As usual, genetics plays a part in ovarian cancer. Learn what other factors matter.
Endometriosis, infertility and early menstruation can all increase a woman’s chances of developing ovarian cancer, as can a family history of breast or ovarian cancer. But the best high-risk assessment lies in your DNA: some 10 percent of cases are hereditary. Women who inherit mutations on their BRCA1 and BRCA2 genes – both of which are involved in DNA repair – are at a much higher risk for ovarian cancer. The BRCA2 mutation points to a 15 to 27 percent lifetime risk; the BRCA1 mutation skyrockets that number as high as 40 percent. In both cases, carriers typically fall ill around or after age 40 (the average patient has a 1.4 percent lifetime risk and is diagnosed after 60). “When a woman has one of these mutations, we’ll monitor her every six months with a physical exam and ultrasound,” says Prof Hennie Botha, head of the Unit for Gynaecological Oncology at the University of Stellenbosch and Tygerberg Hospital. “We’ll wait for her to finish having kids, then offer the option of removing the ovaries and Fallopian tubes, which cuts her risk for ovarian cancer by nearly 96 percent and reduces the risk of breast cancer.”
Research indicates that preventative surgery in those with a genetic problem should happen asap, but science suggests there might be ways to fine-tune your risk assessment – and put off the surgery. For example, doctors now know that the BRCA1 and BRCA2 genes are very large, and that the mutations can occur anywhere along them. Pinpointing the exact spots could help further define your risk and aid your doctor in coming up with a prevention plan. What’s more, promising new research in the Journal of the American Medical Association shows that carriers of the BRCA mutations might have better survival rates after treatment than non-carriers.
If you have a strong family history of ovarian cancer (two or more first- or second degree relatives have had it), see a genetic counsellor for a BRCA blood test. Ask her about another genetic condition called Lynch syndrome, which has been linked to ovarian and endometrial cancer. If you test positive for either, find a gynaecological oncologist you feel comfortable with and study all of your options before making any decisions.
One bright note for high-risk women: you don’t need to rush into motherhood. Even if you have the surgery early, it’s possible to harvest eggs, remove the ovaries and Fallopian tubes and implant fertilised eggs in the uterus. You don’t necessarily need your ovaries to be pregnant or deliver a baby.