Ovarian Cancer

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Ovarian Cancer Prevention: Methods for High-Risks Patients

Dr. Ritu Salani Ohio State University Wexner Medical Center

A number of exciting technologies have emerged in recent years that can help to prevent ovarian cancer. Dr. Ritu Salani, a Gynecologic Oncologist at The Ohio State University, explains to SurvivorNet a number of strategies, which include genetic testing for susceptibility, surveillance methods that can aid early detection, and medications that can reduce risk.

Dr. Salani breaks down the ways in which the availability of genetic testing has changed how doctors find women who are at risk for ovarian cancer. “We are really excited about how genetic testing has really revolutionized ovarian cancer care,” Dr. Salani says. “When you have a relative who’s been affected with ovarian cancer or certain types of breast cancer, oftentimes genetic testing is performed,” she explains. These tests focus in on the BRCA I and II genes, which usually fight against tumor growth in the body. Genetic tests can now determine whether mutations exist in these genes, which is a reliable sign of a woman having a genetic predisposition for ovarian cancer.

If these tests come back showing a genetic cause for the woman’s disease, then the rest of the woman’s family should be brought in. “If they test positive, then this would be important for their family members to be tested, because this is our best opportunity to prevent a cancer from developing,” Dr. Salani explains. “So, if a family member tests positive, usually the first and second members will be tested, and if they test positive then we’d have some opportunities.”

Once doctors can firmly establish the genetic susceptibility to ovarian cancer in a family, then they have several available paths to prevent the disease. One method that doctors have utilized to limited success is to surveil a woman’s levels of CA 125, a protein biomarker that is often more present in the blood of those who are at high risk for ovarian cancer. This test can be helpful, but there are also a number of reasons other than cancer that a patient’s CA 125 levels might be high. Doctors can also perform transvaginal ultrasounds (TVUS). These tests utilize sound waves to get a visual of the uterus, fallopian tubes, and ovaries. While they can locate the presence of a mass, they cannot on their own determine whether a mass is malignant or benign.

Beyond these limited surveillance methods, doctors are increasingly using birth control pills as a means of ovarian cancer prevention. “One of the most exciting and probably understated medicines in the OBGYN world are birth control pills, or what we call oral contraceptives pills,” Dr. Saloni reveals. Oral contraceptive pills (OCPs), which have been common forms of contraception for over half a century, can reduce risk for ovarian cancer by up to 50% if taken for five years.

The precise reasons why OCPs so decrease the likelihood of ovarian cancer are still obscure.

Dr. Salani states that OCPs can be effective for those both with BRCA mutations and for the general population. “And that’s not only true for ovarian cancer, it’s also true for endometrial or uterine cancer. So there’s a lot of promise in birth control pills.” Dr. Salani also reminds women, however, that there are risks in taking OCPS. “It’s not always safe for everybody,” she says. “So it’s important to understand what those risks are and if you’re a candidate for it. But it is one of the most powerful chemo-preventative agents that we know of.”

Even with these advances, for those women who have BRCA mutations the safest form of prevention is still the removal of the fallopian tubes and ovaries. This removal is recommended for women who show a BRCA I and mutation by age 35 to 40. Dr. Saloni talks through the difficulties of this decision for women. “We know that these are important instruments in childbirth and if you’re young and you still haven’t completed your family, then this is not something that would be appropriate for you.”

Even if removal is not feasible, however, surveillance and OCPs can still be a remarkably effective method for many high-risk individuals to prevent ovarian cancer.

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Dr. Ritu Salani is a gynecologic oncologist and associate professor in the Department of Obstetrics and Gynecology at The Ohio State University Wexner Medical Center. Read More

Ovarian Cancer: Screening and Risk

Ovarian cancer is notoriously hard to detect in the early stages when it’s most effectively treated. That’s why women should evaluate their risk factors for the disease and be vigilant about possible symptoms and warning signs.