Ovarian Cancer and Its Insidious Threat
From the WSJ:
By Marisa Weiss
As a breast cancer oncologist and a breast cancer survivor, I am very aware of the tough treatment choices women are forced to make when facing this disease. Angelina Jolie performed a useful service with her recent announcement that she had undergone prophylactic double mastectomies after learning that she had a BRCA1 gene abnormality that indicates a propensity for breast cancer.. For those of us in the field, Ms. Jolie's disclosure about her course of treatment provides a great opportunity to educate the public. Unfortunately, the insidious risk of ovarian cancer that these same genetic mutations pose has received far less attention—despite reports that Ms. Jolie plans to have both of her ovaries removed.
Statistics help explain why. Breast cancer is far more prevalent than ovarian cancer. For American women, 29% of all cancers start in the breast while 3% begin in the ovaries. The average woman's lifetime risk of developing breast cancer is about 12%; for ovarian cancer it's 1.8%. For those with a BRCA1 or BRCA2 gene abnormality, the percentages are much higher: The risk of breast cancer can run as high as 87%, and the odds of ovarian cancer climb to 54%. While the overall incidence of ovarian cancer is far lower, the risk of death from the disease is much higher. The five-year survival rate for ovarian cancer is just 44% as compared with nearly 90% for those with breast cancer.
Another major difference between these two cancers is that early detection is significantly better among breast cancer patients. Screening tools such as mammograms, MRIs and clinical exams have resulted in the majority of breast cancer patients being diagnosed at an early stage of the disease. Those with ovarian cancer face more dismal odds. Currently, the only tools for early detection are transvaginal ultrasound and a blood test—and both are unreliable. If the disease is caught early, a woman's chance of surviving ovarian cancer is more than 90% at five years. But only 15% are diagnosed early.
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To reduce the high risk of ovarian cancer, many women have their ovaries and fallopian tubes removed (a procedure known as a bilateral salpingo-oophorectomy, or BSO) to reduce the risk of ovarian cancer by about 80%. Interestingly, removal of the ovaries in premenopausal women can also drop the risk of breast cancer by approximately 50%. While Ms. Jolie chose to proceed with mastectomies first, women actually have more time to consider breast surgery than they do a BSO, which should be done between the ages of 35 and 40, or when childbearing years are complete. The earlier the ovaries are removed, the lower the risk for both ovarian and breast cancer. There's more wiggle room in the timing of prophylactic mastectomies, since regular screenings, lifestyle choices and medications such as tamoxifen, which blocks the estrogen receptor, are reasonably effective as a short-term strategy.
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Dr. Weiss is the director of breast radiation oncology at Lankenau Medical Center in Wynnewood, Pa. She is also the president and founder of Breastcancer.org.
http://online.wsj.com/article/SB10001424127887323475304578499433797136750.html
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