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Sunday, March 29, 2015
How commonly are women diagnosed with ovarian cancer?
Does pregnancy increase your risk of developing cancer?
What effect does pregnancy have on pre-existing cancer?
What is the survival rate of someone diagnosed with ovarian cancer?
Can oral contraceptive pills reduce my risk of ovarian cancer?
What are the most forward thinking treatments for advanced ovarian cancer?
I have developed cysts on my ovaries... What are my treatment options?
Unfortunately there is not yet a good, non-invasive and cost effective screen for ovarian cancer. The best tool we have is a yearly pelvic examination and gynecologic history. The overall age-adjusted incidence of ovarian cancer is 13.9 women per 100,000 screened, based on the best data possible from 1998-2002.1 This is not the total number currently diagnosed with ovarian cancer (prevalence). This number is more difficult to find since the data is not easily obtainable. The lifetime risk of being diagnosed with ovarian cancer is 1.48% for women of all races. It is higher for white women (1.82%) than black women (1.04%). For additional statistics on ovarian and other cancers, see the SEER Cancer Stat Facts
The answer, for the most part, is no. In fact, statistically you are at decreased risk of developing ovarian, endometrial (uterine) and breast cancer if you have been pregnant. The younger a woman is at the time of her first pregnancy, and the number of pregnancies, may decrease the risk further, depending on the cancer.
Endometrial cancer has the greatest risk reduction with pregnancy. A single pregnancy can reduce a woman's risk by 10 to 40%. A woman who has been pregnant more than five times may reduce the risk by up to 80%.
The Nurses' Health Study, a large, long-term study of US nurses, showed a 16% decrease in ovarian cancer with one full-term pregnancy. There seems to be little benefit in cancer reduction with further pregnancies.
A study in Australia noted a 27% decrease in breast cancer in women who had at least one child. There is more recent European data that shows a short-term increase in detection of breast cancer after the birth of a woman's first child. These types of studies can be biased (flawed) since there may be a higher rate of detection (rather than true number of cancers) in women who seek regular health care immediately after the birth of a child.
A similar, or even greater, reduction in endometrial and ovarian cancer can also be seen in women who use oral contraceptive pills. Women who use the pill have a 40-50% decreased lifetime risk of endometrial and ovarian cancer risk. There is no reduction in breast cancer in birth control pill users.
Cancer is an uncommon finding in pregnant women. Below is a table of the incidence (or occurrence) of different types of cancers during pregnancy.2
1 in 2205 pregnancies
As with any cancer, survival is greatest when caught at an early stage. The symptoms of pregnancy such as fatigue, and changes in are the same as some early symptoms of ovarian cancer. In the end, many pregnant women with cancer are diagnosed at a later stage than those who are not pregnant.
When matched stage for stage, pregnant women with cancer have the same survival rate as those who are not pregnant. Many cancer treatments, including surgery and chemotherapy, can be given during pregnancy under close consultation with an oncologist and obstetrician. Radiation therapy cannot be given during pregnancy.
The five-year survival of ovarian cancer patients has a wide range that depends on the type of cancer, how extensive it is, and the patient's age. Because there is no effective ovarian cancer screening, it is often diagnosed in an advanced stage. The 5-year survival of patients with stage III ovarian cancer ranges from 5-40% depending on the type and grade of the cancer.1 The lifetime risk of dying from ovarian cancer in a woman who lives to be 80 years old is 1.09% for white women, 0.75% for black women and 1.04% for all races.1
It is true that taking oral contraceptive pills can reduce your risks of ovarian cancer by up to 50% in those who take them for 1 or more years. This may be especially important in women who are at greater risk of developing ovarian cancer because of family history or genetic markers. The theory is that the inhibition of ovulation that occurs with birth control pills provides the risk reduction.
Research protocols are usually the most forward thinking treatments for advanced ovarian cancer. The National Cancer Institute has a web site that lists all cancer research protocols -- the Clinical Trial Search section of the Comprehensive Cancer Database. The web site will allow you to search by cancer type as well as by location in the country where the protocol is offered. The patient version displays the descriptions in more understandable language.
Following are direct links to descriptions and treatment options for specific types of ovarian cancer:
In February I underwent surgery to rule out ovarian cancer. No cancer was found. I went for a follow up ultrasound after three menstrual cycles to check the ovaries and cysts. The ovaries are slightly enlarged. There is a cyst on the right ovary. The left ovary has several (1 to 2 cm). What are my treatment options? I'm 39 and ready to have my ovaries removed just to get the problems over with.
It is normal for the ovary to develop cysts every month in an attempt to ovulate. Occasionally these cysts can cause problems requiring surgery, more often than not they resolve within a few months. One of the most effective non-surgical treatments for ovarian cysts is suppression with oral contraceptives. It doesn’t necessarily cause the current cyst to resolve, but prevents the formation of new cysts. Only in rare cases of recurrent, symptomatic cysts is surgery to remove them (oophorectomy) required. Oopherectomy is the removal of fallopian tubes and ovaries. Removal of the ovaries at your young age has significant long-term risks such as osteoporosis and heart disease.
1http://seer.cancer.gov/statfacts/html/ovary.html?statfacts_page=ovary.html&x=10&y=15, Accessed October 13, 2005.
2Hobbins, John C. and E. Albert Reece (eds), Medicine of the fetus and mother, 2nd ed. Philadelphia: Lippincott-Raven Publishers, 1999.
Last Reviewed: Oct 18, 2005
Thomas A deHoop, MD
Formerly Associate Professor of Clinical Obstetrics and Gynecology
Director, Medical Student Education
No longer associated
Arthur T Ollendorff, MD
Associate Professor of Obstetrics and Gynecology
College of Medicine
University of Cincinnati