Dr Douglas A. Levine: Hi! I am Dr Douglas Levine, and I am gynecologic oncologist at Memorial Sloan Kettering Cancer Center in New York City. I am also a member of the Ovarian Cancer Research Funds Scientific Advisory committee. Today I am going to discuss risk factors and the prevention of ovarian cancer. Doctors cannot always explain why one woman develops ovarian cancer and another does not. However, women with certain risk factors maybe more likely than others to develop ovarian cancer. These risk factors include; a family or personal history of ovarian cancer, being over the age of 55, never being pregnant, and having received menopausal hormone therapy. Familial ovarian cancer is a concern of many women. Some women have genetic mutations in their DNA that makes them more likely to develop ovarian cancer. Carmel J. Cohen: All of this comes in the genetic material which we inherit from our parents and forebears and there are also some sporadic mistakes which occur in the replication of cells which we inherit to genes which are BRCA1 and BRCA2. These are mutations of genes which normally occur in women. Certain population such as the Ashkenazi Jewish population has a very high risk of having this BRCA abnormality. Dr Douglas A. Levine: Since these genetic changes, maybe passed from generation to generation, these women often have family members with ovarian or breast cancer. A woman's risk of ovarian cancer is 3 times higher if she has a close relative who had ovarian cancer. The risk is further increased with additional family members who have had cancer, especially ovarian or breast cancer, or if the cancers were diagnosed earlier than age 50. If you fit this pattern genetic counseling and even testing maybe appropriate.
We recommend that women who have inherited a BRCA gene changes, and have not have their ovaries removed, have a Transvaginal ultrasound and a CA-125 blood test twice per year, starting at age 35. It is important to remember that woman with BRCA1 or BRCA2 gene mutations are also at increased risk for breast cancer and specialized breast cancer screening programs exists in many parts of the country. Screening for breast cancer should be discussed between patients, at increased risk, and their doctor. It is important to remember that many women who get ovarian cancer do not have these risk factors. And many women who do have these risk factors never get the disease. There are no known simple protective measures that completely prevent ovarian cancer. However, we know that ovarian cancer occurs less commonly under certain conditions. Birth control pills reduce the risk of ovarian cancer especially among women who use them for several years compare with women who never used oral contraceptives. Those who used oral contraceptives for three years or more have about 50% lower risk of developing ovarian cancer. This is particularly relevant for woman with BRCA1 or BRCA2 mutations who are at an overall increased risk of this disease.
Having one or more children, particularly if the first is born before age 25, and breast feeding may decrease your risk. Tubal ligation is a surgical procedure in which the fallopian tubes are tied to prevent pregnancy. This procedure may also reduce the risk of developing ovarian cancer by up to 50%. It's used as a risk reduction strategy maybe appropriate for high risk individuals and should be discussed with your physician. Hysterectomy has been demonstrated to reduce the relative risk of ovarian cancer. You should not have a Hysterectomy exclusively to avoid the risk of ovarian cancer. But if one is being performed for valid medical reasons and you have a family history of ovarian or breast cancer, or are over the age of 40, you should discuss concurrent ovarian removal with your physician.
Oophorectomy is the surgical removal of one or both ovaries; only recommended for certain high risk patients. A risk reducing Oophorectomy virtually eliminates the risk of ovarian cancer but not the risk for a far or less common cancer called cancer primary peritoneal carcinoma. This cancer is similar to ovarian cancer in spread, presentation, and treatment. Discussion with your physician is necessary to determine your individual risk and options for risk reducing surgery. Eating healthy, staying active, and maintaining a healthy weight are all important things you can do to reduce your risk of all cancers and other diseases. Because there is no one way to reduce or eliminate risk with the exception of the surgical measures, it is all the more important to listen to your body and stay attuned for symptoms. If you want to learn more about ovarian cancer, check out our other videos, including the next one, on how ovarian cancer is diagnosed.