Mutiara Medika: Jurnal Kedokteran dan Kesehatan

http://journal.umy.ac.id/index.php/mm

Vol 20 No 2 Page 62-66 July 2020

Risk Factors of Ovarian Cancer in PKU Muhammadiyah

Teaching Hospital Yogyakarta
Supriyatiningsih1,2, Alfun Dhiya AN1, Witri Andi Pratiwi1, Ralph J. Lelle2, Joerg Haier3
1Obstetrics and Gynecology Department, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah
Yogyakarta. Jl Brawijaya, Tamantirto, Kasihan, Bantul, Yogyakarta, Indonesia
2Geburtshilfe und Frauenheilkunde, Universitatklinikum Muenster/Westfaliche Wilhelms-University of Muenster,

Germany
3Comprehensive Cancer Centre, Hannover Medical School, Germany

DATA OF ARTICLE: Abstract: In PKU Muhammadiyah Teaching Hospital Yogyakarta from 2014 to
Received: 05 Feb 2020 2017, ovarian cancer is 5th out of all types cancers diagnosed. Recognition and
Reviewed: 20 Mar 2020 identification of ovarian cancer risk factors are very important to prevent the
Revised: 18 May 2020 patient both from morbidity and mortality. The purpose of this study was to
Accepted: 20 Jun 2020 estimate the relationship between low parity, infertility, age, and family history
with ovarian cancer in this hospital. This study was an observational analytical
*CORRESPONDENCE:
study with case control design. The sample was medical record of 74 women
supriyatiningsih.wenang@uni-
muenster.de
with ovarian cancer and non ovarian cancer the hospital period April 2014 to
September 2017 with inclusion and exclusion criteria. Data analysis used chi-
DOI: square test. The bivariat analysis showed that there is no relationship between
10.18196/mm.200247 low parity with ovarian cancer (p=0.790 OR=0.87; 95% CI 0.305-2.466), there is
no relation between infertility with ovarian cancer (p=0.104 OR=2.48; 95% CI
TYPE OF ARTICLE: 0.815-7.545), and there is no relation between family history with ovarian cancer
Research (p=0.304 OR=3.18; 95% CI 0.315-32.039). But there is a relationship between
age with ovarian cancer (p=0.01 OR=0.11; 95% CI 0.022-0,510). Age is a risk
factor of ovarian cancer, while there is no relation between low parity, infertility,
and family history with ovarian cancer.
Keywords: Risk Factors, Ovarian Cancer, Age.

Abstrak: Di RS Pendidikan PKU Muhammadiyah Yogyakarta 2014-2017, kanker

ovarium menempati urutan ke-5 dari semua jenis kanker yang terdiagnosis. Pengenalan
dan identifikasi faktor risiko kanker ovarium sangat penting dilakukan untuk mencegah
penderita baik dari morbiditas maupun mortalitas. Tujuan penelitian ini adalah untuk
mengetahui hubungan paritas rendah, infertilitas, umur, dan riwayat keluarga dengan
kanker ovarium di RS ini. Penelitian ini merupakan penelitian analitik observasional
dengan desain case control. Sampel adalah rekam medis 74 wanita penderita kanker
ovarium dan kanker non ovarium di RS tersebut periode April 2014 sampai September
2017 dengan kriteria inklusi dan eksklusi. Analisis data menggunakan uji chi-square.
Analisis bivariat menunjukkan bahwa tidak ada hubungan antara paritas rendah
dengan kanker ovarium (p = 0.790 OR = 0.87; CI 95% 0.305-2.466), tidak ada
hubungan antara infertilitas dengan kanker ovarium (p = 0.104 OR = 2.48; 95% CI
0.815-7.545), dan tidak ada hubungan antara riwayat keluarga dengan kanker ovarium
(p = 0.304 OR = 3.18; 95% CI 0.315-32.039). Tetapi ada hubungan antara umur
dengan kanker ovarium (p = 0.01 OR = 0.11; 95% CI 0.022-0.510). Usia merupakan
faktor risiko terjadinya kanker ovarium, sedangkan paritas rendah, infertilitas, dan
riwayat keluarga tidak ada hubungan dengan kanker ovarium.
Kata Kunci: Faktor Risiko, Kanker Ovarium, Usia.

INTRODUCTION of small cells that will grow up into mass, because

Cancer is an abnormal cell growth. Cancer the cells have lost the ability to stop growing.1
is formed by an organ or body structure consisting Cancer is a major cause of mortality worldwide. By
2015, cancer causes 8.8 million deaths. The most Ovarian cancer usually does not have a
common cancer causes deaths: lung cancer (1.69 symptom at an early stage, so the patient is usually
million deaths), liver cancer (788,000 deaths), diagnosed when the cancer was metastasised.8
colorectal cancer (774,000 deaths), stomach cancer Ovarian cancer that found in the early stages is only
(754,000 deaths), and breast cancer (571,000).2 about 20%. Approximately 94% of patients can
In Indonesia, the prevalence of patient with survive more than 5 years after diagnosis, when
cancer at all ages is 1.4%. Yogyakarta province is the ovarian cancer is diagnosed at an early stage.9
province with the highest prevalence of cancer From the data above, the prevalence of
4.86%, which is much higher than the national rate.3 ovarian cancer in Indonesia is still very high. Ovarian
The next highest prevalence is in Central Java cancer is generally without any early-stage
province of 2.1% and Bali province of 2.0%.4 symptoms makes most ovarian cancers diagnosed
A report from Dharmais Cancer Hospital after metastasis. Of these phenomena, it requires
2010-2013 showed that breast cancer, cervical preventive and promotive efforts in reducing the
cancer, lung cancer, ovarian cancer, rectal cancer, incidence of ovarian cancer, one of which identifies
thyroid cancer, colon cancer, hepatoma and the risk factors of ovarian cancer. This is what
nasopharyngeal cancer are the most common makes researchers interested in conducting
cancer in Dharmais Hospital for four consecutive research to identify most common risk factors in
years. There was also an increase of ovarian cancer our teaching hospital.
incidence reported as many as 113 new cases from a
total of 1722 new cases in 2010 (6.56%).4 The MATERIALS AND METHOD
indicates that ovarian cancer is ranked 4th after A case control design was employed in the
breast cancer, cervical cancer, and lung cancer in study that include a total 37 patients with ovarian
the United States. 5 cancer and 37 patients with non-ovarian cancer for
Ovarian cancer is the fifth leading cause of control group. In this study, the data were collected
death from all types of cancers present in the from medical record data both ovarian and non
female reproductive system. In the United States, ovarian cancer patients in the Hospital of study
by 2017 an estimated 22,440 women will be period of April 2014 to September 2017 which has
diagnosed with ovarian cancer and 14,080 women met the inclusion criteria and exclusion criteria. The
will die from ovarian cancer.2,6 inclusion criteria includes women with ovarian
Medical record data of PKU Muhammadiyah cancer and non ovarian cancer, and there are free
Teaching Hospital Yogyakarta period 2014 to 2017 variable data to be studied. While women with
showed that ovarian cancer is the fifth highest ovarian cancer with complications excluded from
among all diagnosed cancers. In addition, ovarian this study. The study has been approved by the
cancer is also ranked second highest after breast Ethical Research Committee of the affiliated
cancer of all types of cancer in the female institution of the first author.
reproductive system. Statistical Package for the Social Sciences
Ovarian cancer is one of the malignant (SPSS) was used to test the data. Univariate analysis
diseases found in female reproductive organs, was conducted to investigate the characteristics of
which can originate in germ cells, epithelial or respondents and Chi-square was employed to
granulosa cell cells, but almost always from measure the relation between variabel.
epithelial cells. Ovarian cancer results from the
growth of abnormal cells in one or both parts of the RESULT
ovary.6,7 Data number of parities, infertility, age, and
Ovarian cancer is associated with low parity family history was collected and are shown in Table
and infertility. Although it may be related to other 1. Table 1 shows number of parities. Most of the
factors, such as the use of talc, the consumption of samples have parity ≤2 (n=55, 74.3%). and samples
galactose, and tubal ligation, but which is strongly having parity> 2 were 19 people (25.7%). More than
associated with the incidence of ovarian cancer is 75% samples were non infertile.
the history of reproduction and the duration of the Based on age, the number of samples with
history of reproductive work. Early menarche and age ≤40 years were 15 persons (20.3%) and samples
late menopause increase the risk of ovarian cancer. with age> 40 years were 59 people (79.7%). This
The risk of ovarian cancer is strongly associated indicates that the sample in this study was
with family history, especially ovarian cancer from dominated by a sample with age> 40 years. This
epithelial cells accounting for 5% to 10% including study indicates that the samples in both groups
malignant.7

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July 2020

were dominated by samples with no family history Table 3. Relationship of Infertility with The
of cancer (n=70 people, 94.6%). Incidence of Ovarian Cancer
There is no significant relation between Ovarian
ovarian cancer with low parity as shown in Table 2. Infertility Cancer OR CI(95%) P
Yes Not
Since there is no meaningful relationship, the value
Yes 12 6
of OR does not give the relationship meaning 2.48 0.815-7.545 0.104
Not 25 31
accurately or real. The OR score was 0.87 (1 / 0.87 =
1.15) with the meaning of women with > 2 parities
Table 4. Relationship between Age and Incidence
having 1.15 times higher incidence of ovarian cancer
of Ovarian Cancer
than women with low parity ≤2.
Ovarian
Table 3 shows that ovarian cancer is not CI(95%)
Age Cancer OR P
significantly related with infertility. Since there is no Yes Not
meaningful relationship, the value of OR does not ≤40 years
2 13
give the relationship meaning accurately or real. old
0.11 0.022-0.510 0.01
Obtained an OR value of 2.48 with the meaning of >40 years
35 24
women with infertility has a 2.48 times higher old
incidence of ovarian cancer than women who did
not experience infertility. Table 5. Relationship of Family History with The
From Table 4 it can see that there is a Incidence of Ovarian Cancer
significant relationship between ovarian cancer and Ovarian
Family
Cancer OR CI(95%) P
age (p=0.01). Obtained an OR value of 0.11 (1 / 0.11 = History
Yes Not
9.09), meaning that women aged > 40 years have Yes 3 1 0.315-
9.09 times higher chance of ovarian cancer than 3.18 0.304
Not 34 36 32.039
women aged ≤40.
Table 5 shows no significant relationship DISCUSSION
between ovarian cancer and family history. Because
there is no meaningful relationship, the OR does The statistical results of the bivariate analysis
not provide an accurate or real meaning of the in table 2 show that there is no significant
relationship. Obtained an OR value of 3.18 which relationship between low parity and the incidence
means that women who have a family history of of ovarian cancer. In addition, women who have
cancer have 3.18 times higher chance of ovarian parity> 2 have 1.15 times higher chance of growing
cancer than women who have no family history of ovarian cancer than women who have low parity ≤2.
cancer. This is in line with the results of research at RSUD
Table 1. Distribution of Samples Dr. H. Abdul Moeloek Bandar Lampung in 2015-2016
No Variable Amount Percentage
Total Parity
which shows that there is no relationship between
1 ≤2 55 74.3% the number of parity and the degree of
>2 19 25.7% histopathology of ovarian cancer.10 Such condition
Infertility
can be caused chronic irritation in the ovaries of
2 Yes 18 24.3%
Not 56 75.7% nonpregnant women due to repeated ovulation
Age processes.11 In addition, the theory of incessant
3 ≤40 years old 15 20.3% ovulation explains that ovulation every month can
>40 years old 59 79.7%
Family History cause damage to the fallopian and ovarian tissue, so
4 Yes 4 5.4% that when ovulation does not occur (anovulation) in
Not 70 94.6% pregnancy can have a protective effect.12
The statistical results of the bivariate analysis
in table 3 show that there is no significant
Table 2. Low Parity Relationship with The Incidence relationship between infertility and the incidence of
of Ovarian Cancer ovarian cancer. Women with infertility are 2.48
Parity Ovarian Cancer times more likely occurrence of ovarian cancer than
OR CI(95%) P
Low Yes Not women who do not experience infertility. Previous
≤2 27 28 studies found various finding. For example, the
0.87 0.305-2.466 0.790
>2 10 9 current study is in line with findings from previous
study.14 However, the current findings was contrary
with findings from two studies.13 This can be
explained by the theory of increased gonadotropin
hypothesis which shows that an increase in the

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hormone gonadotropin can cause proliferation and CONCLUSION
transformation of epithelial cells into malignant.13 It can be concluded that there is a
The current study found a significant significant relationship between age and the
relationship between age and the incidence of incidence of ovarian cancer. Other factors such as
ovarian cancer. Women who are> 40 years old are low parity, infertility, and family history were not
9.09 times more likely to develop ovarian cancer significantly related with the incidence of ovarian
than women who are ≤40 years old. This is in line cancer
with the results of research at Prof. RSUP Dr. RD.
Kandou Manado period January 2013 - December Conflicts of interest
2015 which showed that ovarian cancer occurs most No conflicts of interest have been declared
often in women with age ≥51 years.15 These results by the authors.
are also supported by the results of previous
studies which showed that most epithelial ovarian Acknowledgement
cancer sufferers were among women> 50 years of This research conducted by collaboration
age.16 This happens because of increasing age in between Department Obstetrics and Gynecology
women can cause genetic changes in epithelial cells Faculty of Medicine and Health Sciences,
on the surface of the ovaries.12 But the results were Universitas Muhammadiyah Yogyakarta/PKU
not in line with the results of a study at the Abdoel Muhammadiyah Teaching Hospital Yogyakarta,
Moelok Regional General Hospital, Lampung Indonesia, University hospital of
Province in 2015 which stated that there was no Muenster/Westfaliche Wilhelms University,
relationship between age and the incidence of Germany and Comprehensive Cancer Centre,
ovarian cancer. This difference is possible due to Hannover Medical School, Germany.
differences in age groupings in the study.17
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