Ovarian cancer is among the top 5 diseases that women fear most. And here’s why: Every year, nearly 25,000 American women are diagnosed with the disease—and for roughly four in five of them, the cancer has already spread beyond the ovaries. At that point, it’s too late to save most of these women. Yet when ovarian cancer is found before it spreads, more than 90 percent of women survive longer than five years. The problem is in the finding. “We need much better tests than we currently have,” says Beth Karlan, MD, an ovarian-cancer specialist at Cedars-Sinai Medical Center in Los Angeles. Here’s what you need to know to boost your own chances of early detection.
Know the symptoms
After decades of claiming there are no true symptoms, several leading cancer organizations, including the American Cancer Society, now recommend that you watch out for the following: bloating, pelvic or abdominal pain, difficulty with eating, feeling full quickly after eating, or the development of urinary symptoms (like urgency or frequency). Don’t just assume that these symptoms are caused by a stomach bug, irritable bowel, or an infection. If you notice any of them every day for more than a few weeks, see your gynecologist. They could be early signs of ovarian cancer. “We need to dispel the myth that this is a silent killer,” Karlan says. “We know there are delays in diagnosis because women are often too busy with their lives to take note of the subtle symptoms. But these symptoms are real. Usually they’re persistent and persuasive. If that’s what you have, make an appointment and ask about ovarian cancer.”
Talk to relatives
Make sure you know everything there is to know about your female relatives’ cancer history on both your mom and dad’s sides. If you have a first-degree relative (mother, sister, or daughter) who has had ovarian cancer, your risks are much higher than average. Even if it’s an aunt, grandmother, or great-grandmother, your risk may be elevated. The same goes for breast cancer in relatives—that, too, could be a sign of higher risks for ovarian cancer. Your overall risk will depend on a variety of factors, such as ethnicity and the age when your relative developed cancer, says David A. Fishman, MD, director of the Screening and Prevention Program at the New York University Cancer Institute. If you do have a family history of ovarian or breast cancer, talk to a geneticist. Ask for a referral from your doctor or insurance plan.
Get tested
A variety of tests are available, some to gauge risk and others to determine whether you may have cancer. But keep in mind: Testing isn’t for everyone, and some tests are controversial.
1. Gene tests
Only 10 percent of ovarian cancer cases are hereditary, but anyone with the Breast Cancer 1 (BRCA-1) or BRCA-2 gene mutations has a 20 to 40 percent risk of developing ovarian cancer, compared with the average risk of about 2 percent. If you have a close relative with ovarian or breast cancer, talk to a geneticist about a blood test that screens for these mutations. Fortunately, fewer than 1 percent of women have a mutation. (It’s much higher—2.5 percent—among Jews with eastern European ancestry, an ancient wrinkle that may be tied to marriages among family members centuries ago.) If you do have a mutation, getting your ovaries removed is an important option for lowering your risk.
2. Blood tests
If there’s a reason to suspect ovarian cancer—you have the constant abdominal symptoms, for instance—a CA-125 blood test can look for elevated levels of a protein found in most ovarian cancer cells. CA means “cancer antigen.” But the test finds early ovarian cancer in only about half the women who actually have the disease, and there’s no evidence, as yet, that it saves lives. It’s also least effective in premenopausal women.
3. Ultrasound
Transvaginal ultrasound—a wandlike instrument that images the ovaries through the vagina—is potentially useful when there’s an elevated risk of cancer or if you have suspicious symptoms. “It’s good at picking up structural changes in the ovaries,” Fishman says. But the $300 test isn’t very effective at figuring out which structural changes are cancer and which aren’t. And, like CA-125, it hasn’t been shown to save lives.
Keep up on the research
Experts continue to study CA-125 and transvaginal ultrasound to find out if they’re more helpful than they appear, and results of a major trial involving 200,000 women are due by 2010. In addition, experts say, a much more accurate blood test may be just a few years away. Ask your doctor about any new research on detection methods for ovarian cancer.
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