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September 2006 – Genetic Risk for Ovarian Cancer
September is Gynecologic Cancer Awareness Month
Some Women Have a Higher Genetic Risk for Ovarian CancerA 2005 poll of women in the United States found that 54 percent believed they were at personal risk for developing a gynecologic cancer, but 58 percent were unaware of any factors that could lower their risk, and 47 percent could not name any symptoms of gynecologic cancers.
The poll was conducted by the Gynecologic Cancer Foundation (GCF). According to the Foundation, more than 79,000 women in the United States are diagnosed with gynecologic cancers each year.
“Gynecologic cancers originate in the female reproductive organs, including the cervix, ovaries, uterus, fallopian tubes, vagina and vulva,” said Janet Osborne, MD, Medical College of Wisconsin gynecologic oncologist and director of the Division of Gynecologic Oncology at Froedtert & the Medical College of Wisconsin. “Any woman is at risk for developing a gynecologic cancer.”
Ovarian Cancer RiskThe most deadly of gynecologic cancers is ovarian cancer, which accounts for more deaths than any other cancer of the female reproductive system. Ovarian cancer ranks fifth in cancer deaths among women. In 2006, the American Cancer Society estimates there will be about 15,310 deaths from ovarian cancer in the United States.
“Ovarian cancer is the second most common gynecologic cancer in the United States, affecting more than 23,000 women each year,” Dr. Osborne said. “It is often called the ‘silent killer’ because most women do not develop symptoms until after the cancer has spread to other organs.” (Symptoms may include abdominal discomfort, bloating, increased abdominal girth, nausea, indigestion, bowel irregularities, urinary frequency, irregular vaginal bleeding and fatigue. These symptoms, however, may be caused by many other common ailments.)
Link between Ovarian Cancer and Breast Cancer“The vast majority — 90 percent — of ovarian cancers occur in women with no apparent family history or known genetic mutation,” Dr. Osborne said. “But 10 percent of ovarian cancers have a significant genetic factor. In recent years, researchers have identified genetic mutations responsible for something called familial breast-ovarian cancer syndrome.”
This syndrome is caused by genetic mutations in the Breast Cancer 1 (BRCA1) gene or Breast Cancer 2 (BRCA2) gene. Women with a BRCA1 or BRCA2 gene mutation have a significantly increased risk for breast cancer and ovarian cancer.
About 10 percent of women in the United States will develop breast cancer, and 1.8 percent will develop ovarian cancer at some point in their lives. In contrast, women with familial breast-ovarian cancer syndrome have up to a 90 percent lifetime risk of developing breast and/or ovarian cancer.
According to the GCF, women with a mutation in the BRCA1 gene have an 80 percent lifetime risk of developing breast cancer and a 20 to 40 percent chance of developing ovarian cancer. Women with a mutation in the BRCA 2 gene have a 10 to 20 percent chance of developing ovarian cancer.
In contrast, women without an inherited genetic mutation, but who have a first degree relative (mother, sister or daughter) with ovarian cancer, have a 5 percent lifetime risk of developing ovarian cancer.
Options for WomenKnowing your family history can increase your chance of early diagnosis and can help you take action toward prevention. Screening and self-examinations conducted regularly can detect certain types of gynecologic cancers in earlier stages, when treatment is more likely to be successful.
Women who are concerned about a personal or family history of breast and/or ovarian cancers should talk to their physician about genetic counseling and testing. Genetic testing usually involves testing the blood of a family member who has been diagnosed with breast or ovarian cancer. If a mutation in the BRCA1 or BRCA2 gene is found, other family members can then be tested to see if they inherited the same mutation.
Pre- and post-test counseling is also important. Genetic testing and counseling should be done by a genetic counselor who has the training and expertise to discuss the complex issues related to this syndrome.
Some women choose not to be tested, but still are at high risk because of their family history or a positive BRCA gene test. For these women, other options exist. These include clinical monitoring (mammograms, blood tests, pelvic exams and ultrasounds), medications and lifestyle changes to reduce risk, and preventive surgery. Women at risk should discuss these options with their physician.
The 2005 National Comprehensive Cancer Network panel provided the following recommendations for women who carry BRCA mutations:
- Monthly self-breast examination starting at age 18
- Clinical breast examination by a healthcare provider every six months
- Annual mammography and/or breast MRI imaging starting at age 25 or earlier
- Annual pelvic examination starting at age 30-35 or earlier
- Blood test known as CA125 annually starting at age 30-35 or earlier
- Transvaginal ultrasound of the ovaries annually starting at age 30-35 or earlier
Health ResourcesSmall Stones, a health resource center of Froedtert & the Medical College of Wisconsin, offers many resources on gynecologic cancer, including:
- Women and Cancer by the American Cancer Society
- Ovarian Cancer, Your Guide to Taking Control by Kristine Conner and Lauren Langford
- Abnormal Pap Smears, What Every Woman Needs to Know by Lynda Rushing, MD, and Nancy Joste, MD
- There’s No Place Like Hope — A Guide to Beating Cancer in Mind-Sized Bites by Vickie Girard
Author: Marla Fraunfelder Date: Sept. 1, 2006 | Medical Reviewer: | Janet Osborne, MD | | Medical College of Wisconsin Gynecologic Oncologist |
Online Editor(s): Christopher Sadler
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