Can You Prevent Ovarian Cancer?

Since ovarian cancer is difficult to detect early, and is more difficult to treat at later stages, one might assume that a good strategy would be to prevent it from developing in the first place. But preventing ovarian cancer isn’t as straightforward as say quit smoking to avoid lung cancer, or wearing sunscreen to try and prevent skin cancer. While many women diagnosed with ovarian cancer will never know why they developed the disease, there is a subgroup of women who carry a genetic risk of developing this cancer, and for those women, once the risk is identified, there are ways to dramatically reduce the odds of developing ovarian cancer.

“The highest risk for ovarian cancer is a genetic predisposition, and what that means is a genetic mutation or error in your BRCA genes, like BRCA1 and 2,” says Dr. Elisabeth Diver, gynecologic oncologist at Stanford University. These gene mutations have been associated with both breast and ovarian cancer, and they are passed down from parents to children.

Reducing Genetic Risk

Women whose blood test for this mutation comes back positive can meet with a genetic counselor to find out what their increased risk is, and what steps they should consider taking. Some women opt for increased monitoring which can include transvaginal ultrasound exams and CA-125 blood tests to screen for ovarian cancer. But some women decide that preventive surgery is their best option.

“This surgery is called prophylactic, which means preventive,” explains Dr. Diver. “It’s a risk-reducing salpingo-oophorectomy: removal of the fallopian tubes and ovaries. This is the surgery that Angelina Jolie had to prevent future ovarian cancer.” Dr. Diver explains that this surgery can help reduce the risk of ovarian family cancer in this population of women by 80 percent.  Often women with the BRCA mutations opt to have this surgery when they complete their families, hoping that it would be many years before an ovarian cancer would develop.

Why doesn’t removing the ovaries and fallopian tubes reduce the risk of developing ovarian cancer by 100 percent? In some cases the surgery is too late, and a woman is found to have cancer during the operation to prevent it. In these cases, though, the cancer may be very small and have been undetectable without a surgical biopsy, making treatment more likely to be successful. Women with the BRCA mutation are also at greater risk of primary peritoneal cancer, which develops in the peritoneum: a thin layer of tissue lining the abdomen and covering the pelvic organs. This cancer can still occur after the ovaries and fallopian tubes have been removed.

No BRCA Mutation, No Risk?

Besides family history and genetic mutations, some other risk factors for ovarian cancer are not preventable. These include:

• Older age: most ovarian cancer occurs in women past age 50
• Early onset of menstruation and/or late menopause

On the other hand, there are also a few risk factors that can be avoided, and even a few preventive steps that may help, although these actions are far from foolproof. Women who want to reduce their risk of developing ovarian cancer can talk to their doctor about:

• Taking birth control pills
• Not using hormone replacement therapy after menopause, particularly in high doses or longterm
• Having children before age 35
• Having a healthy lifestyle in general, including eating a healthy diet and maintaining a healthy weight, engaging in regular physical activity, and getting plenty of sleep

All of these steps–from genetic testing to lifestyle changes–can be helpful for women hoping to prevent ovarian cancer. But none of them take the place of regular gynecological checkups and following your doctor’s recommended screening schedule based on your own personal risk factors. When ovarian cancer can’t be prevented, the next best thing is for it to be detected early, when treatment is most likely to be successful.

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