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One hundred‐fifty ovarian cancer patients plus eight with a diagnosis other than adenocarcinoma and endometrioid cancers and 300 age‐matched control patients were interviewed in New York hospitals. There were no essential differences in marital status, nor in other marital or pregnancy factors. The study suggested a trend for more ovarian cancer patients to have dysmenorrhea. These data may be artifactitious and further studies in this area are indicated. Among the gynecologic findings, the ovarian cancer patient gave a more frequent history of heavy menstrual bleeding and earlier menopause than the control group. A comparison of mortality rates in Americans and Japanese Americans suggests possible differences in the etiologic background of pre‐ and postmenopausal ovarian cancer patients. The increase of ovarian cancer among Japanese immigrants to the U.S. represents a primary lead to the etiology of this type of cancer. It is suggested that further work done on Japanese, Japanese‐Americans, and other native Americans in terms of the effect of diet on steroids with particular reference to their effect on various target organs.

DNA instability, reflected in altered patterns of short tandem repeat sequences (microsatellites) in dividing cells, has been described in hereditary non-polyposis colon cancer (HNPCC) and in other tumor types. Ovarian cancer (OC), although most often a sporadic cancer, can recur, with HNPCC, as part of the Lynch cancer family syndrome. In an investigation of microsatellite instability (MIN) in 90 OC cases, we found MIN in 3/28 (11%) OC cases with, and 8/62 (13%) without, a family history of cancer. For 2/3 MIN+ OC cases with family cancer history consistent with the Lynch cancer family syndrome, we found additional bands in the microsatellite patterns in tumor versus normal tissue (HNPCC-type of MIN), but no germline mutations in two DNA mismatch repair genes, hMSH2 and hMLH1. In 7/8 MIN+ sporadic OC cases distinct MIN patterns not commonly reported in HNPCC were found. These are characterized by partial or total band shifting, leading to fewer bands and/or changes in the intensity of individual bands restricted to the tumor. In only one case was a germline change in hMSH2 or hMLH1 identified: this was subsequently found to be a polymorphism. An apparent hMLH1 somatic change confined to the tumor was found in another case. The fact that we found no germline pathologic mutations in hMSH2 and hMLH1 (predominant sites of mutation in HNPCC) in MIN+ OC cases, suggests that the genetic basis of MIN in OC can be different from that in HNPCC; our finding that distinct microsatellite banding patterns largely distinguish sporadic from familial OC, may reflect the involvement of different DNA repair genes in MIN in individual OC cases.

The authors describe a clinically comprehensive ethical framework for addressing the challenges of managing cancer during pregnancy. The framework is based on the ethical principles of beneficence and respect for autonomy and the concept of the fetus as a patient.