Ovarian cancer is one of the most feared gynecological cancers. It is often known as the “silent killer”. The problem is that it is hard to screen for ahead of time, and hard to detect in the early stage. The lifetime risk for ovarian cancer is 1 in 70. The symptoms include:
- Pelvic pain
- Urinary frequency
- Early satiety (getting full right away when you eat)
Most patients with ovarian cancer have all of these symptoms for at least 2 weeks, and it has to be a change from their baseline (for example, some people feel bloated frequently…this alone is not a symptom of ovarian cancer).
People that have a family history of ovarian cancer are at higher risk of the disease. Anyone with a family history of ovarian cancer is a candidate for genetic testing for the BRCA 1 & 2 mutations. The mutations are detected through a blood or saliva test. The risk of having one of these mutations is 1 in 400 in the general population, but 1 in 40 in people who have Ashkenazi Jewish ancestry.
If you have BRCA 1 or 2 mutation, you are at very high risk for both ovarian and breast cancer (up to a 65% risk of breast cancer and 40% risk of ovarian cancer). The recommendation if you carry this mutation is to have your tubes and ovaries removed after you have completed childbearing, preferably between ages 35-40. Having your ovaries removed also decreases your risk of breast cancer by 50%.
Another genetic mutation that increases the risk of ovarian cancer is Lynch syndrome. This is associated with multiple cancers, especially colon and uterine, and often at an early age (<50). People with Lynch syndrome have a 3-18% lifetime risk of ovarian cancer (compared to 1.8% in the general population). You are candidate for testing for Lynch syndrome if you have a family history of multiple cancers (usually 3 or more): colon, uterine, ovarian, stomach, small bowel, and kidney.
Other factors that slightly increase your risk of ovarian cancer include infertility, endometriosis, and use of hormone replacement therapy. Use of infertility medication has not been shown to increase the risk of ovarian cancer if pregnancy was achieved. Only those patients who were not able to become pregnant had a higher risk of ovarian cancer.
Taking birth control pills decreases your risk of ovarian cancer by up to 50% after 5 years of use. This protective effect persists for up to 30 years after you stop taking birth control pills. Pregnancy and breast feeding also decrease your risk.
Another way to decrease your risk of ovarian cancer is removal of your fallopian tubes. This is often done laparoscopically for sterilization. In the past, we performed bilateral tubal ligation. We now recommend bilateral salpingectomy (removal of the tubes) for sterilization, because this is associated with up to a 65% decrease in risk of ovarian cancer. Women who have had a hysterectomy have a 50% decreased risk of ovarian cancer, even if their tubes were left in place with the ovaries.
Taking 81 mg of aspirin daily may decrease your risk of ovarian cancer. However, it may slightly increase your risk of stroke or ulcer. The benefits and risks need to be discussed with your primary care doctor prior to starting this.
For women with a family history of ovarian cancer who are negative for the BRCA mutation, it is recommended to have an annual vaginal ultrasound and CA-215 level for screening. The ultrasound looks for ovarian cysts or masses. The CA-125 is a blood test that can be elevated in ovarian cancer. It is not a perfect test, however, as there are a dozen benign processes in the body which can cause the CA-125 to be elevated (including fibroids and endometriosis). In addition, 50% of the time in early stage ovarian cancer, the CA-125 is normal.
Why don’t we all just have our ovaries removed when we are done having children? Having ovaries removed prior to age 65 increases the risk of heart disease, osteoporosis, and dementia. Even after menopause, the ovaries produce testosterone which can strengthen the bones. Women who have their ovaries left in place at time of hysterectomy tend to live 1-2 years longer than those who have them removed. For women who do not have a family history of ovarian cancer, the recommendation is to leave the ovaries in place.
The bottom line…pay attention to your body. If you notice changes, alert your doctor. Pay attention to your family history…if you are a candidate for genetic testing, then get tested with us simply and easily in the office at any time. Most people who are tested are negative for BRCA mutations or Lynch syndrome. However, if you are positive, we know how to intervene to prevent ovarian cancer, and that is the goal!