Ovarian Cancer Screen

One out of seventy women will develop ovarian cancer in their lifetime. It is the seventh most common cancer in women, and the most common cause of death among women who develop gynecologic cancers. Many women inquire about screening for ovarian cancer in hopes of detecting the disease early when it is most curable.

Symptoms of ovarian cancer have traditionally felt to be absent until the disease was in its later stages. Studies now suggest that women with early stage ovarian cancer can often be identified by specific, easily identifiable patterns of symptoms. Researchers found that women with ovarian cancer were found to have increased abdominal size, bloating, urinary urgency, or pelvic pain on a recurring basis. While it is not unusual for most women to occasionally have those symptoms, women with ovarian cancer have them 20-30 times per month and with more severity than women with the same symptoms who did not have cancer. Women who persistently have 2 or more of those symptoms do not necessarily have ovarian cancer, but further evaluation is appropriate and we suggest that you contact us schedule an ultrasound, examination, and consultation.

Women who are  at increased risk for ovarian cancer based on family history

Only 5-10% of ovarian cancer is hereditary. However, if a woman is a carrier of one of the gene mutations associated with ovarian cancer, her risk is strikingly higher than that seen in the general population.

In the early 1990s, BRCA1 (Breast Cancer gene 1) and BRCA2 (Breast Cancer gene 2) were identified as gene mutations responsible for the majority of hereditary breast and ovarian cancer. Genes, of course, are the parts of each cell, which contain the hereditary information that one gets from each parent. A mutation is a misspelling of the gene that changes the function of that gene. If the mutation occurs in BRCA1 or BRCA2, there is an increased susceptibility to certain cancers, specifically breast and ovarian.

Women with BRCA1 mutations appear to have a 20-40% risk of developing ovarian cancer during their lifetime as opposed to the 1.4-1.8% lifetime risk seen in the general population. Women with a BRCA2 mutation have a 15-25% risk of developing ovarian cancer. So, if someone does carry a mutation of the BRCA gene, there is a significant chance of developing cancer.

Certain groups of people are at increased risk for carrying the gene mutation. Ashkenazi Jews are one group that has been identified as being at particularly high risk, with 2.5% of the population carrying BRCA mutations. Ashkenazi Jews are Jews that come from Eastern Europe as opposed to Sephardic Jews, which come from Spain, Portugal, Turkey and Mediterranean countries. Most American Jews are of Ashkenazi descent.

Who should be screened for BRCA Mutations?
The presence of a BRCA mutation can be detected in a blood sample.

 If you have breast cancer, particularly if you developed it before age 50, you are at higher risk than someone who was diagnosed post-menopausally. If you have a first-degree relative who is BRCA positive and/or two or more first-degree relatives with ovarian or breast cancer, screening should be considered. 

Ultrasound and CA125 screening
Many women have received e-mails from "helpful" friends and family, touting the benefits of CA125 as a screening test and suggesting that women demand this test from their doctors.

CA125 is a blood test that was developed to identify women with ovarian cancer at an early stage when a cure would be more likely. Unfortunately, CA125 screening in the general population has not resulted in favorable results or we would do it routinely. The false positive rate is extremely high, such that the majority of women with a slightly elevated CA125 do not have ovarian cancer but have a benign condition such as endometriosis or fibroids. Unlike Pap smears, which detect abnormalities years before there is cervical cancer, CA125 doesn't increase until the disease is well established.

There is currently no evidence that regular screening in individuals at average risk for ovarian cancer reduces the number of women diagnosed with ovarian cancer or the number of women who die from ovarian cancer. Having said that, most ovarian cancer screening programs recommend that women who are BRCA1 or BRCA2 positive have a CA125 test every six to twelve months beginning at age twenty-five.

Transvaginal ultrasound is also often requested to aid in early detection of ovarian cancer. Keep in mind that it is entirely possible to have advanced ovarian cancer and have ovaries appear normal on ultrasound. Newer ultrasound technology, such as with Doppler blood flow and 3-dimensional imaging, is available in our office but is not always definitive. Like CA125, annual transvaginal ultrasound is recommended in the high-risk population.

Please schedule a consultation to see if you are a candidate for ovarian cancer screening in order to determine what tests are most appropriate for you.