A New York Times Story of this week about tennis legend Chris Evert’s two-time battle with ovarian cancer Cancer painted a simple and powerful picture: Fearing her own risk, Evert got tested after her sister’s death, detected the disease early at stage 1, and successfully treated it in 2021. And even though the disease came back – again at stage 1, meaning it hadn’t spread – she was able to detect and treat that disease again, too. Now the 69-year-old has been declared cancer-free for the second time.
“As with her original diagnosis,” the story says, “early testing was critical – a message Ms. Evert eagerly spreads.”
However, there is a small problem: there is no early detection of ovarian cancer.
“There is no recognized screening. There is no method for early detection,” says Sarah DeFeo, program director of the Ovarian Cancer Research Alliance (OCRA)told Assets“It is a rare disease,” with a one in 87 in the course of life“So it is not something that happens as part of a preventive medical examination for women, neither at the gynecologist’s nor as part of normal internist treatment.”
That’s because, says Gillian Hanley – Psychiatric ClinicMember of the OCRA Scientific Advisory Board and Associate Professor of Obstetrics and Gynecology at the University of British Columbia, “all screening methods tried so far have failed to reduce the mortality rate. This is the only way to determine whether a screening method is effective or not.”
There are some standard methods for monitoring ovarian cancer when it is suspected, including a CA-125 Blood test which might show tumor markers, and a transvaginal ultrasound, which might help identify masses – they are inaccurate. In addition, they are not indicated or available for women who either have no symptoms – which usually do not show until the cancer is significantly advanced – or who have a high-risk factor, meaning the patient has already tested positive for genetic markers that significantly increase the chance of developing ovarian cancer.
“If you are a normal person with average risk going through the world, a doctor might say: [a routine scan is] not medically indicated. It’s not necessary… There’s no evidence that ultrasound is effective,” says DeFeo. “So it’s not something that’s recommended. It’s not neutral – it’s like, ‘No, don’t do it.'”
Instead, women should consider getting tested for genetic markers, she says. That is something Evert this has already been discussed– after she had tested positive for the BRCA-1 gene following the death of her sister and then had a preventative hysterectomy with removal of her ovaries and fallopian tubes. Only then did she learn from the pathology report that she had stage 1 ovarian cancer (which returnedeven after surgery, as microscopic cancer cells sometimes remain in the abdomen).
None of these details were disclosed in the recent New York Times articles – but actually they are the most important, says DeFeo.
“She talked a lot about getting tested early, but for me it’s really about the importance of knowing your risk and managing risk,” she says. “I think that’s the important takeaway from her story.”
Why there is no reliable method to test for ovarian cancer – and what is recommended instead
Much of the current knowledge on screening results from the disappointing results of a Clinical trial conducted in the UK The study followed 200,000 women over a period of more than 20 years and concluded that screening and education about symptoms do not save lives.
The study, the largest of its kind in the world, randomly assigned patients to three groups: 1) no screening, 2) annual screening with ultrasound, and 3) annual screening with ultrasound and CA-125 blood test. No evidence was found that lives were saved in the groups tested. “We therefore cannot recommend screening for ovarian cancer using these methods for the general population,” said lead researcher Dr. Usha Menon. noticed by the time.
“That’s the insidious and devastating thing about ovarian cancer, that we think it needs to be detected so much earlier for it to impact mortality,” says DeFeo. “It’s not about detecting it three months earlier… We need to find a way to detect this disease Years earlier.”
But that’s not possible right now. “The technology doesn’t exist yet,” she says. Plus, Hanley adds, most cases of ovarian cancer seem to arise in the fallopian tubes, which aren’t easy to reach or biopsy.
That is, why Recommendation from OCRA Last year, the official shift was made from symptom awareness and early detection to something completely different: preventive removal of the fallopian tubescalled salpingectomy. It is an approach that was approved from the American College of Obstetricians and Gynecologists (ACOG) since 2015.
The recommendation applies not only to those who have tested positive for a high genetic risk, such as BRCA-1 or BRCA-2 gene mutations, but also to all women plan to have further pelvic surgery (such as a hysterectomy, endometriosis or cyst removal) when they are finished or do not want to have any more children. (For women at higher risk, an oophorectomy, or prophylactic removal of the ovaries, is also recommended.)
“So we’re not saying that every normal woman on the street needs to have this elective surgery,” says DeFeo. “But we know that hundreds of thousands of women every year have surgery for some other reason, and may have their fallopian tubes removed at the same time. That’s something they should talk to their doctor about, and that’s something doctors should be thinking about.”
Procedure for genetic testing
In addition to salpingectomy, another effective way to prevent ovarian cancer is genetic testing. You can start by examining your family history. “I know that can be difficult in many families,” says DeFeo. “But to the extent that you can examine your family history and determine if there is a history of cancer in your family, particularly breast and ovarian cancer, and particularly at a young age… those are warning signs.”
Hanley adds that it’s important to look at both sides of the family. “There’s a misconception that family history is only relevant on the mother’s side, but you can inherit a BRCA mutation from your father as well,” she says. “So if there’s a history of breast or ovarian cancer on both sides of your family, possibly even prostate or pancreatic cancer, then a BRCA test is a very good idea.”
Then talk to your doctor about induction.
DeFeo notes that genetic testing is more accessible than ever. “Many insurance companies will cover the cost. It really depends on the individual’s situation, but the cost of testing has come down dramatically over the years,” she says. “So it’s increasingly accessible. And OCRA, for example, offers a free genetic testing program.”
If you test positive, prophylactic surgery is then recommended, as was the case with Evert.
“She would never have shown symptoms,” Hanley says. “There’s no screening method that could have detected that. The only reason cancer was diagnosed is because her fallopian tubes were removed and then examined very, very carefully by a pathologist … and that only happens with a BRCA mutation.”
But Hanley and everyone else in the field are hoping that this will change. “We all hope that with technology and better understanding, we might one day be able to develop a screening method that works,” she says. “But we are still a long way from that.”