February 4 is World Cancer Day and February is Cancer Prevention Month. I sat down with Dr. Elizabeth Swisher, medical director of the Breast and Ovarian Cancer Prevention Program of the Seattle Cancer Care Alliance, to learn about her project aimed at preventing ovarian cancer.
Why the focus on ovarian cancer?
Ovarian cancer is the deadliest of the gynecological cancers. We have about 22,000 diagnoses of ovarian cancer in the U.S. every year and about 14,000 deaths, which is a very high mortality rate. As a doctor, I just can’t abide seeing so many women in the prime of life die from ovarian cancer.
What can be done?
I believe we can empower women at high risk of ovarian cancer with the tools they need to decrease their lifetime ovarian cancer risk. That’s what we are trying to do through a research project and clinical trials supported by Stand Up To Cancer and the advocacy groups Ovarian Cancer Research Fund Alliance and National Ovarian Cancer Coalition. Our overall goal is to address barriers to ovarian cancer prevention by delivering high-quality education creating new and more accessible options for genetic testing and counseling, and providing more options for surgical prevention.
What are the risk factors for ovarian cancer?
Unfortunately the most important risk factors are things you really can’t change, like your family history and your own genetic makeup. That’s because about 20 percent of ovarian cancers are hereditary. They are driven by genetic defects particularly in biological pathways that cells use to repair their DNA, which include the well-known BRCA1 and BRCA2 genes. Women with inherited mutations in these and other genes have a much higher likelihood of developing ovarian cancer.
How do you determine if you have that risk factor?
The first thing to do is look at your family history. If your mother or grandmother, sister, or an aunt had ovarian cancer at any age or breast cancer before age 50, that could signal the presence of an inherited modification in your DNA.
A family history of ovarian, breast, pancreatic, colon, and even prostate cancer early in life can all be important. Believe it or not, the family history on your father’s side is just as important as on your mother’s side. That’s just the way heredity works.
If there is a family cancer history, then you should get more information and find out if genetic testing is right for you. Women who have survived breast cancer at a young age should also consider genetic testing. Some groups are more likely to have a genetic risk of ovarian cancer. For instance, 2% of women of Ashkenazi Jewish descent have a mutation that confers a high risk of breast and ovarian cancer. Even individuals without cancers in their families may still have inherited a gene mutation that increases cancer risk, so in the future population testing for cancer genes may become standard. In one of our clinical trials, women will be able to access professional counseling and high quality genetic testing, right from their own homes.
How reliable is genetic testing today?
Done right, it is very valid, but you need to be careful about who is doing the testing. In our clinical trial, we are working with a very reliable company and we have experts interpreting the meaning of the test for women who participate.
Suppose you have a family history of cancer, so you get genetic testing and counseling and find you have a BRCA mutation that gives you an increased risk of developing cancer. What do you do then?
At that point, we have to look at some interventions. Every woman is unique and I can’t say what has to be done in every case, but some things are available. These include looking for ovarian cancer with transvaginal ultrasound and blood tests. Not perfect, but better than just waiting to see what happens. And because the same genetic defect is implicated in breast cancer, women as young as 25 with the BRCA mutation should have MRI (magnetic resonance imaging) screening for breast tumors.
As far as ovarian cancer prevention is concerned, the big decision is whether to have surgery to remove the ovaries or the fallopian tubes before cancer can occur. We would encourage women to have their children first, assuming they want children. Then consider surgery after the age of 35 or so. Usually this means removal of the fallopian tubes and ovaries, which causes premature menopause. However, there is some evidence that some ovarian cancers start in the fallopian tubes so removing only the fallopian tubes, and leaving the ovaries intact, may reduce the cancer risk without triggering premature menopause. That’s something we will test in another clinical trial, so in the future women might have that option.
It is. That’s why we want women to have testing and counseling so they can make an informed decision on a course of action that may save their lives 10 or 20 years down the road. It is also really important for women with genetic risk to talk with experts in genetics and cancer prevention so they can develop a personalized prevention plan.
What about treatment if ovarian cancer occurs?
Surgery and chemotherapy are the standard options. Our Stand Up To Cancer project also involves a component studying what is called targeted therapy, in which we are taking drugs already approved to fight ovarian cancer in women with the BRCA mutation and expanding their use to others, as well as combining them with other drugs, to try to help a wider array of women.
The great majority of women who are diagnosed at a relatively early stage of ovarian cancer can be successfully treated. Unfortunately most are not diagnosed until much later. By then the survival rates are not very good. That’s why prevention is so important and why we are working on getting top of the line genetic counseling available to everyone, anywhere.
You’re obviously passionate about this.
I am. I’ve just seen too many women die of this disease. If we can attack ovarian cancer from both the prevention and treatment angles, we will be doing something very good for women and we will save many lives.