Women with family history of breast cancer face increase risk of ovarian cancer

Ovarian cancer is the most deadly disease of the female reproductive system, with most cases diagnosed in later stages. Yet while ovarian cancer affects 1 in 70 women in the United States, many women have never discussed the risk with their doctor.

According to Dr. Sharyn Lewin, a gynecologic surgical oncologist at the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian Hospital/Columbia University Medical Center, talking with your doctor is especially important for women with a personal or family history of premenopausal breast cancer, ovarian cancer and other cancers. These women may have a genetic abnormality that greatly increases their risk for the disease.

"While we can link only 10 to 13 percent of ovarian cancers to hereditary causes, it's important that these women are aware of their risks and preventive strategies," states Dr. Lewin, assistant clinical professor in the Division of Gynecologic Oncology of the Department of Obstetrics and Gynecology at the Columbia University College of Physicians and Surgeons. "Women with mutations in the BRCA1 or BRCA2 genes -- most commonly seen with premenopausal breast cancer, but also with pancreatic cancer -- have a 10 to 60 percent chance of developing ovarian cancer, as much as 45 times the risk of the general population. Another genetic syndrome called HNPCC is a red flag for ovarian cancer, as well as cancer of the colon, uterus, stomach and small bowel. Any woman with a personal history of these cancers, or who has more than one immediate family member with the diseases, should talk with her doctor about being tested for these genes.

"Unlike with cervical cancer, there isn't an effective way at present to screen the general population for ovarian cancer, but there are important ways women can reduce their risk," continues Dr. Lewin.

Prevention
While most women's lifetime risk for having ovarian cancer is less than 2 percent, women with one of the three high-risk genetic mutations (or defects) have between 10 and 60 percent lifetime risk. This risk increases with age.

"For women testing positive for mutations in BRCA1, BRCA2 or HNPCC, I recommend that if they aren't trying to have children, they should have their ovaries and fallopian tubes removed -- something that can be done by minimally invasive surgery," states Dr. Lewin. "This effectively reduces their chances of getting ovarian cancer.

"Women with high-risk genetic mutations wanting to have children can choose to be monitored by a combination of regular blood testing and ultrasound evaluation. However, this method has limitations and most ovarian cancers aren't detected until they reach a later stage."

Another option is freezing their eggs prior to having their ovaries and tubes removed. These eggs can be fertilized by in vitro fertilization and implanted in their uterus.

Beyond genetic testing, preventing ovarian cancer means being aware of its symptoms, although they often appear only after the cancer has spread. "Ninety percent of ovarian cancers are not genetic, so it is important that women know the warning signs. Persistent symptoms like abdominal pain, urinary urgency and bloating would warrant evaluation, especially if digestive and urinary conditions are ruled out," Dr. Lewin says.

"While women cannot control the genetic and environmental factors that give rise to this cancer, there is a lot they can do to make a difference, including preventive measures like good diet, exercise and annual doctor's exams," she adds. "Oral contraceptives have also been shown to reduce risk for ovarian cancer."

Why Surgical Experience Is Important
After diagnosis is made, the next step is surgery to remove the cancer. Research has shown a major difference in outcomes between surgeons with expertise in this type of surgery and those without.

"Surgeons with specialized training and experience can maximally remove tumors in more than 75 percent of cases, compared with 25 percent or less for inexperienced surgeons. This translates to a 50 percent improvement in survival, adding more than a year to a patient's life," says Dr. Lewin. "In cases of early-stage ovarian cancer, we can improve recovery time by using minimally invasive surgery with high-precision robotic equipment."

Additional treatment may include chemotherapy medications, radiation and immunotherapy. Treatment plans are individualized to minimize side effects while maximizing quality and length of life.

For more advanced cancers, Dr. Lewin recommends both intravenous chemotherapy and chemotherapy applied within the abdominal cavity, an approach proven to extend survival. She is also studying the use of heated chemotherapy, which has been shown to be effective in treating other cancers.

A Personal Approach
At NewYork-Presbyterian/Columbia, patients see one doctor who provides a very personalized approach to cancer care. "As gynecologic oncologists, we both operate on patients and administer chemotherapy," explains Dr. Lewin. "This fosters an intimate environment, allowing us to get to know patients and their families and make them feel comfortable."

"An important part of treating cancer is listening to the patient. This includes making sure their emotional needs are met," Dr. Lewin adds. "We understand how hard it is to go through this experience and we make an effort to give them the support they need with access to psychological counseling and peer groups."