Why Ovarian Cancer Awareness Is So Important
When women are diagnosed with cancer limited to the ovary (that has not spread), their overall five-year survival rates can be as high as 90 percent, compared to 45 percent for those with advanced stage disease. Are we any closer to identifying tools which may prevent ovarian cancer or at least diagnosing it when it is still limited to the ovary (stage I)?
Ovarian cancer is the most lethal of the gynecologic cancers with 21,980 women expected to be diagnosed and 14,270 expected to die of their disease this year (see more). If you’re wondering why it is so deadly, it is because the majority of women present with advanced stage disease due to lack of specific symptoms, as well as effective screening tools. However, when women are diagnosed with cancer limited to the ovary (that has not spread), their overall five-year survival rates can be as high as 90 percent, compared to 45 percent for those with advanced stage disease. So, are we any closer to identifying tools which may prevent ovarian cancer or at least diagnosing it when it is still limited to the ovary (stage I)?
Unlike cervical cancer which can be prevented with the HPV vaccine, there is no vaccine which can prevent ovarian cancer. Thus, we must currently rely on secondary prevention techniques, such as screening, which aim to identify cancer when it is early stage and patients are asymptomatic. However, while various screening techniques for ovarian cancer, including transvaginal ultrasound, pelvic exam and CA125, have been examined, none have proven successful in decreasing the overall mortality from ovarian cancer in women at either average or increased risk for ovarian cancer.
Ovarian is not a common cancer. Only 2 percent of the population will be diagnosed with this disease. Women at higher risk are likely to benefit the most from prevention strategies. One of the most important risk factors for ovarian cancer is family history. Women with a strong family history of either ovarian or breast cancer alone as well as those with confirmed genetic mutations in BRCA1 or BRCA2 and those with Lynch syndrome are at the highest risk of developing ovarian cancers. BRCA1 and 2 mutations comprise greater than 90 percent of all hereditary ovarian cancers, and BRCA1 mutations carry up to a 46 percent lifetime risk of ovarian cancer compared to up to 20 percent for BRCA2 mutations. Women with Lynch syndrome have up to a 14 percent lifetime risk of ovarian cancer. Women with a single first or second degree family member with ovarian cancer have a three-fold increased risk for ovarian cancer.
The most beneficial and cost effective preventive tool that exists for ovarian cancer is prophylactic surgery for patients at high risk for disease. Risk reducing removal of the tubes and ovaries can result in more than 90 percent risk reduction in women with BRCA1/2 mutations and near 100 percent in women with Lynch syndrome. It is recommended that woman at highest risk for disease consider prophylactic surgery around the age of 35 or upon completion of childbearing. Screening with transvaginal ultrasound and CA125 is typically used until patients are ready to commit to prophylactic surgery.
Other prevention measures have centered on risk reducing behaviors. Oral contraceptive pill use, lactation and tubal ligation have been identified as protective factors against ovarian cancer and should be considered in women at any risk for ovarian cancer. The use of OCPs for 5 or more years can result in a 50 percent reduced risk for ovarian cancer in women at average or increased risk. Each month of breastfeeding can reduce the relative risk of ovarian cancer by 2 percent. Tubal ligation can result in a 60 percent risk of disease. These protective factors can be considered in women at both average and increased risk for disease, especially in those women who may not feel ready to commit to prophylactic surgery and the resulting surgical menopause.
In addition to identifying women at increased risk, ALL women should be educated on symptoms which could be linked with ovarian cancer. Identifying symptoms specific to ovarian cancer has been a challenge given that many of the symptoms are vague and nonspecific. In fact, it is for this reason that ovarian cancer is often referred to as a silent killer. However, symptoms of abdominal pain or bloating, urinary urgency or frequency, or early satiety/difficulty eating have been significantly linked to women who have been diagnosed with ovarian cancer. Women should discuss their symptoms with their gynecologist, especially if they have occurred more than 12 times a month.
The overall incidence of ovarian cancer has decreased in recent years. By educating all women, especially those at increased risk for disease, perhaps we can stop this disease before it destroys more lives.
Read a blog from one of Dr. Mantia-Smaldone’s patients, who shared her personal experience.