Professor of Obstetrics, Gynecology and Reproductive Science
Icahn School of Medicine at Mount Sinai
Director of Women’s Health
According to the American Cancer Society, more than 22,000 American women will be diagnosed with ovarian cancer this year. Unfortunately, most of these cases won’t be found until the cancer is advanced and more challenging to treat. No effective routine screening test exists as yet, making ovarian cancer difficult to catch in its early stages. Symptoms don’t usually appear until the disease has spread, and even then the symptoms are non-specific and difficult to interpret. However, there are steps women can take to reduce their risk of developing this cancer, and to help detect it as soon as possible and improve their chances of successful treatment.
The most common symptoms of ovarian cancer are not specific to this disease; they can be caused by other, less serious conditions and experienced by anyone—women or men. Still, if you are a woman, you tend to know your own body, and it is important that you pay attention, and take it seriously if something doesn’t feel right. See your gynecologist right away if one or more of the following symptoms persist for two weeks or longer, or worsen:
· Feeling full more quickly or for longer than usual
· Urinary symptoms, such as frequency or urgency
· Pelvic pain
Many people (even some physicians) do not normally think of most of these symptoms as gynecologic, so it is not uncommon to see a patient who has gone to a gastroenterologist, urologist, or other doctor first. Women need to be aware that there could be a gynecologic cause of these symptoms.
Although any woman can get ovarian cancer, several factors are associated with increased risk. These include obesity, having endometriosis, and never having had children. Some women have a gene predisposing them to ovarian cancer, so genetic testing might be worthwhile for those whose sister, mother, aunt, or grandmother has had ovarian cancer, or had breast cancer at a young age, in both breasts, at two separate times, or of a type called triple-negative. You also may be at risk if a close relative has had other forms of cancer, such as pancreatic cancer or melanoma, at an especially young age. It is always important to note, however, that most women who develop ovarian cancer will have no known family history of cancer, so a negative family history (one without cancer) should not be interpreted as reassurance that ovarian cancer will not occur.
Women with a hereditary tendency to develop ovarian cancer—such as those with a mutation of the BRCA1 or BRCA2 gene—are not guaranteed to get it. But knowing their genetic risk empowers them to take steps toward preventing this cancer if they choose. The best way to prevent ovarian cancer is to remove the ovaries. It is an extreme measure, certainly, but effective. Of course, as with any surgery, there are health risks that need to be weighed against a woman’s risk of cancer.
A less severe preventive measure is taking birth control pills, which diminishes the risk of ovarian cancer by 50 percent or more. One theory, as yet unproven, holds that removing the fallopian tubes may also decrease the risk. So women planning to have their tubes tied for birth control might consider removing them instead; or those having a hysterectomy for another reason might remove the tubes at the same time.
The actress Angelina Jolie announced two years ago that she had her ovaries and fallopian tubes removed because she has the BRCA1 mutation. Her choice dramatically raised awareness of this option, which could be lifesaving for thousands of women.
Early diagnosis and intervention are the holy grail of ovarian cancer treatment. Women whose cancer is diagnosed early, before it has spread, have a five-year survival rate of nearly 93 percent, compared with a significantly lower rate for those whose ovarian cancer is discovered later and has metastasized, or spread, to other parts of the body. At whatever stage ovarian cancer is found, one of the most important things a woman can do is to be treated by a gynecologic oncologist—a doctor specially trained in the care of women with cancers of the reproductive system. Women with ovarian cancer treated by gynecologic oncologists live longer and better than those who are treated by physicians of other specialties.
Treatments today are more effective than they used to be, and a number of new drugs for ovarian cancer have been approved over the past three years. Women diagnosed with ovarian cancer are enjoying longer, fuller lives than ever before, and it is crucial that we continue to support research to sustain this progress.