Category Archives: Ovarian Cancer

Talcum Powder and Ovarian Cancer

Ovarian Cancer, ,
Diana Zuckerman, PhD, and Danielle Shapiro, MD, MPH Cancer Prevention & Treatment Fund

A growing body of evidence suggests that using talcum powder (also called talc) in the genital area can increase a woman’s chances of developing ovarian cancer. The more years she uses talc, the more likely she is to develop ovarian cancer.[1] Talc is an ingredient in many baby powders. If you have ever used talcum powder or baby powder, or if you are still using it on yourself or your baby, here’s what you need to know.

About 1.3% of women in the United States will be diagnosed with ovarian cancer in her lifetime.[2] Although this is much lower than the lifetime risk for developing breast cancer,[3] there is no recommended test to screen for ovarian cancer, so unlike breast cancer, ovarian cancer is rarely diagnosed early. When ovarian cancer is found early, a woman has nearly a 93% chance of surviving at least 5 years after she is diagnosed. Those chances drop off significantly to about 30% if the cancer is found after it has spread to other parts of her body.[4] According to the American Cancer Society, over 21,000 women are estimated to receive a new diagnosis of ovarian cancer in 2021, and almost 14,000 women are estimated to die from it.[5] 

Based on many research studies involving thousands of women, those who have used talcum powder are about 30% more likely to be diagnosed with ovarian cancer than women who have not.[6,7] This means that over her lifetime, a woman who uses talcum powder increases her chances of developing ovarian cancer from 1.3% to 1.7%. That is still a low risk for any individual woman, but if 1 million women use talcum powder, approximately 4,000 more of those women will develop ovarian cancer, compared to the number that would have developed ovarian cancer if they hadn’t used talcum powder.

How Good Is the Evidence?

Most of the evidence comes from a type of study known as a case-control study.  For these studies, researchers recruit two groups of women – women with ovarian cancer (called “cases”) and women without ovarian cancer (called “controls”). All of the women are asked to recall whether they used talcum powder in the past, and if so, how often and how it was used. These studies cannot tell us for sure that using talcum powder causes ovarian cancer, but they can tell us if women who report using the powder in the genital area are more likely to develop ovarian cancer.

It is possible that there is a bias in women’s responses. Women with ovarian cancer might inaccurately recall having used more talc in the genital area than they actually did, leading to a false association between genital use of talc and ovarian cancer. However, it does not seem likely that these results are due to biased answers or faulty memory. While there is never a guarantee that memories are 100% accurate, many women are very sure about whether or not they regularly used talcum powder in the genital area. The International Agency for Research on Cancer (IARC), a well-respected agency within the World Health Organization (WHO), concluded that there was an “unusually consistent” increased chance of developing ovarian cancer among women who reported using talcum powder in the genital area.[8] In addition, the results are consistent for one particular type of epithelial ovarian cancer, called serous carcinoma. If the association between genital talc use and developing ovarian cancer were due to faulty memory or biased responses, we would see an association between it and all forms of ovarian cancer. The fact that it is consistently associated with one type of ovarian cancer means it is more likely that these findings are accurate.[9]

Important Studies

Some of the most convincing evidence comes from two case-control studies published in 2016: the African American Cancer Epidemiology Study (AACES) and the New England study.[10,1]

The AACES study compared 584 African American women who had been diagnosed with ovarian cancer to 745 African American women who did not have ovarian cancer. The women in the study came from 11 different geographic regions of the United States, and women with ovarian cancer were compared to women of the same ages and from the same geographic regions.[10] In this study, talc use was common – about 63% of women with ovarian cancer and 53% of the healthy women said they had used talc.  

The study found that the women who had only used talc in the genital area, as well as women who used talc only in non-genital areas, or who used it in both, were significantly more likely to have been diagnosed with epithelial ovarian cancer than women who did not use talc. Those who used talc in the genital area had a more than 40% increased risk of cancer, whereas those who used talc only in non-genital areas had an increased risk of over 30%. Instead of having a 1.3% lifetime risk, the women who used talc in the genital area would have over a 1.8% risk. Johnson & Johnson has been shown to target African American women in their marketing of talc, and African American women are more likely to use the product than other women,[11] so it is important to understand the risks for this population. 

In that study of African American women, the women who had a respiratory condition (such as asthma) were slightly more likely to develop ovarian cancer if they used talc, compared to women who did not have a respiratory condition.[10] The researchers believe that talcum powder causes the body to develop inflammation, which is known to potentially cause the growth of cancer cells. Women who are more likely to develop inflammation, such as those who have an underlying respiratory condition, may be at a slightly higher risk of developing ovarian cancer from talc.

The New England ovarian cancer study also suggests that the body develops cancer as a result of inflammation caused by talcum powder.[1] The researchers compared approximately 2,041 women living in Massachusetts and New Hampshire who had been diagnosed with ovarian cancer with 1,578 women of the same age and geographic location who did not have cancer. They reported that the women who used talc in the genital area, whether or not they used it elsewhere in their bodies, were significantly more likely to be diagnosed with epithelial ovarian cancer. Most reported using Johnson & Johnson Baby Powder or Shower to Shower brand powder. Many body powders are now made with cornstarch instead of talc, but women who used powders made with cornstarch were not considered talc users in the study.

Overall, the women using talc were about 33% more likely to develop ovarian cancer. Instead of having a 1.3% lifetime risk, a woman who used talc increased their lifetime risk to about 1.7%. However, some women were more at risk than others. Women who used talc and were sterilized prior to menopause (underwent a tubal ligation or hysterectomy) or who took hormone therapy for menopausal symptoms were even more likely to develop ovarian cancer compared to other talc users. The researchers believe that the hormone estrogen may make women less vulnerable to the risk of talc.[1] 

One study published in 2020 reports that there are no consistent findings of a relationship between talc exposure and developing ovarian cancer.[12] However, it is important to note that the study was funded by the Cosmetics Alliance Canada and Industrial Minerals Association-North America. Since the researchers were funded by companies that profit off of talc use, that could have biased their results. Another study published in 2020 also found no statistically significant association between genital application of talc and ovarian cancer across 4 studies.[13] However, the researchers warn that their study may have been underpowered and could have missed a small increase in risk due to talc use. This is especially likely because there are some shortcomings in the research, such as inconsistency with how talc use was measured and no information about the amount of talc in the powders women reported using.

How Could Talc Cause Ovarian Cancer? 

Talc is often found in the same places in the earth as asbestos, so asbestos may be contaminating talc when it is mined.[14]  Asbestos is known to cause cancer in humans. In 2019, the U.S. Food and Drug Administration (FDA) found that a bottle of Johnson & Johnson baby powder tested positive for asbestos.[15] The FDA gathered a team of experts from 8 different federal agencies, and these experts developed recommendations for standardizing testing talc products for asbestos.[15,16]

However, this team of experts said that it is “irrelevant” whether the products contain asbestos because both asbestos and similar minerals (such as talc) are suspected of causing “similar pathological outcomes.”[16] In fact, microscopic photos of talc show that it can look very similar to asbestos, regardless of whether it is contaminated with asbestos. The team of experts asserted that talc, even without any asbestos present, is suspected to cause health problems. One reason that researchers believe genital application of talc can cause ovarian cancer is that talc can enter the ovaries and cause inflammation, and inflammation can cause cancer.[17,18] 

Lawsuits Over Talc and Cancer 

Since 2014, Johnson & Johnson has defended its talcum powder in lawsuits brought by families of women who had used their talcum powder products and died from ovarian cancer. In February 2016, the courts ruled in favor of the family of a woman who died of ovarian cancer at 62 years old. Particles of talc were found in her ovaries, which were removed after her cancer diagnosis. The courts overturned the ruling just a few months later based on jurisdictional issues that were not related to the science.[19] In another matter, a California woman with ovarian cancer won a $70 million dollar against Johnson & Johnson. She continues to fight for fair warning labels on the products it sells. A powder sold by the brand Assured already carries such a warning: “Frequent application of talcum powder in the female genital area may increase the risk of ovarian cancer.”[20]

There is some evidence that men may also be harmed by talc. For example, the courts ruled in favor of a New Jersey man because the powder had caused an asbestos-related lung cancer known as mesothelioma. In this case, the talcum powder was likely contaminated with asbestos. Despite the jury’s decision, Johnson & Johnson continues to deny claims that their product contains asbestos or that it causes cancer. However, the court held that exposure to asbestos from another source was not a likely cause of his cancer.[21] 

A 2018 investigation by Reuters examined Johnson & Johnson’s internal reports, company memos, and confidential documents from 1971 to the early 2000s.[22] According to the documents, as early as 1971, researchers from Mount Sinai Medical Center had told Johnson & Johnson that they had found traces of asbestos in the company’s baby powder made with talc. The documents suggest that Johnson & Johnson claimed that the tiny amount of asbestos found in some samples of its powders was too small to cause health problems, and the company lobbied the Food and Drug Administration to agree with that assessment. 

Currently, Johnson & Johnson is facing over 15,000 lawsuits from people who believe that their cancers were caused by talc products sold by the company.[16] In one lawsuit, a group of 22 women who developed ovarian cancer sued the company and were awarded $2 billion. The company tried to appeal the case before the Supreme Court, but in June 2021, the Supreme Court rejected the appeal, which means that the $2 billion award still stands.[23]

In May 2020, Johnson & Johnson announced that they would stop selling talc-based baby powders in the U.S. and Canada.[24] Nevertheless, the company denies any claims that their product is associated with cancer. Instead, they claim that they are no longer selling the talc-based powder due to low demand and “misinformation around the safety of the product and a constant barrage of litigation advertising.” The company will still sell baby powders that are cornstarch-based, rather than talc-based. 

The Bottom Line

While the scientific evidence has shown a consistent link between talcum powder and ovarian cancer and possibly other health risks, many questions remain. The bottom line question is: why take the risk?

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

The National Center for Health Research is a nonprofit, nonpartisan research, education and advocacy organization that analyzes and explains the latest medical research and speaks out on policies and programs. We do not accept funding from pharmaceutical companies or medical device manufacturers. Find out how you can support us here.

References

  1.     Cramer DW, Vitonis AF, Terry KL, et al. The association between talc use and ovarian cancer: A retrospective case–control study in two US states. Epidemiology. 2016;27(3): 334-346.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820665/
  2.     Torre LA, Trabert B, DeSantis CE, Miller KD, Samimi G, Runowicz CD, Gaudet MM, Jemal A, Siegel RL. Ovarian cancer statistics, 2018. CA: A Cancer Journal for Clinicians. 2018 Jul;68(4):284-96.
  3.     National Cancer Institute. Cancer Stat Facts: Female Breast Cancer. Seer.cancer.gov. https://seer.cancer.gov/statfacts/html/breast.html. 2020. 
  4.     U.S. Preventive Services Task Force. Final Recommendation Statement: Ovarian Cancer: Screening. Rockville, MD:U.S. Preventive Services Task Force. 2018. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/ovarian-cancer-screening1\
  5.     American Cancer Society. Key Statistics for Ovarian Cancer. Cancer.org. https://www.cancer.org/cancer/ovarian-cancer/about/key-statistics.html. Updated 2021. 
  6.     Berge W, Mundt K, Luu H, Boffetta P. Genital use of talc and risk of ovarian cancer: a meta-analysis. European Journal of Cancer Prevention. 2018; 27(3):248-57.
  7.     Terry KL, Karageorgi S, Shvetsov YB, Merritt MA, Lurie G, Thompson PJ, Carney ME, Weber RP, Akushevich L, Lo-Ciganic WH, Cushing-Haugen K. Genital powder use and risk of ovarian cancer: a pooled analysis of 8,525 cases and 9,859 controls. Cancer Prevention Research. 2013; 6(8):811-21.
  8.     International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Volume 93 Carbon Black, Titanium Dioxide, and Talc; 2010. http://monographs.iarc.fr/ENG/Monographs/vol93/mono93-8F.pdf
  9.     Berge W, Mundt K, Luu H, Boffetta P. Genital use of talc and risk of ovarian cancer: a meta-analysis. European Journal of Cancer Prevention. 2018; 27(3):248-57.
  10. Schildkraut JM, Abbott SE, Alberg AJ, et al. Association between body powder use and ovarian cancer: The African American Cancer Epidemiology Study (AACES). Cancer Epidemiology, Biomarkers & Prevention. 2016;25(10):1411-1417. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5050086/
  11. Cohen R.  Talc linked to ovarian cancer risk in African-American women. Reuters Health News. June 6, 2016. https://www.reuters.com/article/us-health-talc-ovarian-cancer/talc-linked-to-ovarian-cancer-risk-in-african-american-women-idUSKCN0YO2T7
  12. Goodman JE, Kerper LE, Prueitt RL, Marsh CM. A critical review of talc and ovarian cancer. Journal of Toxicology and Environmental Health, Part B. 2020; 15:1-31.
  13. O’Brien KM, Tworoger SS, Harris HR, Anderson GL, Weinberg CR, Trabert B, Kaunitz AM, D’Aloisio AA, Sandler DP, Wentzensen N. Association of powder use in the genital area with risk of ovarian cancer. JAMA. 2020; 323(1):49-59.
  14. U.S. Food and Drug Administration. Talc. Fda.gov. https://www.fda.gov/cosmetics/cosmetic-ingredients/talc. Updated March 2020. 
  15. The Mesothelioma Center. FDA Panel Recommends Standardized Talc Testing for Asbestos. Asbestos.com. https://www.asbestos.com/news/2020/01/21/standardized-talc-testing-asbestos/. January 2020. 
  16. Reuters. Government experts urge new talc testing standards amid asbestos worries. Reuters.com. https://www.reuters.com/article/us-usa-fda-talc-testing/government-experts-urge-new-talc-testing-standards-amid-asbestos-worries-idUSKBN1Z92I4. January 2020. 
  17. Trabert B. Body powder and ovarian cancer risk–what is the role of recall bias?. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2016; 25(10):1369.
  18. Penninkilampi R, Eslick GD. Perineal Talc Use and Ovarian Cancer: A Systematic Review and Meta-Analysis. Epidemiology. 2018; 29(1):41‐49. doi:10.1097/EDE.0000000000000745
  19. Taylor J. Missourinet. Johnson & Johnson case from St. Louis gets heard in Missouri Supreme Court. Missourinet. March 5, 2018. https://www.missourinet.com/2018/03/05/johnson-johnson-case-from-st-louis-gets-heard-in-missouri-supreme-court/
  20. DailyMed. LABEL: ASSURED MEDICATED BODY POWDER- menthol powder. Dailymed.nlm.nih.gov. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c8dad6e4-748f-41c1-98d6-1afa836967ce. Updated November 2017. 
  21. Bellon T.  J&J, Imerys unit must pay $117 million in N.J. asbestos cancer case. Reuters. April 11, 2018. https://www.reuters.com/article/us-johnson-johnson-cancer-lawsuit/jj-imerys-unit-must-pay-117-million-in-n-j-asbestos-cancer-case-idUSKBN1HI2ZD
  22. Girion L, Wood M. Johnson & Johnson knew for decades that asbestos lurked in its Baby Powder. Reuters. December 14th 2018, https://www.reuters.com/investigates/special-report/johnsonandjohnson-cancer/#johnson-research-sidebar
  23. National Public Radio. Supreme Court Says A $2 Billion Verdict In A Baby Powder Cancer Case Should Remain. Npr.org. https://www.npr.org/2021/06/01/1002149828/supreme-court-johnson-johnson-talc-verdict-ovarian-cancer. June 2021.
  24. National Public Radio. Johnson & Johnson Stops Selling Talc-Based Baby Powder In U.S. And Canada. Npr.org. https://www.npr.org/2020/05/19/859182015/johnson-johnson-stops-selling-talc-based-baby-powder-in-u-s-and-canada. May 2020.

Patients Under 50 with Early-Stage Ovarian Cancer: Safe Treatment with no Loss of Fertility

Ovarian Cancer
Julie Bromberg and Danielle Shapiro, MD, MPH, Cancer Prevention and Treatment Fund

Ovarian cancer is especially traumatic for young women, because it is often diagnosed when the disease is advanced. Standard treatment usually includes having both ovaries, fallopian tubes, and the uterus removed. While this “radical” surgery was once considered the safe option, the procedure left younger women with early menopause and unable to become pregnant. Now, many young women have the option of “fertility sparing surgery,” which removes one ovary and one tube.

A 2017 study in the Journal of Obstetrics & Gynecology found that women below age 40 who have early-stage epithelial† ovarian cancer can be safely treated without losing their fertility.  Women in the study had an 89% chance of surviving at least 10 years after their surgery, whether they had the standard surgery or the fertility-sparing surgery.[1]  

A similar 2017 study in the Journal of Gynecologic Oncology examined premenopausal women under age 50 with a more aggressive type of ovarian cancer called early-stage ovarian clear cell cancer. At 5 years after surgery, 90% of women who did not have their uterus removed were alive compared to 88% of women who did. Similarly, 93% of women who had one ovary removed were alive compared to 85% who had both ovaries removed.[2]

The traditional treatment approach for ovarian cancer was to remove the organs to prevent the cancer from coming back. The uterus was also removed, because it was assumed to be safer to remove a nearby organ where cancer could grow. Younger women who were treated for ovarian cancer underwent early menopause (known as surgical menopause) because of the greatly reduced level of estrogen hormones in their bodies, and lost their ability to have children.[3]

Since the 2017 studies only included pre-menopausal women under age 50 with Stage 1 ovarian cancer, it is impossible to know whether older women would have similar survival rates under similar circumstances. Fertility-preserving treatment is risky for women with stage II or later stage ovarian cancer.

Cancer surgery has evolved over the years, becoming less radical. For example, breast cancer used to be treated by removing the entire breast and the muscles underneath, instead of just the cancer and a small area of healthy tissue around it.  Eventually, research proved that women lived just as long with much less radical surgery, and now early-stage breast cancer is often treated by removing just the cancer, rather than one or both breasts. The latest research indicates that breast cancer patients’ survival is slightly better with the less radical surgeries. (Read more on breast conserving surgery here.)

What Happens after Ovarian Cancer Surgery?

After surgery, women need to see their physician frequently for clinical exams during the first 5 years. The Society of Gynecologic Oncologists (doctors specializing in women’s cancers) recommends the following [3]:

  • In the first 2 years after surgery, women should have a regular exam, including an exam of the pelvis and lymph nodes every 3 months (or 4 times a year).
  • In the third year, women should have exams every 4-6 months (or 2-3 times a year).
  • In the fourth and fifth year, women should have exams every 6 months (or twice a year).
  • After 5 years, women can resume annual exams.
  • A blood test that checks for a tumor marker (CA-125) is optional.
  • CT scan should be done only when the doctor is concerned the cancer has recurred.   

How can you Detect Ovarian Cancer Early?

For all cancers, early treatment greatly increases the chances of survival. Unfortunately, the early symptoms of ovarian cancer are easily confused with less serious problems, making it difficult for women to know if they need to be tested for ovarian cancer.

If a woman has any of the following symptoms every day for more than 2 weeks, or if the symptoms are more severe or unusual for her, she should talk to her doctor about being tested for ovarian cancer[4]:

  • Feeling bloated or swelling in the stomach area
  • Pain in the stomach area
  • Difficulty eating or feeling full
  • Gas, bloating, or constipation

The Bottom Line

Treatments that preserve the uterus and at least part of one ovary, instead of removing the uterus and both ovaries, can be safe for women younger than 50 who have Stage 1 epithelial ovarian cancer. Premenopausal women with early-stage ovarian cancer who want to preserve their fertility should find a doctor who is experienced in that treatment and find out whether it is a safe option for them.

 

Footnotes:

  1. Melamed A, Rizzo AE, Nitecki R, Gockley AA, Bregar AJ, Schorge JO, delCarmen MG, and Rauh-Hain JA. (2017). All-Cause Mortality After Fertility-Sparing Surgery for Stage I Epithelial Ovarian Cancer. Obstetrics & Gynecology, 130 (1): 71-79. doi: 10.1097/AOG.0000000000002102
  2. Nasioudis, D., Chapman-Davis, E., Frey, M. K., Witkin, S. S., & Holcomb, K. (2017). Could fertility-sparing surgery be considered for women with early stage ovarian clear cell carcinoma? Journal of Gynecologic Oncology, 28(6), e71. http://doi.org/10.3802/jgo.2017.28.e71
  3. Medscape. Ovarian Cancer Guidelines. (2016, Aug. 22). Available Online: https://emedicine.medscape.com/article/2500016-overview#showall
  4. National Cancer Institute. Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment (PDQ®)–Patient Version. (2017, Oct. 13). Available Online: https://www.cancer.gov/types/ovarian/patient/ovarian-epithelial-treatment-pdq

____________________________________________________
† 85%-90% of all ovarian cancers are epithelial

Ovarian Cancer CA-125 Blood Test: Does It Work?

Ovarian Cancer, Prevention, ,
Stephanie Portes-Antoine, Brandel France de Bravo, MPH, and Laura Gottschalk, PhD, Cancer Prevention and Treatment Fund

Ovarian cancer is a deadly disease because it is rarely diagnosed early. There is not yet an effective, life-saving screening tool for the early diagnosis of ovarian cancer.

When ovarian cancer is diagnosed in the early stage—before the cancer has spread beyond the ovaries—chances of a woman’s survival are very good, with about 93% of women surviving at least 5 years.  Unfortunately, only 15% of cases are caught this early, because the symptoms of ovarian cancer are not obvious. For women diagnosed with advanced ovarian cancer, the chances of 5-year survival drop to less than 30%.[1] Given the dramatic differences in survival outcomes between advanced and early onset diagnosis, it is vitally important to detect ovarian cancer early.

Most women whose ovarian cancer is detected in the late stages will have a relapse (usually many times) following their initial treatment, requiring additional treatment.[2] The most widely used test to screen for the recurrence of ovarian cancer is the CA-125. This blood test measures a protein that tends to be higher in women with ovarian cancer. The test was approved for use on women who have already been diagnosed with ovarian cancer once. In 2008, Dr. Vladimir Nosov from UCLA Medical Center and his co-authors reported that elevated levels of the CA-125 biomarker are found in approximately 83% of women with advanced stage ovarian cancer and 50% of patients with stage I disease.[3]

Is testing for this “biomarker” an effective way to tell early on if a woman’s ovarian cancer has returned? And what about women who have never been diagnosed with ovarian cancer? Why can’t the CA-125 test be used to screen them?

Women with No Symptoms or Who Have Never Been Diagnosed with Ovarian Cancer

Other studies have confirmed that CA-125 by itself is not sensitive enough to diagnose ovarian cancer in the very early stage of the disease, before there are symptoms. Dr. Saundra S. Buys is co-director of the Family Cancer Assessment Clinic at the Huntsman Cancer Institute in Salt Lake City, Utah. According to Dr. Buys, CA125 testing “may be appropriate to screen for ovarian cancer in women who have abdominal symptoms, but for women who have no medical symptoms, doing screening for ovarian cancer results in a lot of false-positives.”[4] False positives are test results that inaccurately show the person might have cancer. Dr. Buys based her conclusions on data for women ages 55 to 75 who were participating in a large study called the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial.[5]

In 2011, Dr. Buys and her colleagues published more results from that trial which involved more than 78,000 women. They concluded that using the CA-125 blood test to screen for ovarian cancer doesn’t prevent women from dying from the disease, it actually is harmful.[6] False positives resulted in many women having unnecessary surgery: 3,285 women received false positives and 1080 of these women underwent biopsy surgery. In 15% of cases, the unnecessary surgery caused serious complications. At the same time, there was no benefit in terms of survival for the women who took the test as compared with those who did not.

Women Who Have Previously Had Ovarian Cancer

CA-125 by itself is clearly not reliable at detecting early ovarian cancer in women of low or average risk—women who have never before been diagnosed with ovarian cancer, and women who have no symptoms. Is it at least effective at detecting a recurrence of ovarian cancer?  In 2010, Dr. Gordon Rustin of the Mount Vernon Cancer Centre in England published the results of a study done with women who had already been diagnosed with and treated for ovarian cancer. He found  that women who started chemotherapy early, based on a CA125 test result indicating relapse of ovarian cancer, did not live any longer than women who did not begin treatment until symptoms of relapse appeared.[7]

The Future of Ovarian Cancer Screening

Research is underway to evaluate whether the CA-125 test can be used more reliably, either by administering it only to women with other biomarkers that indicate increased risk (such as elevated levels of the protein HE4) or combined with other screening tests such as vaginal ultrasound.

Dr. Karen Lu from the MD Anderson Center at the University of Texas has had success correctly identifying postmenopausal women at high risk for ovarian cancer by measuring CA-125 at regular intervals and relying on a mathematical model. Only women whose CA-125 levels went up over time were given a vaginal ultrasound, and only those with suspicious findings on the ultrasound had surgery. This two-staged approach seemed potentially effective .[8] However, when this approach was studied on more than 200,00 women, it did not significantly prevent death from ovarian cancer.[9]

The Bottom Line:

The CA-125 test by itself is not a good screening tool for ovarian cancer. When used alone on women with no symptoms or previous history of ovarian cancer, it leads to many false positives. Among women who have already been treated for ovarian cancer once, it doesn’t seem to matter whether they get treatment for their ovarian cancer recurrence based on CA-125 results or based on their symptoms. Either way, women who relapsed and got treatment lived about the same amount of time.

References:

  1. The National Cancer Institute. Surveillance Epidemiology and End Results. SEER Stat Fact Sheets. Cancer: Ovary. http://seer.cancer.gov/statfacts/html/ovary.html
  2. NCI Cancer Bulletin. Early Chemo to Prevent Ovarian Cancer Recurrence Fails to Increase Survival. June 2, 2009. Volume 6/Number 11. http://www.cancer.gov/ncicancerbulletin/060209/page2
  3. Nosov V., et al. The early detection of ovarian cancer: from traditional methods to proteomics. Can we really do better than serum CA-125? American Journal of Obstetrics and Gynecology. September 2008: 199(3): 215-223.
  4. Reinberg, S. Ovarian screening Methods Inaccurate. National Women’s Health Resource Center. November 7, 2005. http://www.healthywomen.org/resources/womenshealthinthenews/dbhealthnews/ovariancancerscreeningmethodsinaccurate
  5. Buys S.S., et al. Ovarian cancer screening in the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial: Findings from the initial screening of a randomized trial. American Journal of Obstetrics and Gynecology. November 2005: 193(5): 1630-1639.
  6. Buys S.S., et al. Effects of Screening on Ovarian Cancer Mortality: The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial. The Journal of the American Medical Association. July 2011; 2011 (616):1.
  7. Rustin, G.J. and van der Burg. Early versus delayed treatment of relapsed ovarian cancer (MRC OV05/EORTC 55955): a randomized trial. Lancet. October 2010
  8. Lu, Karen et al. A 2-Stage Ovarian Cancer Screening Strategy Using the Risk of Ovarian Cancer Algorithm (ROCA) Identifies Early-Stage Incident Cancers and Demonstrates High Positive Predictive Value. Cancer. September 2013; 2013 (119):17.
  9. Jacobs  IJ, Menon  U, Ryan  A,  et al.  Ovarian cancer screening and mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial . Lancet. doi:10.1016/S0140-6736(15)01224-6.

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

Ovarian Cancer, Uncategorized
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.

Related Content:
Ovarian Cancer: What are the treatment options?

Can a handful of nuts a day keep cancer away?

Breast Cancer, Colon Cancer, Diet, Habits, & Other Behaviors, Ovarian Cancer, Pancreatic Cancer, Prevention, , ,
By Krista Kleczewski, Claire Karlsson, and Edyth Dwyer

Evidence is growing about the many ways in which eating nuts, seeds, and legumes can improve your health. Eating walnuts or legumes like peanuts, beans, or lentils have been linked to healthier hearts and a lower risk of diabetes, but now studies show they may also cut your risk of getting cancer! Here’s what we know and don’t know.

In addition to erroneously thinking that peanuts are nuts, many people think almonds, cashews, and pecans as nuts, but they are actually types of seeds. The difference is based on the plant they grow on, where peanuts grow underground below the plant roots, nuts and seeds grow inside or outside the plant’s fruit. Although this article uses the term “nuts,” the studies we describe include many combinations of nuts, seeds, and legumes. It’s also important to note that each study has different methods, and they need to be interpreted differently. Some studies looked at fewer than 100 people and closely tracked their diet and health, while others were meta-analyses that collected results from many studies of thousands of people and summarized their findings. 

What are some health benefits of nuts?

 In 2015, a Dutch study of 120,000 men and women between the ages of 55-69 found that those who ate about half a handful of nuts or peanuts each day were less likely to die from respiratory disease, neurodegenerative diseases, diabetes, cardiovascular diseases, or cancer than those who consumed no nuts or seeds.[1] The same benefit was not seen for peanut butter, however, which suggests that the salt, vegetable oils, and trans fatty acids in peanut butter may counterbalance the benefits of the peanuts. A serving of nuts is about the size of 30 almonds, and a study found that eating several servings a week had health benefits. A 5-year study conducted in Spain of 7,000 men and women aged 55 to 80 years old found that eating at least three servings of nuts per week reduced the risk of cardiovascular and cancer death.[2] Another study similarly found eating nuts – especially walnuts — reduces the risk of developing cancers, diabetes and heart disease when eaten as a part of the Mediterranean Diet, which also emphasizes fruits, vegetables, whole grains, and legumes.[3] Walnuts were highlighted by the study as reducing inflammation associated with certain cancers and other conditions like diabetes and heart disease. More evidence is needed, however, to determine the specific impact of walnuts on cancer risk.

Breast Cancer

Eating large amounts of peanuts, walnuts, or almonds can reduce the risk of developing breast cancer, according to a 2015 study of 97 breast cancer patients.[4] The researchers compared the lifetime consumption of peanuts, walnuts and almonds among breast cancer patients with the consumption of those without breast cancer, finding that women who ate large quantities were half to one-third as likely to develop breast cancer. No difference was found between people who ate a small amount of nuts, legumes and seeds and those who ate none at all, suggesting that a person needs to consume a substantial amount of these over their lifetime to reduce their chances of developing breast cancer.

Another study looked at the risk of breast cancer for people who ate nuts and peanuts compared to people who did not. Some types of breast cancers respond to the body’s natural hormone estrogen, growing faster when exposed to estrogen. These are called Estrogen Receptor (ER) positive cancers. ER negative cancers are not influenced by exposure to estrogen. In a study of over 4,000 women in the Netherlands, those who ate 10 grams (a large handful) of nuts per day had a 45% lower risk of developing ER negative breast cancer when compared to those who ate no nuts, but it did not significantly affect ER positive breast cancer.[5,6] Since ER negative breast cancer occurs in only a third of the 12% of women who are diagnosed with breast cancer, the risk to the average person decreased overall by about half of 1% when their diet included that many nuts. 

Girls who regularly eat nuts in their diet may be less likely to develop breast cancer as adults. A 2020 study of more than 9,000 girls between the ages of 9-15, and found that girls who regularly ate peanut butter or any kind of nuts were 36% less likely than girls who did not to have developed benign breast conditions when followed up with 10 years later. Although not dangerous, benign breast conditions (such as breast cysts or hyperplasia) increase a woman’s chances of eventually getting breast cancer. [7]

Can eating nuts, legumes and seeds reduce colorectal cancer risk?

To find out whether snacking on foods with peanuts lowers your chances of getting colorectal cancer (also called colon cancer), researchers studied more than 23,000 adults in Taiwan, ages 30 and older.[8] The researchers reported in 2006 that women who ate meals with peanut products at least twice each week were less likely to develop colorectal cancer. More research is needed to see if this benefit is actually from the peanuts.

A 2021 meta-analysis collected results from over 40 studies, and it examined whether eating more nuts would have an impact on colon cancer risk. Researchers found that eating 5 grams of nuts per day could decrease the risk of colon cancer by 25%.[9] Since the lifetime risk of colon cancer is about 4%, a 25% reduction would mean a decrease from 4% to 3% of the overall risk of colon cancer for people regularly eating nuts. Five grams is about 5-6 almonds, and this study found that the benefits of eating nuts started for people averaging just 2 grams per day and continued to decrease for people eating up to 9 grams per day.  After that, the effects leveled off, so eating more than 9 grams was not more beneficial than eating 9 grams. A meta-analysis combines results from many studies, so the 2-9 grams per day were average amounts, whether the person eats them all in one day or spread out over the course of a week. 

In one of the largest studies of diet and cancer, which was conducted in 10 European countries, researchers discovered that eating nuts and seeds reduced women’s chances of developing colon cancer, but did not lower the risk for men.[10] Women who ate a modest daily amount of nuts and seeds (about 16 peanuts or a small handful of nuts or seeds) every day were less likely to develop colon cancer, and women who ate the largest quantities of these foods were the least likely to develop colon cancer. Again, more research is needed to understand these findings.

Researchers have also investigated whether a diet containing nuts and peanuts can improve patient chances of survival for those who have already been diagnosed with colon cancer. In a study of over 800 patients with advanced (stage III) colon cancer, patients who ate more nuts were more likely to survive after treatment, without being re-diagnosed with colon cancer.[11] This study measured a serving of nuts to be one ounce, or about 15 cashews. When compared to those who ate no nuts, those who ate 2 or more servings of nuts per week had 46% lower risk of re-diagnosis of their cancer, as well as a 53% lower risk of dying from the cancer. This study has several important limitations to keep in mind. Not only was it a relatively small study, but it only examined Stage III colon cancer patients, comparing cancer patients who ate nuts to those who did not eat nuts. This means that the results cannot be generalized to the average American’s risk of colon cancer. 

Pancreatic Cancer

Eating nuts also seems to lower the risk of developing diabetes, which may then lower the risk of developing pancreatic cancer.[12] In addition, a large study of women found that frequently eating nuts was associated with less chance of developing pancreatic cancer,13 one of the most deadly cancers.

A 2021 meta-analysis that examined results from over 30 studies, found that the chances of developing pancreatic cancer risk decreased for those who ate more nuts. The average lifetime risk of developing pancreatic cancer is about 1.5%. Because the results show a 6% lower risk for those eating nuts, this means the overall risk of pancreatic cancer may lower from 1.5% to 1.4% for people who regularly eat nuts.[9]

Ovarian cancer

A 2010 study examined the possible link between ovarian cancer and foods high in phytoestrogens and/or fiber, including nuts, beans, and soy.[15] They found that these foods seemed to help prevent “borderline ovarian cancer”—slow-growing tumors that are less dangerous and more likely to affect younger women. However, these foods did not seem to protect against the more aggressive types of ovarian cancer.

What makes nuts good for your health?

There is still some debate about why nuts might be so beneficial. Omega-3 fatty acids are found in peanuts, walnuts, and some seeds, and researchers think their health benefits may help to prevent cancer.[16] The omega-3 acids can help protect cell structures and walls, and since they are anti-inflammatory; that might reduce the risk of cancer for people who regularly eat peanuts, walnuts, and seeds. [17]

Some research has shown that walnuts can also improve your gut biome, meaning it helps you grow healthy bacteria in your gut.[18]  To test this, an experiment was done on 18 people, where some were assigned to eat walnuts and others ate no nuts. Blood and fecal samples were tested, and researchers were able to see changes in the bacteria, and lower levels of “secondary bile” which suggests the nuts decreased inflammation in their intestines. This experiment studied a very small group of people, so more research is needed to understand why these nuts, seeds, and legumes improve the risk of cancer over a lifetime. 

 

The Bottom Line

There is growing evidence that nuts, legumes, and seeds reduce the risk for several types of cancer, as well as having other health benefits. Researchers are still investigating whether the health benefits of nuts are because people who eat nuts have a healthier overall diet, but tree nuts seem to have some health benefits on their own. Peanuts and peanut butter may also have benefits, but the higher levels of fat and sodium could explain why these legume products show fewer health benefits. Peanuts, walnuts, almonds, and other nuts are high in calories, so don’t overdo it. It seems safe to assume that adding these foods to your diet, in small quantities several times a week, is a good idea, especially if you use them to replace less healthy snacks.

 

 

 

  1. Brandt, P., & Schouten, L. Relationship of tree nut, peanut and peanut butter intake with total and cause-specific mortality: A cohort study and meta-analysis. (2015). International Journal of Epidemiology, 44(3), 1038-1049. doi:10.1093/ije/dyv039  
  2. Guasch-Ferré, M., Bulló, M., Martínez-González, M.A., Ros, E., Corella, D., et al. Frequency of nut consumption and mortality risk in the PREDIMED nutrition intervention trial. (2013). BMC Med; 11: 164. doi: 10.1186/1741-7015-11-164  
  3. Toner, CD., Communicating clinical research to reduce cancer risk through diet: Walnuts as a case example (2014). Nutr Res Pract. 8(4): 347–351. doi: 10.4162/nrp.2014.8.4.347  
  4. Soriano-Hernandez, A.D., Madrigal-Perez D.G., Galvan-Salazar H.R., Arreola-Cruz A., Briseño-Gomez L., Guzmán-Esquivel J., Dobrovinskaya O., Lara-Esqueda A., Rodríguez-Sanchez I.P., Baltazar-Rodriguez L.M., Espinoza-Gomez F., Martinez-Fierro M.L., de-Leon-Zaragoza L., Olmedo-Buenrostro B.A., Delgado-Enciso I. (2015). The Protective Effect of Peanut, Walnut, and Almond Consumption on the Development of Breast Cancer. 2015;80(2):89-92. doi: 10.1159/000369997.  
  5. van den Brandt P.A., Nieuwenhuis L. Tree nut, peanut, and peanut butter intake and risk of postmenopausal breast cancer: The Netherlands Cohort Study. Cancer Causes Control, (2018). 29(1):63–75.
  6. Putti T.C., El-Rehim D.M.A., Rakha E.A., Paish C.E., Lee A.H.S., Pinder S.E., et al. Estrogen receptor-negative breast carcinomas: a review of morphology and immunophenotypical analysis. (2005). Mod Pathol, 18(1):26–35.
  7. Berkey C.S., Tamimi R.M., Willett W.C., Rosner B., Hickey M., Toriola A.T., et al. Adolescent alcohol, nuts, and fiber: combined effects on benign breast disease risk in young women. (2020). NPJ Breast Cancer;6(1):61.
  8. Yeh, C. C., You, S. L., Chen, C. J., & Sung, F. C. Peanut consumption and reduced risk of colorectal cancer in women: a prospective study in Taiwan. (2006). World Journal of Gastroenterology, 12(2), 222.  
  9. Naghshi, S., Sadeghian, M., Nasiri, M., Mobarak, S., Asadi, M., Sadeghi, O. Association of total nut, tree nut, peanut, and peanut butter consumption with cancer incidence and mortality: A comprehensive systematic review and dose-response meta-analysis of observational studies. (2021). Adv Nutr, 12(3):793–808.
  10. Jenab, M., Ferrari, P., Slimani, N., Norat, T., Casagrande, C., Overad, K., Riboli, E. et al. Association of nut and seed intake with colorectal cancer risk in the European Prospective Investigation into Cancer and Nutrition. (2004). Cancer Epidemiology Biomarkers & Prevention, 13(10), 1595-1603.  
  11. Fadelu T., Zhang S., Niedzwiecki D., Ye X., Saltz L.B., Mayer R.J., et al. Nut consumption and survival in patients with stage III colon cancer: Results from CALGB 89803 (alliance). (2018). J Clin Oncol,36(11):1112–20.
  12. Jenkins, D. J., Kendall, C. W., Banach, M. S., Srichaikul, K., Vidgen, E., Mitchell, S., Josse, R. G., et al. Nuts as a replacement for carbohydrates in the diabetic diet. (2011). Diabetes care, 34(8), 1706-1711.  
  13. Bao, Y., Hu, F. B., Giovannucci, E. L., Wolpin, B. M., Stampfer, M. J., Willett, W. C., & Fuchs, C. S. Nut consumption and risk of pancreatic cancer in women. (2013). British journal of cancer.  
  14. Lee J.T., Lai G.Y., Liao L.M., Subar A.F., Bertazzi P.A., Pesatori A.C., et al. Nut consumption and lung cancer risk: Results from two large observational studies. (2017). Cancer Epidemiol Biomarkers Prev,26(6):826–36.
  15. Hedelin, M., Löf, M., Andersson, T. M. L., Adlercreutz, H., & Weiderpass, E. Dietary phytoestrogens and the risk of ovarian cancer in the women’s lifestyle and health cohort study. (2011). Cancer Epidemiology Biomarkers & Prevention, 20(2), 308-317.  
  16. Fabian C.J., Kimler BF, Hursting S.D.. Omega-3 fatty acids for breast cancer prevention and survivorship. (2015) Breast Cancer Res;17(1):62. https://breast-cancer-research.biomedcentral.com/articles/10.1186/s13058-015-0571-6
  17. Freitas R.D.S., Campos M.M.. Protective effects of omega-3 fatty acids in cancer-related complications. (2019). Nutrients;11(5):945. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6566772/#:~:text=Omega%2D3%20polyunsaturated%20fatty%20acids,structure%20and%20fluidity%20of%20membranes
  18. Holscher H.D., Guetterman H.M., Swanson K.S., An R., Matthan N.R., Lichtenstein A.H., et al. Walnut consumption alters the gastrointestinal Microbiota, microbially derived secondary bile acids, and health markers in healthy adults: A randomized controlled trial. (2018). J Nutr;148(6):861–7.

BRCA1 and BRCA2 mutations: when your genes increase your cancer risk

Breast Cancer, Breast Cancer, Ovarian Cancer, Prevention
Laurén A. Doamekpor, MPH

When Angelina Jolie announced that she had removed both of her healthy breasts to reduce her risk of breast cancer, she explained that she had inherited the BRCA1 gene mutation, which increases her chances of someday developing breast cancer. This is why she decided to have a preventive (or prophylactic) double mastectomy. Angelina’s public decision drew attention to women with BRCA1 and BRCA2 mutations and the choices they make. Click here to read our response to Angelina’s double mastectomy, published in the Huffington Post.

BRCA1 and BRCA2 gene mutations also increase a woman’s chances of having ovarian cancer. Ms. Jolie has not yet had her ovaries removed.

What are BRCA1 and BRCA2?

BRCA1 and BRCA2 are human genes that produce proteins that suppress tumors and repair damage to our DNA. If there is a mutation in one of these genes and they do not work properly, DNA damage may not be repaired. This can eventually cause cancer.

If you have a BRCA1 or BRCA2 mutation, what are the chances of getting breast or ovarian cancer?

Women who have no family history of breast cancer and don’t carry the BRCA1 or 2 gene mutation, have only a 12% chance of getting breast cancer in their lifetime.11 But women with BRCA1 have about a 55% to 65% chance of developing it by the time they turn 70; the likelihood is a little lower for women with BRCA2 at 45%.12 13

Even though women with BRCA1 or BRCA2 are about 5 times more likely to get breast cancer than the average woman, women with these mutations make up only 5% to 10% of all breast cancer cases. In other words, fewer than 1 in 10 women with breast cancer have either BRCA1 or BRCA2.14

Ovarian cancer is less common than breast cancer. Fewer than 2% of women who have neither BRCA1 or BRCA2, nor a family history of ovarian cancer, will develop ovarian cancer. But, 39% of women with BRCA1 will develop ovarian cancer by age 70, and approximately 11%-17% with BRCA2 will develop ovarian cancer by 70.2 3

Doctors will often suggest testing for the BRCA1 and BRCA2 genes in women with family members diagnosed with breast or ovarian cancer before age 50, family members with cancer in both breasts or multiple breast cancers, and women who come from Ashkenazi Jewish backgrounds.

If you have BRCA1 and BRCA2, what can you do to lower your risk for breast or ovarian cancer?

If you find out that you have the BRCA1 or BRCA2 mutation, it doesn’t mean you will definitely get breast or ovarian cancer.

There are a few ways you can lower your risk of breast cancer:

1) More frequent breast exams to detect cancer as early as possible. Some experts recommend that women with BRCA1 or BRCA2 begin breast cancer screening as early as age 25 4, but that doesn’t mean mammograms should start at such an early age. Young women with BRCA mutations should get screened using magnetic resonance imaging (MRI). MRIs are more accurate than mammograms for young women and do not expose breasts to as much radiation as mammograms do. While early screening can be helpful, if a woman’s genes place her at higher risk, she needs to realize that regular radiation to the breasts at an early age could increase her risk of cancer.

2) Take an estrogen-blocking pill such as tamoxifen. Many breast cancers feed off the estrogen produced naturally by a woman’s body so interrupting the production and flow of estrogen can reduce a woman’s risk of getting breast cancer. Taking tamoxifen after being treated for breast cancer, for instance, usually cuts the risk of breast cancer recurring by about half. However, the effectiveness of raloxifene or tamoxifen in women with BRCA1 and BRCA2 has not been studied specifically yet. 4

3) Preventive mastectomy (removal of the breasts). When a woman with BRCA1 or BRCA2 gets both of her breasts surgically removed, she reduces her chances of getting breast cancer by as much as 95%.15 Why is there still some risk? Because some breast tissue is left behind after surgery, and cancer can develop in that tissue or on the nearby chest wall.16

4) The removal of both ovaries and the fallopian tubes, called salpingo-oophorectomy. The ovaries produce estrogen which make the more common breast cancers more likely to grow, so removing the ovaries and fallopian tubes works much like tamoxifen. Research shows that women with BRCA1 or BRCA2 can reduce their breast cancer risk up to 50% by removing just their ovaries. 5 Removing the ovaries and fallopian tubes is the only known method of reducing the risk of ovarian cancer.

What about having children? While having children reduces the chances of developing the most common types of breast cancer, research published in 2014 found that women with BRCA1 or BRCA2 mutations who decide not to have children are no more likely to develop breast cancer than women with the mutations who do have children. For women with BRCA1 who want to have children, it’s helpful to know waiting until after 30 to have a child and breastfeeding longer—for at least 1-2 years—seems to lower their risk of breast cancer. Delayed childbearing and longer breastfeeding did nothing to lower breast cancer risk among women with BRCA2, however.17

Maintaining a healthy weight and exercising regularly can reduce the chances of breast and ovarian cancer. For women with BRCA1 or BRCA2, some studies show that women who were overweight (BMI>25) at age 18 and lose at least 10 lbs between age 18 and 30 are less likely to develop early-onset breast cancers.18

What women with BRCA 1 and BRCA2 can do to reduce their risk of ovarian cancer

Other than getting a salpingo—oophorectomy (removing the ovaries and fallopian tubes), which can reduce a woman’s risk of ovarian cancer by 90% 19, there is little else a woman with BRCA mutations can do to lower her risk of ovarian cancer. Even after having her ovaries removed, a woman with BRCA mutations will still have a small chance of getting ovarian cancer in the peritoneum (a thin layer of tissue that lines the inside of the abdomen). This can happen if some ovarian tissue is left behind after surgery or if ovarian cancer cells have already spread to that part of the body before surgery.20

The drawback to getting your ovaries and fallopian tubes surgically removed is that you won’t be able to have children naturally and will have to adopt or use some form of assisted reproductive technology like IVF with frozen embryos or frozen eggs. Moreover, studies show that women who have had their ovaries removed are more likely to suffer heart disease, stroke, lung cancer, and depression or anxiety disorders. And the risk of these illnesses is higher the younger the woman is when her ovaries are taken out. Also, if a woman has her ovaries removed before going through menopause, the surgery will cause a sudden drop in estrogen and bring on early menopause.21

There is no widely accepted screening to detect ovarian cancer early. In fact, the U.S Preventative Services Tasks Force recommends against yearly screenings for ovarian cancer in women except those with BRCA1, BRCA2 or a family history of ovarian cancer. Some medical groups recommend transvaginal ultrasound examinations and the CA-125 blood test. But research shows that these screening tools are not very accurate and do not reduce a woman’s chances of dying from ovarian cancer.

Bottom Line

For any woman—whether she is a BRCA carrier or not–maintaining a healthy weight and exercising regularly can reduce the chances of breast and ovarian cancer. You can learn more about ovarian cancer here and more about the risks and benefits of preventive mastectomies to reduce the risk of breast cancer here.

There are other ways women with BRCA1 or BRCA2 mutations can lower their risk of breast and ovarian cancer, such as screening to detect cancer early, surgery to remove breasts, ovaries, and fallopian tubes, estrogen-blocking drugs, and losing weight if they are overweight. While screening regularly for breast cancer with MRIs is safe, surgery and drugs have side effects and risks. Women with the BRCA mutations will want to consult with several different doctors to discuss what is important to them at each phase of their reproductive lives, and weigh the risks and benefits of each prevention strategy.

Flaxseed: What is it and Can it Keep you Healthy?

Breast Cancer, Diet, Habits, & Other Behaviors, Other Cancers, Ovarian Cancer
Carla Bozzolo, Cancer Prevention and Treatment Fund

1024px-Brown_Flax_SeedsSuddenly, everyone is talking about adding flaxseed to your diet.  What is flaxseed and how can eating it make you healthier?

What is Flaxseed?

Flaxseed is the seed of the flax plant and can be eaten as whole seeds, ground into a powder (flaxseed meal), or the oil can be taken in liquid or pill form.[1] There is evidence that it is a great way to incorporate dietary fiber, antioxidants, and omega-3 fatty acids into your diet.

Flaxseed has been shown to lower cholesterol in some people and it may even reduce the risk of breast cancer. People take flaxseed to help with many digestive conditions, including chronic constipation, diarrhea, diverticulitis (inflammation of the lining of the large intestine), irritable bowel syndrome (IBS), ulcerative colitis (sores in the lining of the large intestine), gastritis (inflammation of the lining of the stomach), and enteritis (inflammation of the small intestine). According to the National Institutes of Health (NIH), more study is needed to prove that flaxseed benefits people who have these conditions.[2]

What’s in This Miracle Seed?

Omega-3 essential fatty acids

Flaxseed is the richest source of omega-3 fatty acids,3 which is good for our hearts, brains, and normal growth and development.4 Omega-3 fatty acid can also be found in fish, plants, nuts, and oils made from nuts. No matter how you consume flaxseed—whole, ground or the oil—you will increase your intake of omega-3 fatty acids.

Lignans

Lignans are a type of plant estrogen that may help slow down certain cancers—cancers that depend on hormones to grow. Lignans also work as an antioxidant, which means they protect cells from the damage that comes with aging. Antioxidants—found in berries and many other foods—may help fight certain cancers. Lignans are concentrated in the coat of the seed so when flaxseed is expressed into oil, the anti-cancer and antioxidant benefits of the lignans are lost.

Dietary fiber

Dietary fiber helps regulate the digestive system and can lower bad cholesterol. Dietary fiber in flaxseed is only found in whole and ground flaxseeds, not in flax oil.

Flaxseed and Breast Cancer

For women who have gone through menopause, a small daily serving of flaxseed (just over half a teaspoon) was enough to lower breast cancer risk. While more research is needed, some studies suggest that for younger women who have not yet gone through menopause flaxseed reduces the risk of breast cancer and slows down the progress of certain breast cancers and other cancers that need estrogen to grow. A study published in 2013 found that eating flaxseed decreased a woman’s chance of getting breast cancer by 82%.

Flaxseed and Cholesterol

Flaxseed (but not flax oil) seems to decrease bad cholesterol among people who have relatively high cholesterol. Once again, women who already went through menopause seemed to benefit most: their “bad” cholesterol dropped more than the bad cholesterol of men or younger women. This is important for older women, because bad cholesterol tends to increase after menopause, as estrogen levels decline.

Who Benefits the Most?

Flaxseed has the potential to benefit everyone as a great source of dietary fiber with almost no side effects.  People with high levels of bad cholesterol and women who are post-menopausal benefit the most.

Different Ways to Eat It

Flaxseed is sold as whole seeds, ground seeds (flaxseed meal), liquid oil, and oil in a pill form. It can easily be added to cereal, baked goods, salad, yogurt, and many other types of food.  Since whole seeds tend to go through the body undigested, ground seeds are considered to be more beneficial.  Flaxseed oil delivers essential fatty acids but it doesn’t have fiber or lignans. If you want to get all the benefits of flaxseed—omega-3 fatty acids, fiber, anti-oxidant and cancer-fighting properties—choose ground flaxseed.  

Cautions

Few side effects have been reported from flaxseed. When taken to reduce constipation, it should be taken with plenty of water.

The fiber in the flaxseed may also lower the body’s ability to absorb medications that are taken by mouth, so it should not be taken at the same time of day that you take pills or dietary supplements.

The Bottom Line

Flaxseeds are a great source of dietary fiber and omega-3 essential fatty acids for men and women of all ages. They don’t have any known serious side effects, and ground flaxseeds are easy to include in the foods you eat every day.

References:

  1. National Institutes of Health. National Center for Complimentary Medicine. Herbs At A Glance: Flaxseed and Flaxseed Oil. April 2012: http://nccam.nih.gov/health/flaxseed/ataglance.htm
  2. National Institutes of Health. National Library of Medicine. Flaxseed: MedlinePlus Supplements. August 2011. http://www.nlm.nih.gov/medlineplus/druginfo/natural/991.html
  3. National Institutes of Health. National Cancer Institute. Antioxidants and Cancer Prevention: Fact Sheet. July 2004. href=”http://www.cancer.gov/cancertopics/factsheet/prevention/antioxidants”>http://www.cancer.gov/cancertopics/factsheet/prevention/antioxidants  ▲
  4. Brown L, Rosner B, Willett W, and Sacks F. Cholesterol-lowering effects of dietary fiber: a meta-analysis. American Journal of Clinical Nutrition. 1999; 69:30-42.  ▲
  5. Cotterchio M, Boucher BA, Kreiger N, Mills CA, & Thompson LU. Dietary phytoestrogen intake–lignans and isoflavones–and breast cancer risk (Canada). Cancer Causes Control.2008; 19:259–272  ▲
  6. Buck K, Zaineddin AK, Vrieling A, Linseisen J, & Chang-Claude J. Meta-analyses of lignans and enterolignans in relation to breast cancer risk. American Journal of Clinical Nutrition. 2010; 92:141–15  ▲
  7. Velentzis LS, Cantwell MM, Cardwell C, Keshtgar MR, Leathem AJ, & Woodside JV.Lignans and breast cancer risk in pre and post-menopausal women: meta-analyses of observational studies. British Journal of Cancer. 2009; 100:1492–1498  ▲
  8. Lowcock E, Cotterchio M, & Boucher B. Consumption of flaxseed, a rich source of lignans, is associated with reduced breast cancer risk. Cancer Causes Control. 2013. E-publicaton ahead of print. Retrieved from href=”http://www.ncbi.nlm.nih.gov/pubmed/23354422″>http://www.ncbi.nlm.nih.gov/pubmed/23354422.  ▲
  9. Pan A, Yu D, Demark-Wahnefried W, Franco O, and Lin X. Meta-analysis of the effects of flaxseed interventions on blood lipids. American Journal of Clinical Nutrition. 2009; 90:288-297.  ▲
  10. Fukami K, Koike K, Hirota K, Yoshikawa H, and Miyake A. Perimenopausal changes in serum lipids and lipoproteins: a 7-year longitudinal study. Maturitas. 1995; 22:193-197.  ▲

 

Breastfeeding: the Finest Food for your Infant Isn’t Sold in any Store

Breast Cancer, Diet, Habits, & Other Behaviors, Ovarian Cancer
Margaret Aker, Cancer Prevention and Treatment Fund

For years evidence has been mounting about the health advantages of breastfeeding for both mother and child. From a reduced risk of obesity to an increased resistance to disease, study after study shows that breast milk is the ideal food for your newborn child. Can you believe it? Our own bodies produce the best food we can give our children? And for free!

How is Infant Formula Different from Breast Milk?

Infant formula is an imitation of human breast milk. It is made by blending various dairy substitutes. Formula, however, can never exactly duplicate a mother’s breast milk. Formula is more difficult for a baby to digest, it lacks antibodies that help infants fight off diseases and infections, and it doesn’t change to accommodate a growing baby’s nutritional needs the way natural breast milk does.

What are the Health Benefits of Breastfeeding?

Breastfeeding has significant health benefits for you and your child. Exclusive breastfeeding (meaning no formula or other food) during at least the first three months offers the greatest benefits, although some breastfeeding is better than none.

Benefits for your Child

Protection from Disease: Breastfed infants have lower rates of allergies, infections, and respiratory disorders, such as asthma. They also have lower rates of diseases such as diabetes and leukemia.

  • Antibodies that protect infants from disease are transferred from a mother to her child through breast milk.
  • Infant formula can’t provide these antibodies. Breast milk is the first example of “personalized medicine.”

Defense against Obesity: Breastfeeding decreases the likelihood that an infant will become overweight or obese.[1]

  • Breastfeeding is better for teaching infants how to stop eating when they are full. While parents sometimes find it reassuring that they can tell by looking at the bottle how much food their baby has consumed, they also tend to overfeed when bottle-feeding. Instead of looking for cues from their baby showing that he or she is full, parents look at whether the bottle is empty or not.
  • Breast milk contains the flavors of the food the mother is eating. It therefore exposes infants to a wider range of tastes at an early age. This may lead the infant to later accept a well-balanced diet containing a wide variety of foods.

Benefits for You

Protection from Disease: Breastfeeding reduces the mother’s risk of certain types of cancers.

  • Women who breastfed for 18 months or longer are much less likely to develop ovarian cancer than women who never breastfed.[2]
  • The risk of breast cancer decreases the longer a woman breastfeeds her child. Research now shows that this decreased risk has less to do with the number of children a woman breastfeeds and more to do with the length of time she spent breastfeeding each child.[3]
  • Many experts believe these benefits are the result of the delayed return of a woman’s period while she is breastfeeding. Other factors may play a part as well.

Weight loss after Pregnancy and Childbirth:

  • Breastfeeding helps women return to their pre-pregnancy weight. Exclusively breastfeeding is said to burn up to 600 calories a day![4] That’s about the same number of calories burned by running 6 miles or doing the Stair Master for about an hour. (Of course, breastfeeding will only help you lose weight if you don’t eat 600 calories more each day.)
  • Breastfeeding may help to delay the return of your period. The hormones that trigger the production of breast milk may also delay the release of hormones that bring on your period. This does not always happen, however, so if you don’t want to have another child anytime soon you should not be rely on breastfeeding as a form of contraception. For more information about safe contraceptives to use while breastfeeding check out our “Guide to Selecting Safe Medical Contraception.”

Benefits for you Both: Building a Close Relationship Between Mother and Child.

  • Women who breastfeed often have more physical contact (skin-to-skin) with their babies than women who bottle feed. This kind of close contact promotes closeness between mother and child. With breastfeeding, nothing comes between a baby and mother.
  • Feeding-whether by breast or bottle-is an important demonstration of love and an opportunity for bonding. One of the advantages of bottle-feeding is that others can participate in the duty and pleasure of feeding, but that can sometimes be a drawback. Because it is easy to pass the baby to someone else for feedings, and even to teach the infant to hold the bottle and feed himself, a mother who is rushing to get everything done may miss out on some of the time she would otherwise spend bonding with her child.

The Health Benefits of Breast Milk are Unmatched by Baby Formula. So Why Would any Mother not Breastfeed?

Given the multiple benefits mentioned above, there are many reasons why it is a good idea for you to breastfeed your child. It is important to keep in mind, however, that there are also many reasons why a mother might not be able to or might choose not to breastfeed. Every mother’s situation is different. It does not make you a bad mother if you don’t breastfeed your child.

In addition to the physical inability of some women to produce sufficient milk, some reasons that women may be unable or unwilling to breastfeed include:

  • Cost: Breast milk is free, but most newborn babies request around 8-12 feedings each day. So, committing to exclusively breastfeed may entail taking paid-time off work to stay at home with the child, go home for feeding breaks, or pump breast milk. While this type of commitment may be feasible for women whose employers offer great maternity-leave benefits or who do not work, for many it isn’t.
  • Disease: Many women are concerned about breastfeeding when they are sick, have an infection, or are taking a medication. For most illnesses and many medications, it is safe for the mother to continue to breastfeed as normal. Women infected with HIV/AIDS, active tuberculosis, or undergoing certain medical treatments, however, may be required to stop breastfeeding temporarily or permanently. The best thing to do if you are concerned about whether or not breastfeeding is safe for you and your child is to ask your doctor.
  • Food Habits: You are what you eat, and breast milk is essentially what a mother eats. It is important, therefore, that a breastfeeding mother eat well in order to provide good nutrition to her child. Mothers who are not likely to eat a balanced diet or limit their intake of caffeine and alcohol might find it in the best interest of their child to refrain from breastfeeding. No mother using illegal drugs should breastfeed. Talk to your doctor if you have any questions about whether your lifestyle is compatible with breastfeeding your child.
  • Discomfort: Some women simply do not enjoy breastfeeding. They may find it uncomfortable or frustrating. This is not a reflection on the type of mother that you are. Since the pain and difficulty almost always goes away, women are encouraged to try breastfeeding for at least 14 days before giving up.[5] A mother who is having trouble should consider asking her doctor where she can get free advice or help on breastfeeding. However, it is important that each mother considers her own needs when deciding whether to breastfeed. If a mother finds the breastfeeding experience incredibly unpleasant, it will only get in the way of mother-child bonding. Try to be patient, but don’t be a martyr.

When it is possible, breastfeeding is the ideal way to feed your child. Breast milk is naturally manufactured to protect and nourish a growing infant, as well as to help your body bounce back from pregnancy-and, it does a great job at both of these tasks. It is amazing that women’s bodies have outdone the efforts of thousands of scientists and food manufacturers to create the perfect food for infants!

Breastfeeding is not a feasible option for every mother. The multiple benefits of breastfeeding for you and your child, however, make it worthwhile to try to make breastfeeding work. And remember, if you need to supplement breastfeeding with bottles while you’re at work or sometimes in the middle of the night so you can get more sleep, that kind of compromise will still give you and your baby most of the benefits of breastfeeding.

In the end, each mother must personally decide the best way to feed her child. While the health benefits of breast milk are great, there are many other factors that will determine if breastfeeding is right for you and your family.

References:

  1. Breastfeeding: The First Defense Against Obesity. California WIC Association and the UC Davis Human Lactation Center. (2006 March). http://www.calwic.org/docs/reports/bf_paper1.pdf.
  2. Danforth K, Tworoger S, Hecht J, Rosner B, Colditz G, and Hankinson S. Breastfeeding and Risk of Ovarian Cancer in Two Perspective Cohorts. Cancer Causes & Control. Vol. 18, No. 5 (2007 June), pp. 517-523.
  3. Chang-Claude J, Eby N, Kiechle M, Bastert G, and Becher H. Breastfeeding and Breast Cancer Risk by Age 50 among Women in Germany. Cancer Causes & Control. Vol. 11, No. 8 (2000 Sept), pp. 687-695.
  4. Kramer F. Breastfeeding reduces maternal lower body fat. Journal of American Dietician Association. (1993), pp. 429-33.
  5. Love S, Lindsey K. Dr. Susan Love’s Breast Book. Perseus Publishing. 3rd Ed, (2000), pp. 33-50.