Are you aware that while mammography screens for breast cancer and the Pap test for cervical cancer, there is no equivalent screening test for the early detection of ovarian cancer?
At a gathering of women executives in Toronto, these facts were met with the wide eyes and dropped jaws of disbelief.
Ovarian cancer, a disease that affects one in 70 Canadian women, is Canada’s most fatal gynecologic cancer. Each year, it claims the lives of 1,500 women. Here are some other notable statistics:
In 2004, 2,300 Canadian women were diagnosed with the disease – 60 percent of them between the ages of 50 and 79.
Nine out of 10 women diagnosed with ovarian cancer have no family history of the disease.
While the cause of ovarian cancer is unknown, it occurs more often among women living in developed countries.
Early diagnosis is key
When ovarian cancer is detected at an early stage and treated before it has a chance to spread to other parts of the body, the five-year survival rate is as high as 90 percent. For decades, however, it has usually been diagnosed at an advanced stage, when five-year survival is closer to 20 percent.
The reason: telltale signs of the disease – including bloating, increased abdominal size, fatigue and pelvic or abdominal pain – often are subtle. They can be common experiences during the menstrual cycle, and in later years, many women attribute these symptoms to aging.
For physicians trying to arrive at a diagnosis, symptoms can be non-specific; they can mimic menopausal or perimenopausal symptoms, irritable bowel syndrome and other medical conditions or diseases.
To increase public awareness, the National Ovarian Cancer Association (NOCA), now merged with Ovarian Cancer Canada (OCC) under the OCC name, launched an education campaign in 2005 -- entitled Turn Up the Volume! -- to help Canadian women and their doctors work together so this disease can be detected earlier and treated more successfully.
That’s good news to Marilee Little, 65, of Fredericton, who had surgery and chemotherapy following a diagnosis of Stage III ovarian cancer in May 2003.
‘I knew nothing about the signs and symptoms of ovarian cancer. I regret being so docile at the beginning. We all need to take full responsibility for our health and do whatever it takes to be heard.’
Although Little had persistent indigestion, bloating and abdominal swelling, she assumed they were part of getting older. When she developed vaginal bleeding, she sought medical attention. However, diagnosis took another three months, as uterine polyps were initially believed to be the cause.
Today, the grandmother of three, journalist and former editor of The Atlantic Advocate magazine, speaks to groups of well women in the Fredericton area about ovarian cancer. She presents OCC’s Listen to the Whispers (a combination video/live educational program) to women in the workplace, church groups and community groups. ‘I’m passionate about getting this information out to other women. I couldn’t not do it – that’s how I look at it.’
Lister to your body
Elisabeth Ross, CEO of OCC, said women must be vigilant.
‘Listen to your body and be persistent about reporting symptoms and getting them investigated,’ she said.
In the absence of a screening test for ovarian cancer, ‘women should have regular medical checkups and become educated by learning the signs and symptoms of the disease,’ Ross advised.
‘Women who look at a list of the signs and symptoms of ovarian cancer for the first time can become alarmed because they may have experienced several or all of the symptoms at some point in their lives,’ said Dr. Lesa Dawson, a gynecologic oncologist at the Newfoundland Cancer Treatment and Research Foundation.
‘What we need women to understand is that if they have one or more of these symptoms that persist for longer than three weeks, they need to see their doctor for a pelvic exam.’
Another survivor, Irene Worrell of Richmond Hill, Ont., has also worked to raise awareness and educate others. She was diagnosed and treated for Stage III ovarian cancer in 1997. Now over 80, she no longer has the stamina to do educational presentations in her community. But she does appear in the video and has found another way to contribute to the cause: offering support by phone and e-mail to women living with ovarian cancer.
She has formed bonds with women as far away as Texas, England and China.
‘The women I connect with are clever, intelligent, courageous women with so much to offer – and for many, life won’t give them the opportunity,’ she said.
Still, Worrell values hope as one of the most important gifts she has to give. ‘I’ve been lucky – blessed. A lot of women with Stage III ovarian cancer do not do as well as I have. I think the fact that I’ve survived so long is, in itself, a ray of hope for these women.’
There is something profound and lasting about the ovarian cancer experience that moves people to action. Bruce Galloway of Oakville, Ont., is chair of the board of OCC. His wife Sheila died of ovarian cancer in 2002, and he is committed to raising awareness about the disease and promoting research.
‘The more I learned about ovarian cancer, the more I realized how little people know about this disease and how limited the progress has been in the past 30 to 40 years toward finding a cure,’ he said.
‘I want to be sure that nobody else I know is impacted by ovarian cancer in the future. I don’t want to live with it again, and I hate the thought of other people having to do it as well.’
Hope lies in research
‘Research is really the only way we are going to change the fate of women who develop ovarian cancer,’ said Dr. Barbara Vanderhyden, who is the Corinne Boyer Chair in Ovarian Cancer Research at the University of Ottawa.
‘In the past few years, momentum has gathered on the research front. Large studies on risk factors, prevention, screening and novel treatments are taking place on a scale like never before.’
Substantial progress has been made over the past three years in the area of early detection, Vanderhyden said.
‘The ideal screening test must be both highly sensitive and highly specific, meaning it should detect virtually all ovarian cancers and nothing but ovarian cancers. Most scientists believe that a combination of tests will be necessary, and it is likely that any new test will be made available first for the screening of high-risk women,’ she said.
‘The recent advances in technology have ensured that the development of a good screening test for ovarian cancer is one giant step closer.’
In the meantime, vigilance is the best defence women have against ovarian cancer. As Irene Worrell wisely said: ‘Any symptoms that persist – no matter how subtle – need to be checked out. Ask the questions. Get the answers.’
Facts you should know:
- A Pap test is used to detect cervical cancer, not ovarian cancer.
- If you have one or more of the following symptoms of ovarian cancer and they last longer than three weeks, see your family doctor:
- Abdominal swelling or bloating
- Pelvic discomfort or heaviness
- Back or abdominal pain
- Fatigue
- Gas, nausea, indigestion
- Change in bowel habits
- Frequent need to empty your bladder
- Menstrual irregularities
- Weight loss or gain
What factors increase the risk of ovarian cancer?
- Family history of breast, ovarian or colon cancer
- Never having children
- Getting older – ovarian cancer is most common after age 50
- Never having used oral contraceptives
- Being of Ashkenazi Jewish descent: about 1 in 50 Ashkenazi Jews carries a BRCA 1 or BRCA 2 gene mutation that increases the risk for breast, ovarian and related cancers
What factors decrease the risk of ovarian cancer?
- Having used birth control pills
- Having breast fed your children
- Term pregnancies
- Tubal ligation
- Removal of the ovaries if risk is high
What you can do:
- Have an annual vaginal/rectal (bimanual) pelvic exam.
- Let your doctor know if you have had symptoms for more than three weeks and ask about: a vaginal/rectal pelvic exam, a transvaginal ultrasound and a CA-125 blood test.
- If symptoms persist (even though the tests are negative), ask for referral to a gynecologist or gynecologic oncologist.
- If you have a family history of breast or ovarian cancer, speak to your doctor about genetic counselling.
- If your doctor suspects ovarian cancer, see a gynecologic oncologist. To find one in your area, contact OCC.
- Find a doctor you are comfortable with. Be persistent.
Resources:
- For further information about ovarian cancer, visit www.ovariancanada.org.
The following educational resources are available:
- Listen to the Whispers: An educational program (video and manual) about ovarian cancer for presentation to groups of well women.
- You Are Not Alone: A free, award-winning book and video package with information and support for those newly diagnosed.
- Knowledge Is Power: An educational symposium held in the spring and fall in cities across Canada for health professionals and women living with ovarian cancer.
