Mahmoud F. Fathalla

INCESSANT OVULATION—A FACTOR IN OVARIAN NEOPLASIA ?

Focus is on some evidence of a possible relationship between the repeated involvement of the ovarian surface epithelium in the process of ovulation and the frequency of the development of the common ovarian neoplasms from this epithelium. Data about comparative ovarian oncology have been accumulating, and 3 noteworthy features have been revealed: 1) practically all tumor types encountered in the human ovary may be seen in the mammalian ovary; 2) ovarian tumors in other mammals are apparently much rarer than in human beings; and 3) this rarity is largely because of the infrequency of epithelial neoplasms derived from the ovarian surface epithelium--the cystadenoma and the adenocarcinoma. In women these account for the majority of all ovarian neoplasms and for the great majority of ovarian malignant neoplasms. Another situation has been revealed in the domestic fowl, with its frequent egg production. Adenocarcinoma of the ovary is the most common epithelial neoplasm in the entire body. The relation to egg production was demonstrated in an experiment where adenocarcinomas were induced in the ovaries of 17 out of 19 hens by maintaining them throughout life in a stable environment with 12 hours of fluorescent lighting daily. Egg production rapidly reached a maximum; it then declined over 3 years, with no seasonal rest periods. No tumors appeared in control hens kept under normal lighting conditions with seasonal variations. The surface epithelium of the ovary does not appear to play any active role in the adult processes of reproduction. The few electron microscopic studies available suggest a simple mesothelial function. The process of ovulation involves repeated minor trauma to the covering epithelium as well as repeated exposure of the ovarian surface to the estrogen rich viscous follicular fluid. Epidemiological data in human beings may be suggestive of a possible relationship between the process of ovulation and the development of the common ovarian neoplasm. In the absence of ovulation, ovarian neoplasms of surface epithelial origin are very rare, but germ cell and mesenchymal tumors occasionally arise. In patients denied the ovarian physiological rest periods afforded by pregnancies, a higher incidence of ovarian cancer has been reported. The hypothesis that the extravagant and mostly purposeless ovulations in the human female may have a contributing role in neoplasia of the surface epithelium of the ovary requires additional consideration.

Factors in the causation and incidence of ovarian cancer.

This paper presents an overview of the present knowledge about etiologic factors in the development of ovarian cancer. It is divided into 3 main headings: 1) epidemiologic observations about human ovarian cancer; 2) studies on spontaneous animal ovarian tumors that gave rise to an interesting field in comparative oncology; and 3) studies on experimental ovarian tumors. Factors which have been related to the causation and incidence of human ovarian cancer are: 1) racial and geographical incidence; 2) socioeconomic factors; 3) genetic factors; 4) age; 5) menstrual characteristics; 6) marital status and parity; 7) relationship to intersex states; 8) laterality; 9) endometriosis; 10) previous hysterectomy; 11) previous oophorectomy; 12) relationship to other neoplasms; 13) thyroid disease; 14) mumps; 15) x-irradiation; 16) asbestosis; and 18) incessant ovulation. A review of literature on ovarian tumors in animals showed that animals have a much lesser incidence than humans and thus was attributed to the infrequency of tumors arising from the ovarian surface epithelium which in humans comprise the great majority of ovarian tumors. On the other hand the prevalence of ovarian cancer among egg-laying domestic fowls is attributed to the frequency of adenocarcinoma. Such data may be helpful in determining the etiology of certain types of ovarian cancer. Experimental ovarian tumors have been induced in animals by x-irradiation; ovarian grafting; ligature of blood vessels; partial castration; and progestrational steroids. The implications of these experiments in human problems are briefly discussed as are the need for more studies in the field of epidemiology of human ovarian cancer.

Female genital cutting (mutilation/circumcision): ethical and legal dimensions

The practice better described as female genital cutting (FGC) is of long standing in some communities, and has spread to non‐traditional countries by immigration. It is of varying degrees of invasiveness, often including clitoridectomy, but all raise health‐related concerns, which can be of considerable physical and/or psychological severity, and compromise gynecological and obstetric care. The practice is not based on a requirement of religious observance, although parents usually seek it for their daughters in good faith. It is directed to the social control of womens sexuality, in association with preservation of virginity and family honor. FGC is becoming increasingly prohibited by law, in countries both of its traditional practice and of immigration. Medical practice prohibits FGC. In compromising womens health and negating their sexuality, FGC is a human rights abuse that physicians have a role in eliminating by education of patients and communities.

Sexual and reproductive health for all: a call for action

At the United Nations International Conference on Population and Development in Cairo in 1994, the international community agreed to make reproductive health care universally available no later than 2015. After a 5-year review of progress towards implementation of the Cairo programme of action, that commitment was extended to include sexual, as well as reproductive, health and rights. Although progress has been made towards this commitment, it has fallen a long way short of the original goal. We argue that sexual and reproductive health for all is an achievable goal--if cost-effective interventions are properly scaled up; political commitment is revitalised; and financial resources are mobilised, rationally allocated, and more effectively used. National action will need to be backed up by international action. Sustained effort is needed by governments in developing countries and in the donor community, by inter-governmental organisations, non-governmental organisations, civil society groups, the womens health movement, philanthropic foundations, the private for-profit sector, the health profession, and the research community.

Reproductive health: a global overview.

WHO defines reproductive health as people having the ability to reproduce to regulate fertility and to practice and enjoy sexual relationships. It also means safe pregnancy child birth contraceptives and sex. Procreation should include a successful outcome as indicated by infant and child survival growth and healthy development. 60-80 million infertile couples live in the world. Core infertility i.e. unpreventable and untreatable infertility ranges from 3% to 5%. Sexually transmitted diseases aseptic abortion or puerperal infection are common causes of acquired infertility. Sub-Saharan Africa has the highest prevalence of acquired infertility. In 1983 the world contraceptive use rate stood at 51% with the developed countries having the highest rate (70%) and Africa the lowest rate (14%). About 40 countries in Africa and the Arabian Peninsula practice female circumcision. The percent of low birth weight infants is greater in developing countries than in developed countries (17% vs. 6.8%). Intrauterine growth retardation is responsible for most low birth weight infants in developing countries while in developed countries it is premature birth. About 15 million infants and children die each year. Maternal mortality risk is highest in developing countries especially those in Africa (1:21) and lowest in developed countries (1:9850). Sexually transmitted diseases continue to be a major problem in the world especially in developing countries. Chlamydia afflicts 50 million people each year. The proportion of women with AIDS is growing so that between the 1980s and 1990s it will grow between 25% and 50%. More available contraceptive choices enhance safety in fertility regulation. Socioeconomic conditions that determine reproductive health are poverty literacy and womens status. Sexual behavior reproductive behavior breast feeding and smoking are life style determinants of reproductive health. Availability utilization and efficiency of health care services and level of medical knowledge also determine womens reproductive health.

Reproductive health: a global overview

WHO defines reproductive health as people having the ability to reproduce, to regulate fertility, and to practice and enjoy sexual relationships. It also means safe pregnancy, child birth, contraceptives, and sex. Procreation should include a successful outcome as indicated by infant and child survival, growth, and healthy development. 60-80 million infertile couples live in the world. Core infertility, i.e., unpreventable and untreatable infertility, ranges from 3% to 5%. Sexually transmitted diseases, aseptic abortion, or puerperal infection are common causes of acquired infertility. Sub-Saharan Africa has the highest prevalence of acquired infertility. In 1983, the world contraceptive use rate stood at 51% with the developed countries having the highest rate (70%) and Africa the lowest rate (14%). About 40 countries in Africa and the Arabian Peninsula practice female circumcision. The percent of low birth weight infants is greater in developing countries than in developed countries (17% vs. 6.8%). Intrauterine growth retardation is responsible for most low birth weight infants in developing countries while in developed countries it is premature birth. About 15 million infants and children die each year. Maternal mortality risk is highest in developing countries especially those in Africa (1:21) and lowest in developed countries (1:9850). Sexually transmitted diseases continue to be a major problem in the world especially in developing countries. Chlamydia afflicts 50 million people each year. The proportion of women with AIDS is growing so that between the 1980s and 1990s it will grow between 25% and 50%. More available contraceptive choices enhance safety in fertility regulation. Socioeconomic conditions that determine reproductive health are poverty, literacy, and womens status. Sexual behavior, reproductive behavior, breast feeding, and smoking are life style determinants of reproductive health. Availability, utilization, and efficiency of health care services and level of medical knowledge also determine womens reproductive health.

Women's health: An overview

’ President-Elect, International Federation of Gynecology and Obstetrics, and Senior Advisor, Biomedical and Reproductive Health Research, The Rockefeller Foundation. beyond the reproductive years and even if the system did not engage at all in reproduction, Apart from reproductive diseases, women share with men the risk of disease in all other body systems. Cardiovascular disease, for example, kills more women than genital cancer, including breast cancer, in both developed and developing countries [2]. Genetic and hormonal differences between males and females can be reflected in differences in the disease burden. The noble task of reproducing the species has been rewarded by Nature in a biological advantage to the female, making her a better survivor at all stages of the life cycle from intrauterine life to old age. Nature, in its wisdom, knew what researchers have documented only recently, that in poorresource settings survival of the mother is much more critical to survival of the infants and children than survival of the father (31.

The girl child.

The health of the girl child is a concern for obstetrician‐gynecologists. Pediatric gynecologic conditions deserve special attention. The obstetric performance of the adult woman depends in large part on the health and healthcare of the girl child. Gender discrimination against the girl child violates her human rights and adversely impacts on her health and her life. The profession has a social responsibility to advocate for the girl childs right to health.

MALIGNANT TRANSFORMATION IN OVARIAN ENDOMETRIOSIS

IT is now forty years since Sampson (1924, 1925) first pointed out the possibility of malignant transformation in ovarian endometriosis. However, its frequency and clinical and pathological characteristics remain widely unrecognized. Few studies have been made and most of the literature on the subject has been limited to the reporting of isolated cases. Recent interest in this problem has been aroused by the more general realization among pathologists of the frequency with which endometrial-like adenocarcinoma is encountered among cases of primary ovarian carcinoma (Long and Taylor, 1964). The General Assembly of the International Federation of Gynaecology and Obstetrics at Mar del Plata in September 1964 adopted a recommendation to introduce a new group, termed “endometroid”, into the histological classification of the common primary epithelial tumours of the ovary, because the frequency of occurrence of tumours so designated was considered to warrant the status of a separate group. MATERIAL

THE OCCURRENCE OF GRANULOSA AND THECA TUMOURS IN CLINICALLY NORMAL OVARIES

THE aim of this report is to draw attention to a special group of granulosa and theca cell tumours which cause no significant enlargement of the ovary and betray their presence only by evidence of abnormal oestrogenic activity. Of 91 cases of granulosa and theca cell tumours, examined in the pathology laboratory of the Department of Obstetrics and Gynaecology of the University of Edinburgh since 1950, 25 tumours were encountered in ovaries that were normal-sized or only slightly enlarged.