HERSHEY, Pa. — By 2024, approximately 19,680 women in the United States will receive a new diagnosis of ovarian cancer and 12,740 women will die from the disease, said Dr. Shaina Bruce, a gynecologic oncologist at Penn State Cancer Institute. The median age of all patients who develop ovarian cancer is 63.
Historically, women at higher risk for ovarian cancer were recommended to have their fallopian tubes and ovaries removed once they had completed having children. Taking that step to protect themselves comes at a huge cost ― surgical menopause.
But Bruce says medical science is catching up with ovarian cancer. The studies may lead to new methods for preventive care and the surgery needed to lower the risk may be easier than before. Below, during Gynecologic Cancer Awareness Month, Bruce discusses the disease and why it’s worth taking action to reduce your risk.
What is the connection between heredity and ovarian cancer?
About 25% of all cases of ovarian cancer occur in people with a hereditary predisposition for the disease, says Bruce, so if one of your first degree (mother or sister) or second degree (aunt or first cousin) relatives have had the disease, you should undergo genetic testing to see if you are at increased risk.
The most common genetic culprits of ovarian cancer are mutations in BRCA1 and BRCA2, two genes that are also known to increase the risk for breast, prostate and other types of cancer. A patient with a mutation in their BRCA1 gene has a 40% chance of developing ovarian cancer, Bruce said, and BRCA2, 20%.
In patients with known genetic mutations that increase the risk of certain cancers, steps can be taken to reduce their risk. Family members can also determine if they have the same genetic risk.
What does the operation entail?
“The problem with removing the ovaries from a young woman in her 30s and 40s is that it puts the patient into surgical menopause,” says Bruce. Women who receive surgery have the same symptoms of menopause that a woman might experience without surgery but later in life – hot flashes, vaginal dryness and mood swings.
“Also, the estrogen your ovaries make is important,” says Bruce. The hormone protects a woman’s heart and bones, and may reduce the likelihood of one day developing dementia.
Over the past 10 to 15 years, however, doctors have discovered that more than 80% of ovarian cancers begin in the fallopian tubes. Penn State College of Medicine is participating in a surgical choice study that will compare simply removing the fallopian tubes of women with a mutation in the BRCA1 gene ― who plan to have the ovaries removed later ― with women who have had their ovaries removed both the tubes and ovaries. . The researchers hope to determine the effects of both practices on their risk of developing ovarian cancer. Women who have a BRCA1 mutation and are interested in participating in this study should contact Penn State Health Gynecologic Oncology for more information.
One thing women can do to reduce their risk if they are planning tubal ligation surgery – or “having your tubes tied” – instead of having the fallopian tubes burned or tied surgically, is asking to remove the tubes entirely.
In any case, the surgery ― whether it removes only the fallopian tubes or the ovaries and tubes ― is minimally invasive outpatient surgery. These are three small cuts and usually take a few weeks to heal.
Are there any nonsurgical possibilities to reduce your risk?
Some women choose to wait to have surgery until after they have had children. Regular screening for ovarian cancer using transvaginal ultrasounds and blood tests to look for cancer-expressing antigen is also an option. That’s often recommended in young patients, Bruce says.
For BRCA1 patients, doctors generally do not recommend surgery until age 35 to 40. The recommended age for preventive surgery for BRCA2 patients is 40 to 45.
“If a patient is younger than that, we can safely do the screening until they’re ready for risk-reducing surgery,” Bruce said.
Are BRCA1 and BRCA2 mutations dangerous for men too?
Yes, men can also develop breast cancer and the mutation can also play a role in the risk of prostate cancer, pancreatic cancer and melanoma, Bruce said. So, if a female family member has a known BRCA mutation, male relatives should also be tested.
Who should get tested?
Anyone with a first- or second-degree relative affected by ovarian cancer meets the criteria for testing. In someone who has no family members with ovarian cancer, their lifetime risk is 1% to 2%. If the patient has a first degree relative affected by ovarian cancer, their lifetime risk is approximately 5%. Two relatives, 7% to 10%.
Currently, doctors do not test people for ovarian cancer unless they have a genetic predisposition for it.
What are the other risk factors other than heredity for ovarian cancer?
- Use of hormone replacement therapy after menopause.
- Never been pregnant.
- Endometriosis.
The idea of ​​preventive surgery is terrifying. What if I don’t want to know?
Compared to surgery to remove the ovarian cancer itself, preventive surgery is usually worth it, Bruce said.
“Ignorance is bliss, right?” said Bruce. “Unfortunately, in oncology I hear that more often than I’d like to admit. But I can say that knowledge is power. If you know you have a predisposition, there’s usually something that can be done about it. Basically, what can be done in prevention or to reduce your risk is less invasive than what needs to be done if you are diagnosed with the cancer in question.”
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The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.
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