Montgomery Medicine No. 787

Ovarian Cancer

Ovarian cancer is a particularly concerning illness because it is often diagnosed at an advanced stage, making it more difficult to treat effectively. By the time most women are diagnosed, the cancer has already spread beyond the ovaries into the abdominal cavity or nearby lymph nodes, which is considered stage 3. This delay in diagnosis contributes to a poor survival rate, with less than half of women surviving five years after their diagnosis. In the United States, there were approximately 20,000 new cases of ovarian cancer in 2022, and about 12,800 women died from the disease. While ovarian cancer accounts for less than 3% of all cancers in women, it is the fifth leading cause of cancer-related deaths, behind breast, lung, colorectal, and uterine cancers.

The risk of developing ovarian cancer increases with age, with an average age of 63 and peaking in the late 70s. Fortunately, the overall risk remains relatively low, with about a 1.3% lifetime chance of developing the disease. In fact, the incidence of ovarian cancer has been gradually declining since the late 1980s. Several factors increase a woman’s risk, including infertility, endometriosis, polycystic ovarian syndrome, smoking, obesity, estrogen use, and a family history of breast or ovarian cancer. Women who test positive for the BRCA1 or BRCA2 gene mutations are also at higher risk. For those with one first-degree relative, such as a mother or sister, the risk rises to about 4-5%, and it increases to about 7% if there are two affected first-degree relatives. On the other hand, certain factors are associated with a reduced risk of ovarian cancer, such as having had a pregnancy, breastfeeding, using oral contraceptives, undergoing tubal ligation, or using an intrauterine device (IUD).

Ovarian cancer is often called a “silent killer” because its symptoms can be subtle or absent in the early stages. When symptoms do appear, they may include bloating, abdominal or pelvic pain, a sense of fullness after eating only small amounts, decreased appetite, urinary urgency or frequency, and changes in bowel habits, such as constipation. Unfortunately, these symptoms are nonspecific and can easily be mistaken for less serious conditions. Women who experience any of these symptoms for more than a few weeks should consult a healthcare provider for further evaluation.

Diagnosing ovarian cancer early improves survival rates, but there is currently no effective screening test for women at average risk who do not have symptoms. Routine screening in this group has not been shown to reduce mortality and is associated with a high rate of false positives. These false positives can cause unnecessary stress and expose women to potential harm from invasive procedures and surgeries. Occasionally, ovarian cancer may be detected during a routine pelvic exam, but this typically occurs when the disease is already advanced. Women who are at higher risk due to genetic factors or family history, or those with persistent, unexplained symptoms, may benefit from additional testing. This could include a pelvic examination, pelvic ultrasound, and a blood test known as CA-125.

The CA-125 test is often discussed in social media and has been promoted in widely circulated messages, including emails, as a screening tool for ovarian cancer. Some versions of these messages have been shared for decades, claiming that women who do not have annual CA-125 testing are endangering their lives and accusing the medical community and insurance companies of withholding this test. However, these claims are misleading. While the CA-125 test is useful for monitoring women who have already been diagnosed with ovarian cancer to track their response to treatment, it is not an effective screening tool for detecting the disease in the general population.

The CA-125 test has significant limitations. It is not very sensitive, as it is only elevated in about half of women with ovarian cancer, and it often remains normal until the cancer has already spread. This means that a negative result does not rule out the presence of ovarian cancer. The test is also not specific, as CA-125 levels can be elevated for reasons unrelated to ovarian cancer, such as normal menstruation, pregnancy, endometriosis, and benign uterine tumors. It can also rise in conditions like pancreatitis, appendicitis, and other cancers, including breast, lung, and colon cancers.

Given these limitations, the CA-125 test is not recommended as a routine screening tool for ovarian cancer. Instead, women should focus on recognizing symptoms and understanding their individual risk factors. If a woman experiences persistent symptoms, such as bloating, pelvic pain, or changes in bowel or urinary habits, she should consult her healthcare provider. A thorough medical history, physical examination, and additional testing, if necessary, can help determine the cause of her symptoms. For women at increased risk due to family history or genetic predisposition, a combination of risk-reducing strategies and careful monitoring may be appropriate.

Ultimately, awareness and early recognition of symptoms are key to improving outcomes for ovarian cancer. Women should be proactive in discussing their concerns and risk factors with their healthcare providers to ensure appropriate evaluation and care. While ovarian cancer remains a challenging disease, advances in research and ongoing efforts to improve early detection and treatment offer hope for better outcomes in the future.