A woman in her late 40’s dies less than a year after ovarian cancer is diagnosed. She has 3 daughters ranging from 15 to 25 years of age. How can ovarian cancer be prevented in those 3 young woman? How can ovarian cancer be prevented during the lifetime of ANY woman, whether or not she has a family history of ovarian cancer?
As it is often the case in trying to solve a health problem, a single approach is not enough. There are several ways of preventing women from ever getting ovarian cancer. But what the world seems to be most excited about today and which will probably be rewarded with a Nobel Prize when it is accomplished, is a test to diagnose ovarian cancer early. NONE EXISTS TODAY. But ways to prevent ovarian cancer do exist today! And, of course, when we prevent ovarian cancer from ever happening we definitely do lower ovarian cancer deaths.
So what can be done to decrease the risk of ovarian cancer for those 3 daughters of the woman who died last month from ovarian cancer?
- A woman may use contraceptives that that primarily work by suppressing ovulation. Pills, patches, rings, Nexplanon implants and Depo-Provera injections all markedly suppress ovulation reducing a woman’s risk for ovarian cancer. A British physician/epidemiologist, calls ovarian cancer a disease of “incessant ovulators”.
- The hormonal contraceptive with which we have by far the most experience is birth control pills.
- Birth control pills taken for a total of 10 years diminish by 80% a woman’s risk of developing ovarian cancer and the protective effect persists to some extent for 30 years after she stops taking pills.
- A woman need not have taken pills for ten consecutive years. It is the cumulative number of years that counts.
If a woman has tubal sterilization done, her fallopian tubes may be removed since it is now known that changes in the cells of the delicate parts of the fallopian tubes that reach out over the ovaries is where “ovarian cancer” often begins. WHEN TUBAL STERILIZATION IS GOING TO BE PREFORMED A WOMAN SHOULD COMMUNICATE TO HER PHYSICIAN THAT SHE WANTS HER FALLOPIAN TUBES REMOVED NOT SIMPLY BLOCKED BY LIGATION, BURNING OR CLAMPING.
- Similarly, if a woman has a hysterectomy (most often done for women in their late 40’s and early 50’s), the ovaries and the fallopian tubes can be removed. If hysterectomy is done prior to the late 40’s it is generally recommended that the ovaries be left in to gain the beneficial effects of the hormones produced by the ovaries.
- A woman’s genetic predisposition to breast and ovarian cancer can be detected by an expensive test. This is the test that was positive for movie star, Angelina Jolie, leading to removal of her breasts and reconstructive surgery earlier this year. People discussing her mother’s death from breast cancer, her operations in 2013, and her plan to have her ovaries removed when she approaches menopause have brought attention to this third way of preventing ovarian cancer deaths: removal of the ovaries in high risk women.
Take home messages for women – not just teenagers:
- Use of pills for 10 years will lower your risk of ever developing ovarian cancer while on pills and for almost 30 years after stopping pills. Depo-Provera injections appear to have the same protective effect.
- If you are going to have a tubal sterilization operation, be sure your physician knows you want your fallopian tubes removed too. Not all physicians know this. Also tell female relatives about this!
- If having an hysterectomy in the late 40’s or older, the ovaries should also be removed.
- Some women at high risk for ovarian and breast cancer may be wise to have genetic testing done to see if their risk for ovarian or breast cancr is increased.
To learn more about the advantages and disadvantages of all available contraceptive methods, go to www.managingcontraception.com and click on Choices ( available in English and Spanish)
You can also order this wonderful new educational book from the above website or by calling 404-875-5001
Robert A. Hatcher MD, MPH
Professor of Gynecology and Obstetrics
Emory University School of Medicine