Childhood adversity, characterized by the presence of sexual and physical abuse, is a global problem of significant proportions.^1,2 Epidemiologic studies^3-5 indicate prevalence rates for all forms of childhood sexual abuse and physical abuse ranging from 11% to 35%.Childhood sexual abuse and childhood physical abuse are among the strongest predictors of psychiatric pathology and severity of clinical course, including suicide.^2,4-14 The influence of childhood sexual abuse and childhood physical abuse on psychological development is thought to be mediated directly by changes in cognitive processing of threatening stimuli,^15-18 resulting in enhanced negative affect to daily life stressors.¹⁹ Although there is a clear link between early-life adversity and psychopathology, very little is known about the molecular mechanisms responsible for the long-lasting behavioral consequences of childhood abuse. Significant insight into this critical issue comes primarily from animal studies and from recent translation research in humans investigating epigenetic mechanisms.^20,21

The genomic complexity of profound copy number aberrations has prevented effective molecular stratification of ovarian cancers. Here, to decode this complexity, we derived copy number signatures from shallow whole-genome sequencing of 117 high-grade serous ovarian cancer (HGSOC) cases, which were validated on 527 independent cases. We show that HGSOC comprises a continuum of genomes shaped by multiple mutational processes that result in known patterns of genomic aberration. Copy number signature exposures at diagnosis predict both overall survival and the probability of platinum-resistant relapse. Measurement of signature exposures provides a rational framework to choose combination treatments that target multiple mutational processes.