What increases the risk of ovarian cancer in a 47-year-old female with hypertension and taking oral contraceptive pills?

Risk Factors for Ovarian Cancer in This Patient

Age is the only factor among the options listed that increases ovarian cancer risk in this patient, while oral contraceptive pill use actually provides substantial protection against ovarian cancer. 1, 2

Analysis of Each Factor

Age (INCREASES Risk)

• Age is a well-established risk factor for ovarian cancer, with incidence rising progressively after age 40 3
• At 47 years old, this patient is in the age range where ovarian cancer risk begins to increase significantly
• This is the correct answer among the options provided

Oral Contraceptive Pills (DECREASES Risk)

• OCPs reduce ovarian cancer risk by approximately 40-50%, regardless of estrogen or progestin dose 2
• This protective effect persists even with modern low-dose formulations (containing as little as 15-35 μg ethinyl estradiol) 2, 4
• The risk reduction is duration-dependent: longer use provides greater protection 2, 4
• Both high-estrogen/high-progestin pills (OR = 0.5,95% CI: 0.3-0.7) and low-estrogen/low-progestin pills (OR = 0.5,95% CI: 0.3-0.6) provide identical protection 2
• OCPs are considered chemopreventive for ovarian cancer 5, 3
• The protective mechanism appears related to duration of anovulation rather than cumulative hormone exposure 4

Parity (DECREASES Risk)

• Higher parity (G4P3 in this patient) is protective against ovarian cancer 1
• Multiple pregnancies reduce lifetime ovulation cycles, which decreases ovarian cancer risk
• This patient's history of 3 deliveries provides protection, not increased risk

Hypertension (NO Direct Effect)

• Hypertension itself is not a recognized risk factor for ovarian cancer 1
• While hypertension is relevant for contraceptive safety and cardiovascular risk, it does not independently increase ovarian cancer risk
• The evidence linking hypertension to cancer outcomes is limited to cardiovascular complications, not malignancy 1

Important Clinical Context

While OCPs are protective against ovarian cancer, this patient's combination of hypertension and OCP use creates significant cardiovascular concerns that are separate from cancer risk:

• Combined hormonal contraceptives in hypertensive women increase myocardial infarction risk 6-68 fold and stroke risk 8-15 fold 6, 7
• This patient should be counseled about switching to progestin-only methods or non-hormonal contraception given her hypertension, even though OCPs reduce her ovarian cancer risk 6, 7

Answer: A - Age

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