Ovarian cancer survival rates are low, in part because the cancer is usually advanced by the time it is detected.
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Screening for Ovarian Cancer a Challenge
The death of comedienne Gilda Radner from ovarian cancer in 1991 pushed what is often called the ‘silent disease’ into the spotlight. The past decade has seen new approaches to treatment, yet survival rates remain distressingly low, in part because by the time it is diagnosed ovarian cancer has usually reached an advanced stage. Although there is still no reliable screening test available, a new test is currently under development that may prove useful as a general screening test in the future.
Ovarian cancer was diagnosed in 23,300 women in the United States last year and was responsible for almost 14,000 deaths. If detected early, which is rarely the case, the cure rate can be as high as 90 percent. Most often, however, ovarian cancer is detected at stage III or IV, when five-year survival is only 35 percent.
A woman has about a 1 in 70 lifetime risk of developing ovarian cancer. Current diagnostic tests include ultrasound, pelvic exams and a blood test to detect the protein CA125, yet none of these tests is able to reliably diagnose ovarian cancer at an early stage.
One experimental test generating considerable interest maps blood proteins to detect cancer markers. The test was able to successfully identify 100 percent of samples with ovarian cancer. Of healthy control samples, five percent were assigned false positives, meaning cancer was identified when it wasn’t present.
Although the perfect diagnosis of the cancerous samples was impressive, cancer experts point out that if used in the general population a five percent false positive rate is unacceptably high for this disease. Statistically, ovarian cancer is diagnosed in 1 of every 2,500 American women over age 35 each year. That means for every case of ovarian cancer identified by the test, more than 100 other women would be given a false positive result. This usually involves follow-up exploratory abdominal surgery, an unacceptably high-risk and expensive approach. Some experts think that the test, if it becomes available, may be most appropriate for high-risk women.
The company Correlogics is currently working with the National Cancer Institute to develop a protein pattern drug test that will be affordable and feasible for large-scale testing. A clinical trial is scheduled to begin in April of 2003.
There are a number of factors that increase a woman’s risk of developing ovarian cancer.
· Older age–the average age of diagnosis is 61.
· A family history of ovarian cancer. The risk more than doubles for women with an immediate family member with the disease.
· Having a personal history of either breast cancer or colon cancer.
· Late menopause.
· Never having borne a child.
· Carrying the BRCA 1 or BRCA 2 genes which are linked with hereditary breast and ovarian cancer.
· Long-term use of talcum powder in the genital area.
· Use of estrogen-only replacement therapy for 20 years is associated with a three-fold increase in risk.
There are also a number of factors associated with a lower risk of ovarian cancer. These include having used oral contraceptives for four or more years; having had a tubal ligation; childbearing and breast feeding; having undergone an oopherectomy; and certain dietary habits such as adequate calcium intake, regular consumption of carrots and cooked tomato products such as pizza and pasta sauces.
Although ovarian cancer can progress with few or no symptoms, women need to be aware of symptoms that may occur. These include swelling of the abdomen; increased girth; unexplained abdominal pain or vaginal bleeding; changes in bladder or bowel habits; feelings of pressure in the abdomen. These symptoms may be a result of unrelated problems, but women who feel that something is not right should request a gynecological exam.
When ovarian cancer is diagnosed, treatment usually involves surgical removal of the tumor followed by chemotherapy. A recent study found that immediate treatment with chemotherapy after surgery improved survival in women with early ovarian cancer to 79 percent compared to 70 percent for surgery without early chemotherapy.
Progress against ovarian cancer has been disappointingly slow, but researchers continue to develop and test new treatment approaches. The search for a reliable test continues. If an accurate test with a minimum of false positives can be developed, it will offer women both peace of mind and a chance to catch this difficult disease at an earlier and more treatable stage.
Talcum Powder
May Pose Risk
Australian researchers have found that regular use of talcum powder, especially in the genital area, may increase a woman’s risk of developing ovarian cancer.
Scientists have found traces of talcum powder in ovarian tumors that have been removed and dissected. They theorize that the talc causes irritation that leads to inflammation and ultimately disrupts normal cell function.
Talc contains asbestos and is also used in plastics, detergents, pharmaceuticals, paper and animal feed.
[SOURCE: “Talcum Powder Linked to Ovarian Cancer,” European Cosmetic Markets, February 2002]
Carrots and Tomatoes
Fight Ovarian Cancer
Women can take comfort in the fact that simply eating healthy foods helps protect against ovarian cancer.
Carrots may protect against ovarian cancer according to an observational study comparing the diets of 549 women with ovarian cancer against the diets of 516 healthy controls. Results showed that postmenopausal women with diets rich in alpha carotene were 60 percent less likely to develop ovarian cancer. Alpha carotene is found in raw carrots.
Premenopausal women whose diets were rich in lycopene, found in cooked tomato products such as pizza and pasta sauce, had a 63 percent reduction in ovarian cancer risk.
Experts recommend real foods over supplements, suggesting women eat five carrots and two half-cup servings of tomato sauce per week.
[SOURCE: “Paul Cerrato, “Carrots, Tomatoes and Ovarian Cancer,” Contemporary OB/GYN, July 2002]
Obesity Increases Risk
Being obese at age 18 doubles a woman’s risk of being diagnosed with ovarian cancer before menopause, particularly if the person has never used oral contraceptives, which have been shown to reduce risk.
Another study found that obesity in the adult years increases the risk of death from ovarian cancer in postmenopausal women.
[SOURCE: “Adolescent Obesity Increases Risk of Premenopausal Ovarian Cancer,” Women’s Health Watch, December 12, 2002]
Women Should
Act on Suspicion
Up to 90 percent of women experience vague symptoms and feel that something is wrong in the year before they are diagnosed with ovarian cancer. Women with symptoms of nausea, fullness, bloating, diarrhea and abdominal or pelvic pain should request a pelvic exam when no diagnosis is apparent, according to Dr. Joanna Cain, professor and chair of obstetrics and gynecology at Oregon Health Sciences University, Portland.
There are many possible causes for such symptoms, but a pelvic exam might help identify instances of ovarian cancer months earlier and increase overall chances of survival.
[SOURCE: Sherry Boschert, “Classic Error in Ovarian Cancer Diagnosis: No Pelvic Exam,” Family Practice News, May 15, 2002]
Milk Does a Body Good
Women can cut their risk of ovarian cancer in half simply by drinking a glass of low-fat milk per day, according to a recent study funded by the National Institutes of Health.
Women who consumed at least one serving of dairy products per day (especially those consuming low-fat milk) were 57 percent less likely to develop ovarian cancer than those who consumed little dairy.
Researchers believe that calcium slows the production of parathyroid protein implicated in the development of ovarian cancer.
The study found that calcium supplements did not afford the same protection offered by milk products.
[SOURCE: “Cut Your Cancer Risk in Half,” Natural Health, March 2003]
Most Ovarian Tumors Benign
An estimated 5 to 10 percent of American women will undergo surgery for suspected ovarian cancer at some time in their lives. At least 60,000 surgeries to remove benign (harmless) ovarian tumors are performed each year.
For younger women in their reproductive years, 85 percent of ovarian tumors will prove benign. For women under 45, the chance that an ovarian tumor will be malignant is only 1 in 15.
[SOURCE: Ann Schrecengost, “Ovarian Mass–Benign or Malignant?” AORN Journal, November, 2002]
For More Information
On Ovarian Cancer
More information on ovarian cancer is available from:
· American Cancer Society (800) 227 2345 www.cancer.org
· National Ovarian Cancer Coalition (888) 682 7426 www.ovarian.org
· Ovarian Cancer National Alliance (202) 331 1332 www.ovariancancer.org
REFERENCES:
“Adolescent Obesity Increases Risk of Premenopausal Ovarian Cancer,” Women’s Health Weekly, September 12, 2002.
Kjell Bergfeldt et al, “Risk of Ovarian Cancer in Breast-Cancer Patients with a Family History of Breast or Ovarian Cancer,” The Lancet, September 21, 2002.
Sherry Boschert, “Classic Error in Ovarian Cancer Diagnosis: No Pelvic Exam,” Family Practice News, May 15, 2002.
Sherry Boschert, “Pilot Study Could Lead to Blood Test for Detecting Ovarian Cancer,” Family Practice News, July 1, 2002.
Paul Cerrato, “Carrots, Tomatoes and Ovarian Cancer,” Contemporary OB/GYN, July 2002.
“Correlogic Systems Signs Agreement To License Diagnostic Test,” Women’s Health Weekly, December 12, 2002.
“Many Women Don’t Know Enough About Ovarian Cancer,” Women’s Health Weekly, October 17, 2002.
Norra MacReady, “Blood Test for Early Ovarian Cancer,” Internal Medicine News, September 15, 2002.
Norra MacReady, “Long-Term Estrogen Use Tied to Ovarian Cancer Risk,” Family Practice News, August 15, 2002.
Susan Mayor, “Adjuvant Chemotherapy Improves Survival in Early Ovarian Cancer,” British Medical Journal, January 25, 2003.
Alison McCook, “Lifting the Screen: An Accurate Test Is Not Always the Best Way To Find Cancer,” Scientific American, June 2002.
Kenneth Noller, “Estrogen Replacement Therapy and Risk of Ovarian Cancer,” JAMA, July 17, 2002.
Ann Schrecengost, “Ovarian Mass–Benign or Malignant?” AORN Journal, November 2002.
“Single-Agent Chemo for Ovarian Cancer: Just as Effective and Less Toxic,” Contemporary OB/GYN, January 2003.
“Talcum Powder Linked to Ovarian Cancer,” European Cosmetic Markets, February 2003.
Martin Tattersall, “Ovarian Cancer Chemotherapy: Carboplatin as Standard,” The Lancet, August 17, 2002.
Sharon Worcester, “Prophylactic Oophorectomy Cuts Cancer Risk 75 Percent in BRCA Mutation Carriers,” Internal Medicine News, July 15, 2002.
“Yale Researchers Reveal Phenoxodiol’s Unique Ability to Kill Cancer Cells,” Cancer Weekly, October 15, 2002.
