbone, M., Arezzo, F. et al. Contraception as chemoprevention of ovarian cancer in BRCA1 and BRCA2 women. Hormones 23, 277–286 (2024). https://doi.org/10.1007/s42000-023-00519-6

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