In 2013, Angelina Jolie had a double mastectomy (surgical removal of breasts). A year later, she made the tough decision to have both her ovaries and fallopian tubes removed to mitigate her high genetic risk of cancer. There may be a huge debate surrounding her decision, but the fact is that it has led to a huge number of women talking about it and undergoing diagnostic tests to detect cancer at an early stage. Not surprisingly, it has been dubbed the ‘Jolie effect.’
Ovarian cancer has emerged as one of the most common cancers affecting women in India. Women who have their first full-term pregnancy after the age of 35 or who never carried a pregnancy to term are known to have a higher risk of ovarian cancer.
It is one of the most fatal gynaecological cancers because it remains silent for a long time. If the cancer isn’t identified at an early stage, it can spread to the abdomen and pelvis, including other parts of the female reproductive system.
Is it in your genes?
Angelina found out she carries a faulty BRCA1 gene, which predisposes women to developing breast and ovarian cancer. Three women in her family – her mother, aunt and grandmother – were diagnosed with breast or ovarian cancer while still under the age of 60. All three died of their illness. The genes known as BRCA1 and BRCA2 usually help prevent cancers.
Everyone has two copies of both. But in some women, one of the copies of either has an error or fault so it doesn’t work properly. The result is a high risk of developing breast and ovarian cancer at younger ages than usual. The lifetime risk of ovarian cancer for a woman with a faulty BRCA1 gene is about 40 to 60 per cent. This risk increases from her late 30s and continues on an upward trajectory with age. Breast cancer risk is also higher for these women and can be up to 80 per cent depending on family history.
A host of factors such as family history, age, obesity, fertility drugs, personal history and hormone replacement therapy (HRT) affects female ovaries. Ovarian cancer is a major cause of morbidity and mortality, especially in middle-aged women. Women who have a close relative, such as a mother or a sister, who was diagnosed with ovarian cancer while younger than 70 should definitely undergo tests at regular intervals to detect cancer, if any, at an early stage.
The risk of surgery
Removing both ovaries and tubes of women with a BRCA fault reduces ovarian cancer risk by 90 per cent. However, a downside to this is the fact that it will hasten the onset of early menopause. Menopause, at a younger age, comes with its own problems like an increased risk of heart disease and osteoporosis, which can be countered by HRT.
Use of HRT may help delay or reduce the onset of menopausal symptoms, such as hot flushes, premature ageing of tissues, vaginal thinning (causing sexual discomfort) and decreased libido. One way to reduce the risk of ovarian cancer is by using the oral contraceptive pill, which can halve your risk with five years of use.
According to Indian Journal of Cancer, one out of five women are prone to ovarian cancer. The majority of ovarian cancers arise from the epithelium (outer lining) of the ovary. You need to watch out for warning signs such as ongoing pain or cramps in the belly or back, abnormal vaginal bleeding, nausea, and bloating.
Sometimes, there are vague symptoms such as frequent bloating, eating trouble, feeling full quickly, or urinary problems such as an urgent need to urinate or urinating more often than usual.
Healthy living Ovarian cancer is a difficult disease to diagnose. And this is all the more reason for women to listen to their body and watch out for the symptoms carefully.
If you notice some of the symptoms cropping up repeatedly, it’s a good idea to visit a gynaecologist and get a medical opinion. More so, if you have other women in your family who have been diagnosed with cancer. As a practice, women should get their blood calcium levels monitored on a regular basis – if the levels are high, there is believed to be an increased risk of ovarian cancer.
Secondly, not only do contraceptive pills reduce the risk of ovarian cancer in women but also protect them from the disease, even 30 years after they stop taking the drugs.
Lastly, a diagnosis of ovarian cancer need not spell doom. Women with early-stage ovarian cancer can preserve fertility by keeping at least one ovary or the uterus, without the risk of dying from the disease. They can also consider the option of freezing their eggs, before embarking on treatments such as chemotherapy or surgery.
(The author is gynaecologist & infertility specialist, Lilavati & Bhatia Hospitals, Mumbai & Fortis Hospitals, New Delhi)