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Ovarian Cancer and Prevention.

It has been a tremendously exciting era in ovarian carcinoma research and clinical applications. First, histotype and molecular categorization has completely transformed the approach to research and clinical management of this disease. Second, the appreciation of the role of the fallopian tube in the development of ovarian cancers has shed new insight on established epidemiologic risk factors, unveiled precursor lesions, and offered new opportunities in prevention. Ovarian cancer still claims more lives than any other gynecologic malignancy in the developing world. Despite well-run clinical trials in tens of thousands of women we still have no screening modalities proven to significantly reduce mortality. Surgical interventions and chemotherapy, both conventional and targeted, have enabled improvements in progression-free survival but only minor differences in overall survival. This unfortunate reality has prompted renewed interest in prevention of ovarian cancer. Herein, the authors review the new classification system of ovarian cancer, a state of the art review on the changes taking place in the transition of normal fallopian tube epithelium to pelvic serous carcinomas, novel insights on endometriosis-associated ovarian carcinomas, the role of hereditary factors in the development of ovarian cancer, actionable opportunities in women at average risk, or high risk (eg, BRCA1/2 mutation carriers) for developing ovarian cancer or who have an incidental finding of preinvasive lesions, cost considerations for these interventions, and finally preclinical models that have been of paramount importance and we hope will enable further advances in research discovery.