title: Ovarian epithelial tumors and reproductive factors: a systematic review.
abstract: OBJECTIVE
  The aim of this systematic review is to summarize the current knowledge about the etiology and pathogenesis of borderline tumors ovarian cancer with special emphasis on the role of endocrine treatments and reproductive factors to establish a foundation for future studies.
  
  
  METHODS
  We performed a systematic review on the relation between ovarian epithelial tumors (OET) and reproductive factors using the keywords: ovarian cancer, ovarian tumor, ovarian borderline tumor, age at menarche, age at menopause, parity, infertility, PCO syndrome, oral contraception, menopausal hormone therapy, fertility treatment. Totally, 3,290 abstracts were scanned for their relevance in this publication and 127 were finally included.
  
  
  RESULTS
  The incidence of ovarian epithelial cancer and ovarian borderline tumors is influenced by certain reproductive factors. The strongest protective effects are conferred by parity and use of oral contraceptive pills. Recent molecular biologic and histopathologic studies prove that OET represent a diverse group of tumors, each histologic type with a different genetic background. This is at least partly reflected in epidemiologic and clinical studies showing different risk modulating effects of reproductive factors and endocrine therapies on OET.
  
  
  CONCLUSIONS
  The etiology and pathogenesis of ovarian cancer are still not fully understood. None of the so far proposed hypothesis on the development of OET can fully account for the epidemiologic and clinical findings in the context of reproductive factors and OET development. Further research approaches are warranted and need to put more weight on the clinical and genetical diversity of OET to yield a more detailed insight into their pathogenesis.
authors.affiliation: Department of Obstetrics and Gynecology, University of Regensburg, Caritas-Hospital St. Josef, Landshuter Straße 65, 93053 Regensburg, Germany. sschueler@caritasstjosef.de
authors.forename: Susanne
authors.initials: S
authors.lastname: Schüler
authors.forename: Marvin
authors.initials: M
authors.lastname: Ponnath
authors.forename: Jörg
authors.initials: J
authors.lastname: Engel
authors.forename: Olaf
authors.initials: O
authors.lastname: Ortmann
mesh_terms: D000367:Age Factors; D000728:Androgens / Q000502:physiology; D000077216:Carcinoma, Ovarian Epithelial; D003276:Contraceptives, Oral; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000502:physiology; D005260:Female; D006065:Gonadotropins, Pituitary / Q000502:physiology; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy; D016239:MEDLINE; D008572:Menarche; D008593:Menopause; D009375:Neoplasms, Glandular and Epithelial / Q000209:etiology / Q000235:genetics / Q000473:pathology; D010051:Ovarian Neoplasms / Q000209:etiology / Q000235:genetics / Q000473:pathology; D010298:Parity; D011085:Polycystic Ovary Syndrome / Q000150:complications; D011247:Pregnancy; D011374:Progesterone / Q000502:physiology; D012098:Reproduction; D012307:Risk Factors
chemical_list: D000728:Androgens; D003276:Contraceptives, Oral; D004967:Estrogens; D006065:Gonadotropins, Pituitary; D011374:Progesterone