Ovarian cancer may relate to ovulation

WOMEN'S HEALTH

February 16, 1993|By Dr. Genevieve Matanoski | Dr. Genevieve Matanoski,Contributing Writer

Ovarian cancer is the most common, fatal, gynecologic cancer. Fortunately, only one in 70 women will develop this cancer. By comparison, one in 10 women will develop breast cancer.

But for the 22,000 women who will be diagnosed with this cancer in the next year, it is not very comforting to realize that only 40 percent will live five years. The most frustrating fact to scientists is that despite 20 years of studies in humans and 40 years of studies in animals, we have not yet discovered how to prevent the disease.

Q: What do we know about ovarian cancer?

A: Studies indicate the disease is rare before age 40. The rate rises after 40 until around 60, when the risk levels off. Ovarian tumors which occur under age 40 are very benign and have a five-year survival rate of 98 percent. Those occurring at older ages are highly cancerous, with a survival rate of only 34 percent.

Ovarian cancer is less frequent in blacks and Asians, but we are not sure why. This may be due to cultural differences. For example, Japanese women living in Japan have a lower rate of ovarian cancer than those in the United States who have acquired more American habits.

Q: What is the current thinking about how ovarian cancer develops?

A: Some scientists believe trauma to the surface of the ovary that occurs each time a woman ovulates may be instrumental in causing ovarian cancer. This would mean that the more a woman ovulates, the higher her risk. Another way of looking at it is that anything that prevents ovulation lowers the risk -- things such as pregnancy, oral contraceptives, late age at starting to menstruate and early age at menopause. Others contend that exposure to high levels of hormones called pituitary gonadotropin, which actually sets the ovulation process in motion, may increase risk for ovarian cancer.

Q: How is ovarian cancer detected?

A: Today, ovarian cancer is detected only through your regular gynecological examination. If your doctor finds irregularities to the surface or shape of your ovaries, you may undergo a sonogram or other X-ray studies. We often can resolve further questions through laparoscopy rather than the exploratory surgery of the past. This procedure requires a small incision and the insertion of a tiny camera to visualize the area.

Unfortunately, we're a long way from the routine screening tests that

exist for cervical and breast cancer. Researchers are testing a screening combination that includes a blood test and sonogram, but we must wait to see the results.

Q: What can I do?

A: The good news is that a lot of women should have routine gynecological exams. Older women and those who have a family history of ovarian cancer should have exams at least once a year. As research emerges regarding effective screening technology, your doctor should be able to provide you with the new options.

If you would like more information regarding ovarian cancer, a cancer information line sponsored by the National Cancer Institute and located at the Johns Hopkins Medical School Department of Oncology, (800) 422-6237, is open to the public.

Dr. Matanoski is a physician and professor of epidemiology at the Johns Hopkins School of Hygiene and Public Health.

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