Ovarian Cancer Risk

Ovarian cancer is the deadliest gynecological cancer and affects up to 1 in 70 women in the US. Accordingly, many women are worried about what their risks are of having this kind of cancer. Currently, there are no screening tests for ovarian cancer, but women at high-risk should discuss with their health care providers what options are available to them to reduce their risk.
One of the main problems in diagnosing ovarian cancer are that so many of it’s symptoms are things that we all suffer from occasionally anyway. These include bloating, pelvic or abdominal pain, feeling full quickly, and urinary symptoms like urgency and frequency. The difference is that is normal to feel these symptoms for a day or two here or there, but if they persist almost daily for two to three weeks, you should certainly see your doctor.
The ways we can diagnose ovarian cancer may include a physical exam with a pelvic exam, a vaginal ultrasound, and sometimes a blood test for CA125. CA125 is not useful in all women and often has false positives in women who have not yet gone through menopause. This test is most useful when there is an abnormality on the exam or pelvic ultrasound, if a woman is post-menopausal, or if she is at very high risk of ovarian cancer based on other factors.
While ovarian cancer can affect any woman, there are four categories of risk.

• Average risk: the lifetime risk of developing ovarian cancer is 1 in 70. Women in this category do not have a family history of breast or ovarian cancers, never had problems getting pregnant, and have never taken hormone replacement therapy. For these women, the recommended screening for ovarian cancer is an annual gyn exam with pelvic exam.
• Slightly increased risk: the lifetime risk in this group is 1 in 20. Women in this category may have had problems getting pregnant or taken medications to help get pregnant, have a history of endometriosis, may have taken hormone replacement in menopause, or had breast cancer after age 40. The recommended screening in this group includes an annual gyn exam with pelvic exam. You may also want to discuss with your doctor ways to reduce your risks (see below).
• Moderately increased risk: a lifetime risk of 1 in 10. These women may have had a mother or sister with ovarian cancer, had breast cancer before age 40 or had breast cancer themselves with other members of their family with breast cancer as well, have a strong family history of breast cancer under age 50, have Ashkenazi Jewish heritage, or a close family relative with uterine or colon cancer under age 50. The recommendations for these women include genetic counseling and screening, and possibly testing for the BrCa mutation (a genetic predisposition to breast, ovarian, colon, or uterine cancers). These women should also have an annual gynecological exam with pelvic exam with close follow-up for any problems noted on the exam.
• Very increased risk: lifetime risk of up to 1 in 2. These women may be BrCa1 or BrCa2 positive (gene mutations that increase the risk of breast, ovarian, colon, and uterine cancer), or MLH1, MSH2, or MSH6 positive (gene mutations which increase the risk of colon, uterine, ovarian, and kidney cancers).

Women with the BrCa mutations should have a pelvic exam with a gynecologist 1-2 times a year. Some women will opt to have their ovaries and uterus removed (hysterectomy and bilateral salpingoophorectomy) once they have completed childbearing. Women who wish to avoid surgery should have a vaginal ultrasound and CA125 testing twice a year starting at age 30-35. They should also have an annual mammogram and breast MRI to check for breast cancer, starting at age 25-30.
Women with the MLH or MSH mutations should see their gynecologist 1-2 times a year, as well as have a vaginal ultrasound and CA125 test twice a year. They should also have an endometrial biopsy every year to check for endometrial or uterine cancer. Additionally, they should have colonoscopy every 1-2 years to screen for colon cancer, starting at age 20-25. Some women will also elect to have their uterus and ovaries removed when they have completed childbearing.
Reducing the risk of ovarian cancer can be discussed with your doctor. Birth control pills (and presumably the ring and patch) have been shown to reduce the risk of ovarian cancer by 50% in women who use it for more than 5 years. The longer this form of contraception is used, the more benefits. This is one of the simplest, most effective ways to reduce your risk of ovarian cancer.
For women at very high risk of developing ovarian cancer, removal of the ovaries is an option. Surprisingly, this does not completely eliminate the risk of ovarian cancer, but dose reduce it bu 85-90%. This can also reduce the risk of breast cancer by 40-70% in women who have the surgery before they go through menopause. Surgery is usually only recommended in women who have undergone genetic counseling and testing and have been shown to carry a genetic risk for cancers.
To learn more about ovarian cancer, check out the Women’s Cancer Network at http://www.wcn.org/ or the Gynecologic Cancer Foundation at http://www.thegcf.org/. To learn more about genetic counseling and testing, click on http://www.cancer.gov/cancer-topics/Genetic-Testingfor-Breast-and-Ovarian-Cancer-Risk.