Shaking off the shadow of ovarian cancer

ABOUT ONE IN EVERY 57 women in the U.S. will have ovarian cancer at some point in her life, according to statistics from the National Cancer Institute. Each year, approximately 22,000 individuals are diagnosed with the disease, and more than half of them will die from it. Ovarian cancer ranks as the fourth-leading cause of cancer deaths (after lung, breast, and colon) for American women, and is the most deadly form of gynecological cancer. There only has been a slight decline in death rates from this disease in the past 50 years. The exact causes have yet to be determined completely. However, it manifests itself when certain cells within the ovaries become abnormal, then divide rapidly. These cancer cells can invade the surrounding tissue and metastasize, spreading to other parts of the body.

This information became an obsession to me after I was classified as high risk since my sister--suddenly and out of nowhere--was found to have ovarian cancer. In the course of two terrible weeks, she (following vaginal bleeding) had been diagnosed with endometrial cancer and underwent surgery. During the procedure, her surgeon discovered an ovarian tumor, which was diagnosed as malignant. However, both cancers were at stage one--the lowest risk category for recurrence. The endometrial cancer apparently posed no threat to my sister's chances of survival; the ovarian cancer was another story. Ovarian cancer has few symptoms, and (unlike in my sister's case) usually is not detected until it has reached an advanced stage.

In the aftermath of my sister's ordeal, I was aware that her illness probably placed me in a higher risk category for cancer. It was a problem I preferred not to face at the time, but had to. On the second of my daily visits to my sister in the hospital, I met her surgeon during rounds. The next day, my sister gave me a blunt message from him: ovarian cancer runs in families and I needed to have my ovaries removed.

Her surgeon may have been correct about the advice, but wrong if he thought he would acquire another patient in the family. I quickly made an appointment to see my own gynecologist. In addition to being my trusted physician for 20 years, he--by an uncanny coincidence--is one of the leading authorities on ovarian cancer in the country. We spoke about my sister's case and he calmly advised me to have my ovaries removed--a procedure known as a prophylactic oophorectomy. It could be done by video laparoscopy, making it less invasive than regular surgery. The procedure usually takes about 70 minutes.

While I should not have been taken aback by his statement, I started to feel numb when he spoke to me and did the first thing that came to mind: 1 scheduled the surgery at his earliest available date. It never crossed my mind to ask him if there were any options other than surgery. The only question I could think of asking was whether endometrial cancer was inherited. He told me it was not. The operation, however, did not take place as planned. My gynecologist was scheduled for jury duty, and his next available date was not for another two months. This interlude gave me an opportunity to reconsider, so I decided to find out more about ovarian cancer.

I made several telephone calls to prominent hospitals and health organizations and soon amassed more information than I probably needed. I started to keep a file, and read an array of articles from leading medical journals. In the course of my research, I noted that various studies have identified certain factors known to increase the risk of this disease:

Family history. A first-degree relative--mother, daughter, sister, grandmother, or aunt--on either the mother's or father's side who has had the disease increases the likelihood that you will be afflicted.

Age. Most ovarian cancer cases occur in women over the age of 50, with those 60 and older incurring the highest risk.

Childbearing. Women who never have had children are at a higher risk than those with offspring; the more children, the lower the risk.

Ethnicity. A higher proportion of women from an Eastern or Central European Jewish background are stricken.

Fertility drugs. Individuals on these drugs can be more prone to develop ovarian cancer.

Talc. Those who have used it in the genital area over a period of time may have increased their risk.

Hormone replacement therapy. Post-menopausal women on this regimen may have added to their chances of getting the disease.

I was distressed to find out that I fit into four of these categories. Nevertheless, I felt perfectly healthy, and the thought of submitting to prophylactic surgery gave me pause. Some of my friends expressed a similar concern, and one of them commented, "Why let a doctor remove healthy tissue from you?"

One of the most interesting things I learned from my research was that a patient at high risk for ovarian cancer has several options. As I have explained, I already knew about the first one. However, it also is possible to undergo genetic tests to see if there is a mutation of either the BRA1 or BRA2 gene that could increase the likelihood of getting ovarian cancer. More over, a patient can be examined every six months with two screening tests--transvaginal ultrasound (performed by placing a small instrument inside the vagina) and CA 125 assay (a blood test to measure a tumor marker that often is found in higher-than-normal amounts in women with ovarian cancer). Of course, there is no decree that forces an individual to do anything. A woman is free to act on the assumption that she never will be diagnosed with ovarian cancer.