Ovarian cancer is scary because it is usually only found and diagnosed at a late stage, when the prognosis is not very good. Part of why it's not detected earlier is the relatively deep placement of the ovaries inside the body and their poor accessibility for biopsies. Another reason is the dearth of noticeable symptoms that could prompt a woman to seek help in good time.
Each year, more than 20,000 cases of ovarian cancer are diagnosed in the U.S., with a corresponding 15,310 deaths. Consequently, much research is under way to find ways to detect the disease earlier.
So far, though, researchers haven't been able to come up with a generally accepted testing sequence for ovarian cancer that's as good as the tests for breast cancer (annual mammograms) and cervical cancer (Pap smears).
For awhile, a protein called CA125, looked like it might be a good biomarker for ovarian cancer. Unfortunately, however, CA125 did not pan out as a trustworthy candidate. Nevertheless, some of my women patients still ask me to order a CA125 test for them.
This request usually prompts from me a long explanation about how the test often gives false-positive results - that is, it indicates the presence of ovarian cancer even when no cancer is present. A false-positive test is very undesirable because it will generally lead to unnecessary surgery.
And last, I tell the women wanting a CA125 test that no current research justifies performing this assessment in women who have no symptoms or risk factors for ovarian cancer.
Often, my explanations are to no avail and are met with, "Well, my insurance will pay for it and I just want to know" - which lets me know that I haven't done a very good job explaining the multiple downsides of this test.
Other women become concerned about ovarian cancer after having some type of imaging test - usually a CT scan done to evaluate other symptoms like abdominal pain-that reveals a mass in the ovaries.
In a panic, the patient naturally asks me if this means she has cancer. It's much more likely that such an abnormality will turn out to be an ovarian cyst, a common disorder that tends to appear prior to ovulation. The maturing egg lives in the cyst until it ruptures (sometimes accompanied by Mittleshmertz, a mild, one-sided twinge or pain in the lower abdomen), releasing the egg that then awaits fertilization.
Women who are at risk for ovarian cancer
- have a strong family or personal history of ovarian cancer or associated cancers like breast and prostate
- have a BRCA genetic mutation
- are over 50, especially if they have never had children
- Have been on hormone replacement therapy (HRT) for a decade or longer
Things that lessen the risk of developing ovarian cancer:
- pregnancy - and the risk keeps dropping with each pregnancy
- breastfeeding
- tubal ligation and hysterectomy (even without ovary removal)
- oral contraceptive use (the longer they are used, the greater the reduction in risk) In fact the Pill so powerfully reduces the risk of ovarian cancer that it may become the recommended preventative treatment for those with a genetic predisposition for ovarian cancer
Do keep watching for updates on ovarian cancer screening because there is plenty of room for improvement and a lot of research is currently under way. In the meantime, if you aren't planning on having children and aren't already beyond the childbearing years, consider taking the Pill (after, of course, first weighing all of the Pill's risks and benefits).
