Newsweek magazine asked, What did comedienne Gilda Radner, singer Laura Nyro and actress Jessica Tandy have in common? The answer was, All three were great performers “ and all three died of ovarian cancer. (Underwood A. Newsweek. Spring/Summer 1999; p44.) Although it accounts for only 3% of cancers in women and is much less common than breast cancer (1 in 71 versus 1 in 8 over a lifetime) it is much more deadly. Of the 22,280 women the American Cancer Society says were diagnosed in 2012, almost 15,500 will die. Why so many? Because two thirds of the time it has spread widely (Stage III) before it is diagnosed and by then the cure rate is a disappointing 20%. If it is found early, which occurs in only 15% of cases, the 5-year survival rate is nearly 95%.
One of my patients, Debby, came to me in her early 30s hoping to start her family. She had no symptoms at all. While investigating her infertility I found a cyst on her ovary that turned out to be early ovarian cancer. She was treated, cured and later went on to conceive. Had I not found this cancer she might have been treated with fertility drugs and thought that they caused her cancer, or worse yet, she might have died.
Why is ovarian cancer so hard to diagnose? First of all the symptoms are vague “ mild abdominal bloating, fullness after eating small amounts, constipation, indigestion, and frequent urination. Second, tests like the Pap smear rarely pick it up and blood tests like CA “ 125 are often falsely positive or negative. I have screened patients with CA “ 125 whose levels were quite elevated only to find the levels returning to normal after removing a breast cyst, endometriosis from their pelvic organs or a fibroid tumor from their uterus. In the meantime, they were worried sick that they had ovarian cancer. I think the CA “ 125 causes more worry than it provides help.
What is a good test? An ultrasound of the ovaries. I believe every woman after age 50 should have a pelvic ultrasound every two to three years and a pelvic exam annually. This is my opinion and many don’t agree. Insurance often won’t pay for the ultrasound because they say it isn’t cost effective and there are studies that say it won’t help save lives. Translation “ it’s cheaper for them to pay for the 22,280 women who get ovarian cancer than to pay for the millions of ultrasounds that would be negative.
Women who have had a pregnancy, who breast-fed, or who used oral contraceptives (five years of use cuts your risk in half) are at lower risk for ovarian cancer. Never pregnant, a family history of breast or ovarian cancer and a high fat diet increase your risk. If you are in this latter category, get the ultrasound, even if you have to pay for it. Other things that increase your risk of getting ovarian cancer include a history of hereditary nonpolyposis colorectal cancer or having either the BRCA1 or BRCA2 genes. If you have one of these conditions, you should talk with a genetic counselor and consider having your ovaries removed as soon as you can after you have had children; perhaps as early as 35. It could prevent ovarian cancer and save your life.
Obesity and using talc powder in the genital area are also associated with an increased risk of ovarian cancer. Powder containing cornstarch is not associated with any increase in ovarian cancer risk. The role of HRT and ovarian cancer risk is not absolute. Estrogen plus progesterone does not appear to increase the risk of ovarian cancer; estrogen alone, especially over 10 years, might increase ovarian cancer risk. Factors that lower your risk of ovarian cancer include a history of pregnancy, breastfeeding, past use of oral contraceptives (OCs), or having both tubes tied have consistently been associated with a lower risk of ovarian cancer by up to 30%. The more full-term babies, months of OCs or months of breastfeeding, the lower your risk of ovarian cancer.
Cervical cancer is a concern that woman should take seriously. Visit your doctor and get the necessary tests to ensure that you are in good health. Remember, its better to stay well than to get well.
Until next time,
Dr. Mache Seibel, Founder of My Menopause Magazine http://bit.ly/MyMenoMag
Professor, University of Massachusetts Medical School
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