Ovarian cancer: Not the 'silent killer' it was

Q: A friend of mine died of ovarian cancer in her early 50s. This disease scares me. Could I be genetically predisposed to it? And are there ways to detect it before it’s too late?

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A: Many women fear this insidious cancer, which is known, ominously, as the “silent killer.” It’s the fifth-leading cause of cancer death in American women.

Although we hear stories of people such as actress Gilda Radner, who died young of ovarian cancer, the disease is more likely to occur after menopause. The median age at diagnosis is 61. The lifetime odds of developing ovarian cancer are 1.45 percent, with just under 1 percent of those over 40 at risk from the disease.

Younger women who develop ovarian cancer are more likely to have a genetic mutation in one of their BRCA genes. (BR=Breast and CA=Cancer, although these genes are also connected with ovarian cancer). This mutation not only increases their lifetime risk of developing ovarian cancer (to between 16 and 64 percent) but their lifetime risk of breast cancer (to between 50 and 80 percent).

Women with a family history of ovarian cancer, early breast or colon cancer, or male breast cancer might have this mutation, especially if they are of Eastern European descent.

Because your genes come from both your mother and your father, you must look at the medical history on both sides of your family. If you are worried, consider genetic counseling and testing for a BRCA mutation.

That’s the bad news. The good, at least in terms of detecting ovarian cancer, is that the disease is not as silent as we thought — and that there are tests on the way which should make detection much easier.

More than 70 percent of women with ovarian cancer had recurring symptoms that offer the possibility of early detection, according to a recent article in the Journal of the American Medical Association.

Unfortunately, these symptoms were not very specific and often occur with other medical problems.

They included:

• Pain: pelvic, abdominal or back pain.
• Eating: indigestion, inability to eat normally, nausea or vomiting, weight loss.
• Abdomen: bloating, increased abdominal size, ability to feel abdominal mass.
• Bladder : urgency, frequent urination.
• Bowels: constipation, diarrhea.
• Menses/vaginal bleeding: menstrual irregularities, bleeding after menopause.
• Intercourse: pain or bleeding during intercourse.
• Other : fatigue, leg swelling.

Women diagnosed with ovarian cancer were more likely to have four or more symptoms. Often, they were severe, frequent and long-lasting.

If you have similar problems, see a doctor, who will run tests, which may include a pelvic ultrasound.

If an ovarian mass is present, the doctor will test your blood for CA-125, a protein produced by some ovarian cancers. Screening all women with this test isn’t effective. There are too many false positive results, due to protein levels being elevated from other causes, such as fibroids, endometriosis, infection or liver problems.

In the near future, we expect to have a better blood test that can more reliably detect the early stages of ovarian cancer. Called OvaCheck, it will most likely be available within a year and will analyze blood for protein patterns known to occur in women with ovarian cancer.

Dr. Reichman’s Bottom Line: Ovarian cancer is not as silent as once thought. There are many signs that can lead to early diagnosis and treatment.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," published by William Morrow, a division of HarperCollins.