Toward Earlier Detection of Ovarian Cancer

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AUGUST 4, 2009

HEALTH JOURNAL
Toward Earlier Detection of Ovarian Cancer

By MELINDA BECK
WSJ


Two new studies offer a glimmer of light into the dark puzzle of ovarian cancer, which remains one of the most deadly cancers because it is so difficult to detect early. Researchers in the United Kingdom have identified a new genetic variation that appears to raise a woman’s risk of developing ovarian cancer. BNC2, as the gene is called, is far more common than the previously identified genes, BRCA1 and BRCA2, and it doesn’t raise the risk of ovarian cancer nearly as much, according to the study, which was published in Nature Genetics. But it’s the first of what scientists believe will be many common gene variations linked to ovarian cancer that, when combined, may raise the risk significantly.

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The second study, published in the online journal PLoS last week, provides new insights into what ovarian tumors typically look like before they are discovered. Researchers at Stanford University School of Medicine and the Canary Foundation, a nonprofit group dedicated to early cancer detection, analyzed reports of tumors found in ovaries and fallopian tubes that were removed as a precaution from women who had the BRCA1 mutation. Even though all the women were believed healthy at the time, about 8% had undiagnosed serous ovarian tumors, the most deadly kind. Using a mathematical model, the researchers determined that most such tumors remain extremely small—less than 1 centimeter in diameter—for about four years before metastasizing, and about half of them were still just 3 centimeters across by the time they did spread.

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Researchers have been hoping to find a screening test that would help detect ovarian cancer early, much like prostate-specific antigen, or PSA, tests do with prostate cancer and mammograms do for breast cancer. But the best tests to date—a CA 125 blood test and a transvaginal sonogram—give many false positives as well, so neither are currently recommended for screening the population at large. Both tests are recommended for women who have a family history of ovarian cancer, or who experience symptoms such as abdominal bloating, pain, change in bowel habits or unusual fatigue. It’s unclear how big a tumor has to be before such symptoms are evident, but even when they are, women often ignore them and doctors often dismiss them as gastrointestinal upset. In a recent survey by the National Ovarian Cancer Association, a nonprofit advocacy group, 83% of women said their doctors had not discussed the symptoms of ovarian cancer with them, and 62% of Americans believe—erroneously—that a Pap smear can diagnose it.

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Women with numerous cases of breast, ovarian and colon cancer in their extended families are urged to see a genetic counselor, who may suggest testing for a BRCA mutation. Only about one in every 500 women carries either BRCA1 or BRCA 2, but when they do, they have five times the usual risk of breast cancer, and between three and eight times the risk of ovarian cancer. “If I hadn’t opened that envelope, I would have passed away years ago,” says Donna Lackey, 42, of Southlake, Texas. Her mother and grandmother died of breast cancer in their 40s, and in 2002, a cousin wrote to say that she and her siblings had tested positive for BRCA1. Ms. Lackey tested positive too and scheduled what she thought would be a preventative double mastectomy and oophorectomy (removal of the ovaries). But the surgeons found that ovarian cancer had already spread throughout her abdomen and lymph nodes, even though she had no symptoms whatsoever. Ms. Lackey has since had seven cancer recurrences and has been on chemotherapy continuously for the past year. Still, she has beaten the five-year odds and is grateful she had the surgery. “If I hadn’t, my boys would have lost their mom in second and fifth grade. Their whole lives would have been different,” she says.

To date, only about 25% of ovarian-cancer cases appear to have a family connection. The rest are probably related to unknown genetic problems or to environmental causes, or an interplay of both. “We don’t believe that anybody inherits cancer. What you may inherit is a predisposition to it,” says Thomas Sellers, a genetic epidemiologist at Moffitt Cancer Center in Tampa, Fla... Researchers also have high hopes for preventing ovarian cancer in the first place. Bearing children, breast-feeding them and taking birth-control pills for at least five years all seem to lower the risk significantly—probably because each suppresses ovulation temporarily. Maintaining a healthy weight is also recommended.

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http://online.wsj.com/article/SB20001424052970204313604574328573230828740.html (subscription)


Printed in The Wall Street Journal, page D3

[ayeshahaqqiqa]

1. Interesting

I've read some cutting edge studies about the connection between lack of iodine in the body and an increased incidence of breast and ovarian cancers. Doctors examined all their female patients for iodine sufficiency and then tested for cancer being present. There was a significant number of those with cancer who also lacked iodine - will have to look up the study, but it was well over 50%. The doctors have used iodine therapy on patients to see if this helps with shrinking of tumors, and it appears to have had an effect. They are now in the process of setting up double-blind studies to see if the treatment can be verified as successful.