By Hayden E. Klein
For Ovarian Cancer Awareness Month in September, Rebecca Brooks, MD, talked to The American Journal of Managed Care® (AJMC®) about how genetics and family history play a large role in ovarian cancer risk, what symptoms to look for, and how to achieve early detection at a time where there is no uniform screening test for ovarian cancer.
Brooks serves as professor at and division director and fellowship program director of gynecologic oncology at UC Davis Health.
AJMC: What are some risk factors associated with ovarian cancer, and what preventive measures can women take to reduce their risk?
Brooks: Ovarian Cancer Awareness Month is a really important time. Ovarian cancer is not as common when we think about female cancers—breast cancer is oftentimes predominant—so it’s nice to have some time to draw attention to the importance of ovarian cancer treatment and diagnosis.
As far as risk factors go, family history is probably the biggest risk factor that patients need to know about. We think that about 10% to 20% of ovarian cancer cases occur in patients who have a genetic predisposition to cancer, either a BRCA mutation or Lynch syndrome or something like that. And a lot of times, these patients are out there and just don’t know to be screened. So I think it’s important that patients, especially if they are of Ashkenazi Jewish descent or if they have a first-degree family member affected by breast cancer at a young age, has had breast cancer twice, or has had ovarian cancer, make sure that their doctor knows and to consider being evaluated for genetic testing. I think genetics is probably the biggest risk factor, and again, just reporting that to your doctor allows [them to] identify who has a genetic mutation. We can potentially offer different screening that we might not do for the regular population or a risk-reducing surgery if somebody tests positive.
Other risk factors would be nulliparity, so in a woman who has never had children and someone who has either early menarche or late menopause. We think that the longer or more times a woman goes through the reproductive cycle opportunities, the surface of the ovary [may] have small damage or we have to repair small things like that that could result in a cancer. Increasing age is another risk factor, and endometriosis can increase the risk of some less-common subtypes of ovarian cancer.
As far as preventive measures, being on oral contraceptive pills, or birth control pills, for long periods of time can help decrease the risk of ovarian cancer, especially in somebody who has a genetic mutation putting them at higher risk, and reporting to your doctor any symptoms or your family history. And if you are somebody who tests positive for a mutation, we can do things like risk-reducing surgery, either with removal of just the fallopian tubes or removal of the fallopian tubes and ovaries, which is a nuanced discussion. But if we can remove the organs that can lead to cancer down the road before they actually become malignant, then that can decrease the risk of cancer by about 90%.
AJMC: Ovarian cancer is often called the “silent killer” because symptoms can be subtle. What are some common signs and symptoms that women should be aware of?
Brooks: One of the most frustrating things about ovarian cancer is that the symptoms just aren’t very specific, so a lot of times they get discounted to other things, [like] if a woman has bloating and they think they’ve got gas, or it’s kind of discounted by a physician who a lot of times is seeing similar symptoms from nonmalignant causes. The combination of bloating, having a hard time eating, getting full really quickly, increasing abdominal girth or if your pants are fitting tighter or you have abdominal swelling, and urinary frequency are probably the most common symptoms.
Especially, the one that always gets my attention is if somebody can’t eat a full amount and they take a few bites and then they’re full. If those symptoms are present, especially if they’re new, persistent, or getting worse, [patients should] have a very low threshold to report that to your doctor and consider an ultrasound or CA-125 [cancer antigen 125] test, especially if those symptoms aren’t getting better over the course of a few weeks.
AJMC: Early detection is crucial for improving the prognosis of ovarian cancer. With no uniformly effective screening at this time, what screening tools are available, and what can patients and clinicians do to catch the cancer as early as possible?
Brooks: Again, knowing the symptoms like we talked about and making sure you’re reporting them. The pendulum kind of swings back and forth about how often women should have pelvic exams, but seeing a gynecologic provider during your reproductive years and also if you have any issues for an exam, because sometimes we will catch masses by feeling things. Again, being really aware of your family history, because if you’re somebody who tests positive for a mutation, you’re somebody who we might consider doing ultrasounds and CA-125s every 6 months.
A common question we get is, “Why isn’t there a screening test?” We have done large studies looking at the role of ultrasounds, blood tests, etc, to try and detect ovarian cancer in the general population. Unfortunately, those tests a lot of times result in just identifying ovarian masses that aren’t cancer, and we wind up doing a bunch of surgeries that patients didn’t necessarily need that occasionally can result in complications, or we unfortunately don’t diagnose a cancer early enough to impact the outcomes markedly.
As frustrating as it is, in the absence of symptoms or in the absence of a family history, overtesting doesn’t always help. Just knowing your body and knowing how to advocate for yourself and reporting your family history can all help.
This article was published by: AJMC