Ovarian Cancer

Ovarian Cancer

Frightening but
Frequently Preventable

One year after she was diagnosed with ovarian cancer, Christine Peloghitis, director of student services at Allentown College in Pennsylvania, embarked on a 2,935-mile foot race from Huntington Beach, California, to New York City.

Peloghitis entered the race not knowing if the surgery she'd had to remove one ovary and part of another had cured her cancer. But Peloghitis, who managed to finish 1,000 miles in nearly 22 days of running, did know this: At age 27 she wanted to be the toughest woman this disease had ever attacked. So far, she's succeeding in her fight against it.

"Ovarian cancer is the fifth leading cause of cancer deaths in the United States," says Michael Muto, M.D., co-director of the Familial Ovarian Cancer Center at Brigham and Women's Hospital in Boston and assistant professor of obstetrics and gynecology and reproductive biology at Harvard Medical School. Its only symptoms are the common complaints of bloating, constipation and a swollen waistline. It attacks 24,000 women every year--5 out of every 100,000 women over age 30, 8 of every 100,000 women over age 35 and 12 of every 100,000 women over age 40. A woman's risk of getting the disease over her entire life span is 1 in 80.

While the chances that Peloghitis would develop ovarian cancer were low, the chances that she'll survive it are high.

Younger women like Peloghitis who are of childbearing age are more likely to get a lazy, slow-growing tumor with what doctors call low malignant potential, meaning it takes a long time to invade other parts of the body. Older women, particularly postmenopausal women in their fifties, are more likely to develop invasive epithelial cancer, that is, cancer that grows rapidly and literally strangles organs, like the bowels, then rapidly spreads to other parts of the abdomen. Any woman of any age, however, can develop either type of ovarian cancer.

When tumors with low malignant potential are confined to the ovary, surgical removal results in a cure rate of 90 percent, Dr. Muto says. Even if the tumor spreads to other parts of the abdomen, the survival rate is better than that for epithelial cancer, which spreads more aggressively.

"Our track record in treating advanced disease is quite poor," says Dr. Muto. "Take a look at the survival rates in 1969 and then again in 1994. Just pull an old book out of the library, look up the survival rates over the last 30 years and you won't find a bit of difference."

Who's at Risk?

One of the difficulties in finding better ways to treat ovarian cancer is that its cause is still a mystery.

Some scientists feel it's caused by a gene that has been preprogrammed by heredity to cause trouble. Women who have a mother, sister or daughter with ovarian cancer have a 1-in-20 chance of getting the disease themselves, says Dr. Muto. Women who have two or more close relatives with the disease have a 3-in-10 chance of getting it. And the rare woman who has a defect in the gene that has been identified as a cause of ovarian and breast cancer has an 8-in-10 chance of getting one or both diseases.

Still, scientists point out that heredity accounts for only 5 to 7 percent of all ovarian cancer. What causes the rest?

Some scientists feel that it's triggered by a virus or a chemical carcinogen that travels from outside the body through the vagina and cervix, into the uterus and out through the fallopian tubes into the abdominal cavity, where the rich hormonal mix from a woman's reproductive system promotes malignant growth.

But others suspect the cause is more direct. "It may have something to do with the trauma and wound healing experienced by the ovary," says Alice Whittemore, Ph.D., professor of epidemiology and biostatistics at Stanford University Medical School, who has conducted epidemiological research on ovarian cancer.

"Every month an egg literally bursts through the outer layer of this walnut-size ovary. It's then caught by the fallopian tube and sent on its way to the uterus. The trauma of ovulation, followed by the repeated wound healing, may set off the cancer."

The Best Protection

The data suggests, says Dr. Whittemore, that "the more you ovulate, the higher your risk."

That's why the common denominator of most strategies that researchers suggest to reduce risk involves reducing the number of times you ovulate over your life span. Here's what they have in mind.

Take the Pill. "Data suggest as much as half of ovarian cancer can be prevented if we use the Pill for four years sometime before menopause," says Dr. Whittemore. "Since 24,000 women get the disease every year, that means we could save 12,000 women every year."

Get pregnant. Women who don't have children have twice the risk of ovarian cancer of women who have two or three, says Dr. Whittemore.

Breastfeed. "Breastfeeding also reduces risk," says Dr. Whittemore. In fact, breastfeeding for a total of 12 to 24 months can reduce your risk of ovarian cancer by about one-third.

Powder your nose, not your bottom. A study of more than 400 women at Harvard Medical School found that women who used talc on their genitals on a daily basis for many years were three times more likely to get ovarian cancer than women who did not.

"The female genital tract is wide open," says Dr. Muto. "Anything you put on your external genitals will get into your abdomen. It goes into your vagina, into your uterus, into your tubes and right on out to your ovaries. So the talcum powder can get right up there."

Since few talc fibers have actually been found within an ovarian tumor, however, Dr. Muto is not so sure that the talc causes cancer. Nevertheless, he adds, until more research has been done, it's probably a good idea to forgo the powder.

Eat green and orange vegetables. A study of 213 women at Ohio State University found that loading up on foods rich in beta-carotene, such as dark leafy greens, carrots and sweet potatoes, reduces the risk of ovarian cancer. Even eating as few as three medium carrots every five days was associated with fewer cases of cancer.

Jump up and down. A collaborative study between the National Cancer Institute in Bethesda, Maryland, and the Shanghai Cancer Institute in China indicated that women who hold jobs requiring lots of physical activity may have a reduced incidence of ovarian cancer. Women in the study who sat for long periods of time on the job had an increased incidence of the disease; women who were more active had less.

Tie your tubes. Having your fallopian tubes tied when you're finished with childbearing also reduces your risk, says Dr. Whittemore. A study of more than 120,000 nurses at Harvard Medical School revealed that women who got their tubes tied reduced their risk of ovarian cancer by 67 percent.

Researchers don't know why tying the tubes cuts your risk, adds Dr. Whittemore, but some researchers suspect that it prevents various contaminants from reaching the ovaries.

"My own bias is that it impedes blood flow to the ovaries," says Dr. Whittemore, "but so far surgeons won't admit the possibility."

Think twice about ovary removal. Only women with two or more close family members who have ovarian cancer should even consider having their ovaries removed as a preventive tactic, concluded a panel of experts at a National Institutes of Health conference on ovarian cancer. And they should consider it only after childbearing is complete.

Although getting rid of your ovaries sounds like a good way to prevent ovarian cancer, in women with a strong family history of the disease, it does not reduce the risk of ovarian-like cancers growing somewhere else in the abdominal cavity, says Dr. Muto.