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by Robert Hatcher MD, MPH
Professor Emeritus of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta
A woman in her late 40s dies less than a year after ovarian cancer is diagnosed. She has three daughters ranging from 15 to 25 years of age. How can ovarian cancer be prevented in these three young women? How can ovarian cancer be prevented during the lifetime of ANY woman, whether or not she has a family history of ovarian cancer?
As is often the case in trying to solve or prevent a health problem, a single approach is not enough. There are several ways of preventing women from ever developing ovarian cancer. But what the world seems to be most excited about today, and which probably will be rewarded with a Nobel Prize when it is accomplished, is a test to diagnose ovarian cancer early. NONE EXISTS TODAY. But ways to prevent ovarian cancer from ever happening do exist today! And, of course, when we prevent ovarian cancer from ever happening, we lower ovarian cancer deaths.
What are the options?
So what can be done to decrease the risk of ovarian cancer for those three daughters of the woman who died from ovarian cancer?
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A woman may use contraceptives that primarily work by suppressing ovulation. Pills, patches, rings, Nexplanon implants, and Depo-Provera injections all markedly suppress ovulation, thereby reducing a woman's risk for ovarian cancer. A British physician who is also an epidemiologist calls ovarian cancer a disease of "incessant ovulators."
The hormonal contraceptive with which clinicians have by far the most experience is birth control pills. Birth control pills taken for a total of 10 years diminish a woman's risk of developing ovarian cancer by 80% and the protective effect persists to some extent for 30 years after she stops taking pills. A woman need not have taken pills for 10 consecutive years. It is the cumulative number of years that counts.
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If a woman has a tubal sterilization procedure performed, her fallopian tubes may be removed since it is now known that changes in the cells of the delicate parts of the fallopian tubes that reach out over the ovaries is where "ovarian cancer" often begins. When tubal sterilization is going to be performed, a woman should communicate to her physician that she wants her fallopian tubes removed, not simply blocked by ligation, burning, or clamping.
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Similarly, if a woman has a hysterectomy (most often done for women in their late 40s and early 50s), the ovaries and the fallopian tubes can be removed. If hysterectomy is performed prior to the late 40s, it generally is recommended that the ovaries remain in place to gain the beneficial effects of the hormones produced by the ovaries.
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A woman's genetic predisposition to breast and ovarian cancer can be detected by an expensive test.
This is the test that was positive for movie star Angelina Jolie and led to removal of both breasts and reconstructive surgery earlier this year. With discussion of Jolie's mother's death from breast cancer, Jolie's own operations in 2013, and Jolie's plan to have her ovaries removed when she approaches menopause, attention has been brought to the third way of preventing ovarian cancer deaths: removal of the ovaries in high-risk women.
What to tell patients?
Here are several take-home messages for women, not just teens:
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Use of pills for 10 years will lower your risk of ever developing ovarian cancer while on pills, and for almost 30 years after stopping pills. Depo-Provera injections appear to have the same protective effect.
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If you are going to have a tubal sterilization operation, be sure your physician knows you want your fallopian tubes removed, too. Not all physicians know this. Tell your female relatives about this fact!
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If having a hysterectomy in the late 40s or older, in most instances, the ovaries also should be removed.
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Some women at high risk for ovarian and breast cancer might be wise to have genetic testing done to see if their risk for ovarian or breast cancer is increased. If the test is positive, they might wish to consider removal of their ovaries and/or removal of their breasts.
