September is Ovarian Cancer Awareness Month

Introduction

In the United States, an estimated 21,550 new cases of ovarian cancer will be diagnosed in 2009 and an estimated 14,600 deaths nationwide will be attributed to ovarian cancer. It is difficult to detect in its early stages since routine screening pelvic exams and Pap tests (also called Pap smears) rarely uncover early ovarian cancer. Ovarian cancer is the 8^th common cancer amoung women (excluding non-melanoma skin cancers.)

In an effort to increase public awareness about ovarian cancer, UPMC Cancer Centers joins other organizations nationwide to promote National Ovarian Cancer Awareness Month. UPMC developed these pages as a resource for learning more about ovarian cancer.

Ovarian cancer risk factors

Anything that increases a person's chance of developing a disease is called a risk factor. Though the precise cause of ovarian cancer is unknown, the following factors may increase the likelihood of developing ovarian cancer:

• Age – Most ovarian cancers develop after menopause, a condition when a woman has gone a year without a menstrual period. Half the women diagnosed are over the age of 65.
• Obesity – Based on studies that looked at obesity and ovarian cancer, it appears that obese women (those with body mass index of at least 30) have a higher risk of developing ovarian cancer.
• Reproductive history – Women who started menstruating at an early age (before age 12), either have no children or had their first child after age 30, and/or experienced menopause after age 50 may be at higher risk.
• Gynecologic surgery – Tubal ligation (having your "tubes tied") may reduce the chance of developing ovarian cancer by up to 67%. A hysterectomy (removal of the uterus without removing the ovaries) also seems to reduce the risk of getting ovarian cancer by about one-third.
• Androgens – Androgens are male hormones. Danazol increases androgen levels. A recent study found a link between the drug danazol (used to treat endometriosis) and an increased risk of ovarian cancer. Further studies are planned to look at this.
• Estrogen replacement therapy and hormone replacement therapy – Some recent studies suggest women using estrogens after menopause have an increased risk of developing ovarian cancer. The risk seems to be higher in women taking estrogen alone (without progesterone) for many years (at least 5 or 10). The increased risk is less certain for women taking both estrogen and progesterone.
• Fertility and fertility drugs – Prolonged use of certain fertility drugs, especially without achieving pregnancy, may increase a woman's risk for developing ovarian tumors, particularly a type known as tumors of low malignant potential (LMP tumors). Infertility also increases the risk, even without use of fertility drugs.
• Family history of ovarian cancer – Risk is higher if relatives on either side of the family developed it at a young age. While about 10 percent of ovarian cancers result from an inherited tendency, those with known gene mutations tend to have a better prognosis than patients without any family history of ovarian cancer.
• Breast cancer – Women who have had breast cancer also have an increased risk of developing ovarian cancer. Some risk factors for ovarian cancer may also increase breast cancer risk. Inherited mutations of the BRCA1 and BRCA2 genes greatly increase a woman's risk for both cancers.
• Talcum powder – Many studies suggest a slight increase in risk of ovarian cancer in women who used talcum powder on the genital area. In the past, talcum powder was sometimes contaminated with asbestos, a known cancer-causing mineral, however, powder products have been required by law for over 20 years to be asbestos-free. There is no evidence at present linking talc-free powders with any female cancers.
• Hormone Replacement Therapy (HRT) – Studies conflict on the use of estrogen as a risk factor for developing ovarian cancer. A recent review recalculated results of other previously published studies suggesting that use over ten years increases risk by about 30 percent, and for shorter periods by about 15 percent.
• Diet – A recent study of women who followed a low-fat diet for at least 4 years showed a lower risk of ovarian cancer. Some studies have shown a reduced rate of ovarian cancer in women who ate a diet high in vegetables, but other studies disagree. The American Cancer Society recommends eating a variety of healthful foods, with an emphasis on plant sources. Eat at least 5 servings of fruits and vegetables every day, as well as several servings of whole grain foods from plant sources such as breads, cereals, grain products, rice, pasta, or beans. Limit the intake of red meat and processed meats. Even though the impact of these dietary recommendations on ovarian cancer risk remains uncertain, following these recommendations can help prevent several other diseases, including some other types of cancer.
• Analgesics – In some studies, both aspirin and acetaminophen have been shown to reduce the risk of ovarian cancer. However, the information is not consistent. Women who do not already take these medicines regularly for other health conditions should not start doing so to try to prevent ovarian cancer. More research is needed on this issue.
• Smoking and alcohol use – These do not increase the risk for most ovarian cancers, but some studies have found they increase the risk for the mucinous type.

Ovarian cancer facts

• Some types of prescription hormones used to relieve symptoms of menopause may increase the chances a woman will develop ovarian cancer.
• Among women in the United States, cancer of the ovary ranks fifth in incidence. There are no proven methods of prevention and it often is a rapidly fatal disease.
• Ovarian cancer causes more deaths than any other cancer of the female reproductive system.
• Risk for ovarian cancer increases with age.

Sources: American Cancer Society; National Cancer Institute

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