Ovarian cancer is one of the most challenging types of cancer to identify and treat. Because the ovaries are hidden so deeply within the body, you cannot see symptoms like you would with breast or cervical cancers. And researchers have yet to discover effective screening methods that work well for the general population, making this cancer notorious for late detection and, as a result, poor outcomes.

Thankfully, ovarian cancer is rare, so most women do not need to worry about it. However, those with certain genetic predispositions are at a considerably higher risk. That means it’s important to know your family history and discuss it with your doctor, especially if women in your family have had cancer.

What is ovarian cancer?

Ovarian cancer is the cancer of the ovaries, ovarian tissues, and fallopian tubes. It’s the second-most common gynecological cancer (behind uterine cancer) but it’s the deadliest because it’s usually detected only after it has advanced to Stages 3 or 4.
Because its symptoms are common to so many conditions, ovarian cancer can be hard to identify. Symptoms include bloating, pelvic and abdominal pain, difficulty eating, nausea, unexplained weight loss, and frequent urination. Once it is diagnosed, it’s best to work with a gynecologic oncologist who has special training and access to facilities with the latest medical technology, mental health support, and other resources. At a minimum, treatment usually involves chemotherapy and surgery.

Am I at risk?

Of all the factors that increase your risk for ovarian cancer, your genetics play the biggest role. The rate of ovarian cancer among the general population is 1.3 to 1.5 percent, as compared to women with certain gene mutations whose rate can increase to as high as 45 percent.
Although the average age for ovarian cancer diagnosis is 63, when heredity is at play, we commonly see diagnoses in women between ages 35 and 45. Other risk factors include infertility, which increases the risk of ovarian cancer, but only slightly, and endometriosis—a condition where the tissue lining the inside of the uterus grows outside the uterus. Smoking is the one risk factor we can control.

What about birth control pills?

One big myth about birth control pills is that they increase the risk of ovarian cancer, when it’s actually the opposite: oral contraceptives have been proven to lower your risk. Other risk reducers include a previous pregnancy and a history of breastfeeding. Sterilization through salpingectomy, which is the removal of the fallopian tubes, can also reduce risk for women in the general population, but it’s a major decision that should be carefully considered.

Why is family history so important?

Knowing your family’s detailed history is the single best way to prevent and detect ovarian cancer. Women with genetic mutations in their BRCA1 and BRCA2 (commonly known as breast cancer genes) are at much higher risk for ovarian cancer. The BRCA1 mutation increases the risk of ovarian cancer to between 35 and 45 percent, and the BRCA2 mutation increases the risk to between 11 and 17 percent. Those numbers are significant.

Collecting a detailed family cancer history is the first step in figuring out whether you carry these gene mutations. Your doctor will want to know: 1. Who had cancer (how closely are they related), 2. What type of cancer they had, and 3. How old they were when they were diagnosed. With this information, your doctor will know whether to recommend genetic counseling.

If you are genetically predisposed to get ovarian cancer, you may consider risk-reducing surgery such as a bilateral salpingo-oophorectomy. Effects of the surgery include the early onset of menopausal symptoms which can be significant, but the risk for ovarian cancer drops significantly. These decisions should be made after consultation with your doctor.
Although you cannot change your genetic makeup, thanks to modern medicine you can figure out whether you are at elevated risk and this information allows you to take steps to protect yourself and those you love.

Dr. Seema Nayak is an ob/gyn at Care for Her, the women’s health service of MCHC Health Centers—a local, non-profit, federally qualified health center offering medical, dental, and behavioral health care to people in Lake and Mendocino Counties.