title: Population distribution of lifetime risk of ovarian cancer in the United States.
abstract: BACKGROUND
  In U.S. women, lifetime risk of ovarian cancer is 1.37%, but some women are at a substantially lower or higher risk than this average.
  
  
  METHODS
  We have characterized the distribution of lifetime risk in the general population. Published data on the relative risks and their variances for five well-accepted risk and protective factors for ovarian cancer, oral contraceptive use, parity, tubal ligation, endometriosis, and first-degree family history of ovarian cancer in conjunction with a genetic risk score using genome-wide significant common, low penetrance variants were used. The joint distribution of these factors (i.e., risk/protective factor profiles) was derived using control data from four U.S. population-based studies, providing a broad representation of women in the United States.
  
  
  RESULTS
  A total of 214 combinations of risk/protective factors were observed, and the lifetime risk estimates ranged from 0.35% [95% confidence interval (CI), 0.29-0.42] to 8.78% (95% CI, 7.10-10.9). Among women with lifetime risk ranging from 4% to 9%, 73% had no family history of ovarian cancer; most of these women had a self-reported history of endometriosis.
  
  
  CONCLUSIONS
  Profiles including the known modifiable protective factors of oral contraceptive use and tubal ligation were associated with a lower lifetime risk of ovarian cancer. Oral contraceptive use and tubal ligation were essentially absent among the women at 4% to 9% lifetime risk.
  
  
  CONCLUSIONS
  This work demonstrates that there are women in the general population who have a much higher than average lifetime risk of ovarian cancer. Preventive strategies are available. Should effective screening become available, higher than average risk women can be identified.
authors.affiliation: Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.|Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Celeste Leigh
authors.initials: CL
authors.lastname: Pearce
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Daniel O
authors.initials: DO
authors.lastname: Stram
authors.affiliation: School of Public Health, University of Texas, Houston, TX, USA.
authors.forename: Roberta B
authors.initials: RB
authors.lastname: Ness
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Stram
authors.affiliation: Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Lynda D
authors.initials: LD
authors.lastname: Roman
authors.affiliation: Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: Templeman
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Alice W
authors.initials: AW
authors.lastname: Lee
authors.affiliation: Women's Cancer, Institute for Women's Health, University College London, UK.
authors.forename: Usha
authors.initials: U
authors.lastname: Menon
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center, Erlangen, Germany.|Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Fasching
authors.affiliation: Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of British Columbia, Vancouver.
authors.forename: Jessica N
authors.initials: JN
authors.lastname: McAlpine
authors.affiliation: Section of Biostatistics and Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Doherty
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA.|Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.|Women's Cancer Research Program, Magee-Womens Research Institute, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
authors.forename: Francesmary
authors.initials: F
authors.lastname: Modugno
authors.affiliation: Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA.|Cancer Prevention, Detection and Control Research Program, Duke Cancer Institute, Durham, NC, USA.
authors.forename: Joellen M
authors.initials: JM
authors.lastname: Schildkraut
authors.affiliation: Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.|Department of Epidemiology, University of Washington, Seattle, WA, USA.
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Rossing
authors.affiliation: Department of Pathology, Vancouver General Hospital, BC Cancer Agency, Vancouver, BC, Canada.
authors.forename: David G
authors.initials: DG
authors.lastname: Huntsman
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Anna H
authors.initials: AH
authors.lastname: Wu
authors.affiliation: Gynecologic Cancer Program, Duke Cancer Institute, Durham, NC, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Berchuck
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.|Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Malcolm C
authors.initials: MC
authors.lastname: Pike
authors.affiliation: Department of Oncology, University of Cambridge, Cambridge, UK.|Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: Paul D P
authors.initials: PDP
authors.lastname: Pharoah
mesh_terms: D003276:Contraceptives, Oral; D003710:Demography; D005260:Female; D006801:Humans; D015993:Life Tables; D010051:Ovarian Neoplasms / Q000453:epidemiology*; D012307:Risk Factors; D013246:Sterilization, Tubal; D014481:United States / Q000453:epidemiology
chemical_list: D003276:Contraceptives, Oral