Ovarian cancer: who should be concerned and what can they do?

Prianka Waghray and Laura Gottschalk, PhD

Ovarian cancer is the fifth leading cause of cancer death in women in the U.S. ¹   Most women who are diagnosed with cancer of the ovaries are at least 55 years old.  When women are treated before the cancer has spread, 9 out of 10 will be alive five years later.  Unfortunately, ovarian cancer is usually not detected until it has spread, and then only about 1 in 4 women will still be alive five years later.²

Is there a way doctors could find it earlier and save more lives?  Screening is the key for several other cancers, but is less effective for ovarian cancer.

Is there a screening test for ovarian cancer?

There are ways of screening for ovarian cancer, but they are not very accurate. The current methods are:  the CA-125 blood test, ultrasound, and pelvic examinations.³

Since 2012, the U.S. Preventive Services Task Force has recommended against annual ovarian cancer screening tests for women who do not have symptoms.³ They concluded that women who have no signs or symptoms, no family history of breast or ovarian cancer, and no increased risk based on their genes do not benefit from screening and may even be harmed by it.

The Task Force reviewed all the studies conducted on women with no symptoms of ovarian cancer to see if using two screening methods—the CA 125 blood test and transvaginal ultrasound—would help detect ovarian cancer earlier and save lives.  They concluded that annual screenings using these two methods for women who have no symptoms did not reduce the number of women dying from ovarian cancer.  Moreover, screening resulted in many women being told they might have cancer when they didn’t (false-positive test results), which led to anxiety and potentially harmful unnecessary surgeries.

A 2015 study of over 200,000 British women also did not find that screening resulted in a significant decrease in ovarian cancer deaths compared to women who did not have any screening ⁴. These results further support the recommendation against screening in women with no symptoms.

The Task Force’s recommendation against screening does not apply to women who have a family history of breast or ovarian cancer or known genetic defects such as BRCA1 and BRCA2 gene mutations.

What are the signs and symptoms of ovarian cancer?

Women over 40 years of age who have any signs and symptoms associated with ovarian cancer should ask their doctor about getting screened. Since these symptoms are common to many other diseases as well, they should be reported to the doctor if they persist for two weeks or longer.¹ According to the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI), you should pay attention to the following signs and symptoms:What you need to know about: Ovarian cancer. ⁵

•  Unusual vaginal bleeding, such as irregular periods, bleeding that is heavier than normal for you, or that occurs when you are past menopause
• Discharge from your vagina that is not normal for you
• Pain or pressure in the pelvic or abdominal area (the area below your stomach and between your hip bones)
• A swollen abdomen
• Bloating or feeling full quickly while eating
• Feeling very tired all the time
• Back pain
• Change in bathroom habits, such as having to pass urine very often and with greater than usual urgency, constipation, or diarrhea

Screening Tests for Women with Symptoms or who are at Increased Risk:

CA-125 blood test:

The CA-125 blood test is a screening method that looks for a protein called CA-125, which is higher in women with ovarian cancer and some other conditions, such as   non-gynecological cancers, and endometriosis.⁶   Since CA-125 can be associated with many different health conditions, it is not useful for determining ovarian cancer.  For more information about CA-125 blood test go to http://dev.stopcancerfund.org/prevention/ovarian-cancer-ca-125-blood-test-does-it-work/   

Transvaginal ultrasonography:

This type of ultrasound (sound waves) makes a picture of the uterus, ovaries and cervix.⁷  It can be used to detect small masses.³ Unfortunately, by the time the tumor in the ovaries is big enough to be detected, the cancer has already progressed to the later stages.

Pelvic examination:

A pelvic exam is a physical exam a doctor does to check for problems or abnormalities in a woman’s female reproductive organs.  Sometimes the doctor will combine a pelvic exam, which involves touching and lightly pressing on the lower abdomen, with a rectovaginal exam, in which  the doctor inserts one finger into the vagina and another into the rectum while placing the other hand on top of the pelvis. This allows the doctor to feel for abnormal growths or lesions.  These exams help detect tumors and other abnormalities in later stages of the disease.

Who is at risk and what to do if you have a family history of breast or ovarian cancer

The risk for ovarian cancer increases with age. Most women with ovarian cancer are over 60 years old. ⁸  Other factors that the risk include:

Having family members such as a mother, sister, aunt, or grandmother on either your mother’s or father’s side with either breast or ovarian cancer.

• Having already had uterine, breast or colorectal cancer.
• Having never given birth or having had trouble getting pregnant
• Coming from an Eastern European Jewish background (Ashkenazi)
• Having endometriosis
• Have tested positive for a genetic mutation called BRCA1 or BRCA2

The National Cancer Institute also warns that women who have taken menopausal hormone therapy—estrogen only or estrogen with progesterone—are at increased risk of ovarian cancer.  The risk is greatest for women who took it for 5 years or more.⁷⁹

If you have one or more of these risk factors or you have any of the previously mentioned symptoms associated with ovarian cancer, you should talk with your doctor.  But remember, just because you have one or more of the risk factors above, doesn’t mean you have or will get ovarian cancer!

If several women in your family had ovarian or breast cancer at a young age or told you that they have the BRCA mutation, genetic counseling can help you find out if you have a higher risk as well.  BRCA1 and BRCA2 increase a woman’s risk of breast and ovarian cancer (For more information, click  http://www.center4research.org/2011/09/the-failed-promise-of-gene-based-tests-for-diagnosing-and-treating-cancer/).   Genetic testing is not recommended for all women, just those with a family history of cancer.

What should I do if I have the BRCA1 or BRCA2 genetic mutation?

If you have the BRCA mutation, it doesn’t mean you will definitely get ovarian cancer.  According to the National Cancer Institute, anywhere from 15% to 40% of women with BRCA1 or BRCA2 will develop ovarian cancer.¹⁰  However, you should talk to your doctor about the following strategies to prevent ovarian cancer or detect it early:

1)      Surveillance:  Patients should be screened regularly using currently available methods such as transvaginal ultrasound, CA-125 blood tests, and clinical exams to detect the presence of ovarian cancer.

2)      Prophylactic surgery:  This is surgery to prevent cancer by removing most of the “at-risk” tissues.  One option is the removal of healthy fallopian tubes and ovaries.  Although this type of surgery will reduce your chances of developing ovarian cancer, some women have developed ovarian cancer even after the prophylactic surgery.

3)      Non-surgical ways to reduce your risk:   Avoid hormone therapy (for more information, see http://dev.stopcancerfund.org/newsite/p-breast-cancer/menopause-and-the-ongoing-hormone-therapy-debate/); maintain a healthy weight; increase your physical activity; and reduce your alcohol intake to no more than 3 drinks a week.  While hormone therapy increases the risk, birth control pills —which also contain hormones—tend to reduce your chances of getting ovarian cancer, even if you have BRCA1 or BRCA2. ⁹

What about Medicines?

Medicines such as tamoxifen and raloxifene are taken by some women, including BRCA carriers, to lower their chances of getting breast cancer, but have not been show to protect against ovarian cancer.⁹

The Bottom Line:

The U.S Preventative Services Tasks Force recommends against annual screening methods for ovarian cancer in women who have no symptoms and are not known to be at increased risk for ovarian cancer.  Ovarian screening methods should only be used for women who have a family history of ovarian cancer, the BRCA1 or BRCA 2 gene mutation, or who have signs and symptoms of ovarian cancer.

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