Ovarian Cancer Prevention & Detection
Preventing and finding ovarian cancer earlier
Most ovarian cancers are detected in late stages, so active prevention and early detection are crucial. Early cancers can have a survival rate of over 90%, while advanced stages are in the 5-30% range. Routine screening for cancer of the ovary is only recommended for those who have been diagnosed with gene alterations which put them at higher risk. This includes breast-ovarian (BRCA) syndrome and Lynch Syndrome.
The background lifetime risk of ovarian cancer in women is one in seventy (about 1.5%). The highest risk can be as high as one in two (50%) when there is a BRCA deleterious mutation. Long-term use of fertility drugs, personal history of breast cancer after age 40 with no family history, hormonal replacement, or endometriosis increases the risk minimally, if at all. Genetic screening and/or genetic testing is recommended for women that are considered high-risk with a strong family history or personal history of cancer, especially breast cancer.
Ovarian Cancer Risk & Screening
There are no good screening tools for ovarian cancer! The CA 125 blood test and transvaginal ultrasound are often used but neither is very accurate and there is no research evidence that it catches the cancer early or saves lives. There IS research evidence that deaths have occurred because of inappropriate surgery for what often turns out to not be cancer. Part of the problem is that the CA 125 blood test is not very indicative of ovarian cancer (it can be elevated with ANY kind of inflammation within the body, even a migraine). Ultrasound is not routinely utilized because it is not sensitive nor specific in detecting ovarian cancer. Screening ultrasound can also provide wrong information which can result in unnecessary surgery from which women have died due to complications. Routine pelvic exams only detect 1 in 10,000 ovarian cancers in asymptomatic patients. So, to strongly reiterate, there is no good screening test for ovarian malignancy and this is what national screening policy is based on.
Even patients at high risk for ovarian cancer with genetic predisposition, such as those with BRCA mutations, do not live longer due to screening in the vast majority of studies. However, for lack of a better strategy other than removing the ovaries, screening may be considered in those are high risk. The good news is that more robust combination biomarkers like OVA-1 may be approved in the near future and research is ongoing to optimize algorithms which calculate risk based on blood tests, ultrasound, health status, menopausal status and other factors.
Ovarian Molecular Screening Future
Molecular technologies are being investigated for ovarian cancer screening. Currently, there are new tests which look for circulating tumor DNA (ctDNA or cfDNA) or molecular markers of gene “methylation”, but these are very inaccurate at present. They are super-sensitive and can easily overdiagnose cancer and lead to the same problem as mentioned above regarding CA125. Having said that, these new tests are likely to be the future of screening as soon as we determine how to use them so we don’t over or under-diagnose ovarian cancer. Meanwhile active prevention efforts through nutrition, exercise, toxin avoidance and lifestyle choices are crucial for ovarian cancer prevention. There is no down-side, it leads to better overall health and these recommendations are supported by the CDC, American Cancer Society and other mainstream national organizations.
Active Prevention is possible
You can prevent cancer of the ovaries and possibly reduce the risk of ovarian cancer recurrence through integrative epigenetics and nutrigenomics.
If you are at increased risk for ovarian malignancy based on genetic assessment, you may strongly benefit from risk-reducing minimally invasive surgery to prevent ovarian cancer.