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Ovarian and Breast Cancer Link

Removing Healthy Ovaries to Prevent Cancer is an Option

By Nancy Larson

Updated October 20, 2011

(LifeWire) - After a lumpectomy and the discovery of more cancer in her lymph nodes, the last thing 50-year-old breast cancer survivor Barbara Parks* of Manalapan, N.J., wanted to worry about was ovarian cancer. While her family's cancer history wasn't significant, Parks had another concern about her lineage. She is an Ashkenazi Jew -- a group with a high incidence of genetic mutations that increase the risk of breast cancer and ovarian cancer. After a positive test for the breast cancer gene 2 (BRCA2) mutation was confirmed, Parks had preventive surgery to remove both breasts, her ovaries and her fallopian tubes due to her higher risk.

Three years later, Parks has no regrets. The mild hot flashes triggered by the removal of her ovaries pale in comparison to the anxiety she would have experienced without the surgery.

"As a cancer survivor, all your aches and pains are magnified anyway," Parks says. "I wanted to feel I wasn't going to be sitting and waiting for the other shoe to fall."

Hereditary Breast and Ovarian Cancer Syndrome

Like thousands of other breast cancer survivors, Parks has hereditary breast and ovarian cancer (HBOC) syndrome. Most are at risk for ovarian cancer simply because they have family members who've also had breast or ovarian cancer. A significant family history involves close relatives - parents, siblings, aunts, uncles or grandparents. If two or more have had breast or ovarian cancer, patients face four times more risk of getting ovarian cancer than other women, especially if they were diagnosed before age 50. If their own breast cancer was discovered before they turned 40, their risk is sevenfold.

Women with a family history of both cancers may have a mutation in one of two genes: BRCA1 or BRCA2. Those of Ashkenazi Jewish ancestry have a 10 times greater chance of inheriting the mutations. Women with BRCA1 have a 39% chance of ovarian cancer in their lifetime and those with BRCA2, an 11% chance. These numbers compare to a 1 to 2% chance for the general public.

It's important to note that only about 5% of women have BRCA mutations, yet heredity is suspected in up to a quarter of all breast and ovarian cancer cases, leading scientists to conclude there is much to learn about cancer and genetics.

Ovarian Cancer Symptoms

Overall, the chances of getting ovarian cancer are much lower than the risk of breast cancer. One in seven women will be diagnosed with breast cancer in their lifetime, while only one in 68 will have ovarian cancer.

With early detection (before the disease has spread beyond the ovaries), the chances of surviving ovarian cancer are greater than 90%. Unfortunately, early detection is rare -- occurring in only a quarter of all cases. That's because, unlike breast cancer, ovarian cancer has no distinctive early warning signs. Its symptoms are often dismissed or mistaken for those of many other conditions. They can include:

  • Abdominal pain or pressure
  • Bloating or discomfort that continues and gets worse
  • Painful intercourse
  • Nausea, indigestion or gas
  • Frequent urination, constipation or diarrhea
  • Vaginal bleeding other than menstruation
  • Weight loss or weight gain
  • Difficulty breathing

Detection

Detection of small ovarian tumors is very difficult. Several screening methods are recommended on a regular basis for all women with an elevated risk of developing ovarian cancer:

  • Pelvic and rectal examinations performed twice a year are likely to detect only later-stage ovarian tumors.
  • Transvaginal ultrasound performed once a year uses a small wand inserted into the vagina to detect ovarian masses, which may or may not be cancerous.
  • Cancer antigen-125 (CA-125) blood test performed once a year measures protein levels as a marker for ovarian cancer, but it has high "false positive" and "false negative" rates. If findings are suspicious, computed tomographic (CT) and MRI scans can also help identify the presence of tumors. Only the biopsy of a tumor can confirm ovarian cancer.

Prevention

If you are a woman with HBOC, you can consider several preventive stepswith the help of your doctor, and although some are extreme, they are also extremely effective:

  • Oral contraceptives: Using oral contraceptives for 5 years or more can lower your risk of ovarian cancer by 50%. However, there is some indication they may increase the risk of breast cancer in women with BRCA gene mutations. Other risks include noncancerous liver tumors, liver cancer, heart attack, stroke or blood clots.
  • Removal of ovaries: In women with BRCA gene mutations, oophorectomy (removal of the ovaries) reduces the risk of ovarian cancer by up to 95% and the risk of breast cancer by up to 60%. Some medical experts recommend oophorectomy as a preventive measure, but others advise it only for those who are already undergoing hysterectomy (removal of the uterus) for valid medical reasons.
  • Tubal litigation: This may reduce cancer risk, but it is recommended only for medical reasons.

Another issue is the prevention of breast cancer by ovarian cancer survivors. Women with ovarian cancer who test positive for BRCA gene mutations have a higher risk of breast cancer and may consider preventive mastectomy.

Remember, having an increased risk for any cancer does not mean you will get it. There is still much about the origin of cancer that science does not understand. Family history is only one known indicator of your overall cancer risk, along with obesity and lack of exercise, which are two variables that you can control.

*Name has been changed at the request of the interviewee.

Sources:

Bergfeldt, Kjell. "Risk of Ovarian Cancer in Breast-Cancer Patients with a Family History of Breast or Ovarian Cancer: a Population-Based Cohort Study." The Lancet 360(2002): 891-4. 27 June 2008. (subscription).

"Can Ovarian Cancer Be Found Early?" Cancer.org. 19 Jan. 2008. American Cancer Society. 27 June 2008.

"Can Ovarian Cancer Be Prevented?" Cancer.org. 19 Jan. 2008. American Cancer Society. 27 June 2008.

"Diet and Physical Activity: What's the Cancer Connection? " Cancer.org. 2 Oct. 2006. American Cancer Society. 27 June 2008.

"Estrogen and Progestin (Oral Contraceptives)." nlm.nih.gov. 1 Aug. 2007. U.S. National Library of Medicine. 27 June 2008.

"Genetic Testing for Breast and Ovarian Cancer Risk." Cancer.gov. 20 Mar. 2006. National Cancer Institute. 27 June 2008.

"Hereditary Breast and Ovarian Cancer Syndrome." MDAnderson.org. 25 Aug. 2006. University of Texas M.D. Anderson Cancer Center. 27 June 2008.

"How Is Ovarian Cancer Diagnosed?" Cancer.org. 19 Jan. 2008. American Cancer Society. 27 June 2008.

"Ovarian Cancer and Breast Cancer." Breastcancer.org. 24 April 2008. BreastCancer.org. 27 June 2008.

"Ovarian Cancer Basics." MDAnderson.org. 2008. University of Texas M.D. Anderson Cancer Center. 27 June 2008.

"Preventive Mastectomy: Questions and Answers." Cancer.gov. 27 July 2006. National Cancer Institute. 30 June 2008.

"Researchers Link Family History To Increased Ovarian Cancer Risk." cancer.org. 28 Aug. 2002. American Cancer Society. 27 June 2008.

Susan Klapin. Breast Cancer Survivor. Phone interview, 30 June 2008.

"What Is Hereditary Breast Ovarian Cancer (HBOC) Syndrome?" Cancer.Stanford.edu. 2008. Stanford University. 27 June 2008.


LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Nancy Larson is a freelance writer with 20 years of experience. Her work has appeared in dozens of local and national publications including Health magazine and The Advocate.
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