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Wednesday, May 21, 2008

Are you worried about...ovarian cancer?

Many women worry about getting ovarian cancer, sometimes because one of their relatives has developed the illness. This section explains:

  • Why having just one or even two relatives with cancer does not normally make it more likely that you will get cancer yourself.
  • What we know about the causes of ovarian cancer.
  • What you can do to help yourself.

Cancer risk

The cause of most ovarian cancers is not known. But we do know that some things (called 'risk factors') increase our chances of developing cancer. If you have a particular risk factor for cancer, this does not mean you will definitely get cancer, just as not having it does not mean that you won’t get ill. It is about probability.

Smoking is a good example of this: if you smoke, it is not certain that you will get cancer. If you don’t smoke, it is not certain that you won’t. But if you smoke, your risk of getting lung cancer is far higher than if you don’t. Nine out of ten people who develop lung cancer are smokers.

Risk factors for ovarian cancer are not as clear-cut as smoking and lung cancer. But some risk factors have been identified.

Cancer genes/family history

Genes are the biological information you inherit from your parents. They affect the way your body grows, works and looks.

Two gene changes (called BRCA1 and BRCA2 mutations) can run in a family and increase the ovarian and breast cancer risk of family members who inherit the genetic change. But this is unusual. Only a small number of ovarian cancers (between 5 and 10% or less than 1 in 10) are due to an inherited altered gene that runs in the family.

It is only likely that a genetic mutation that can increase your ovarian and breast cancer risk is present in your family, if you have (on one side of the family):

  • At least two close relatives (mother, aunt, grandmother, sister) with ovarian cancer or
  • One close relative who had ovarian cancer and another who had breast cancer under 50 (or both cancers in the same person) or
  • One close relative who had ovarian cancer and two relatives who had breast cancer under 60 years or
  • Three close relatives with bowel or endometrial (womb) cancer and one with ovarian cancer

If your family is like this, and you are worried about developing ovarian cancer yourself, you might want to talk to your GP. They will confirm your family history and might refer you to see a specialist.

But if you only have one middle-aged or elderly relative who has developed ovarian cancer, or a case of breast or ovarian cancer on each side of your family, this does not significantly increase your risk. If you had one of the ovarian or breast cancer genes in your family, then it is likely that more than one relative would have developed ovarian or breast cancer.

It seems that gene changes are more common among people from Jewish backgrounds. So if you have Jewish ancestry and close relatives with breast or ovarian cancer, you might want to tell your GP.

If you are still worried

It can be a normal reaction to severe illness in the family or to bereavement to feel more vulnerable to the same disease. If you have spoken to your GP and you are not at an increased risk of getting ovarian cancer, but you can’t stop worrying, you may find it helpful to see a counsellor, who can help you get things back into perspective. You can ask your GP for details of a local service, or you can call Cancerbackup, or the Cancer Counselling Trust.

MIND, the mental health charity, has published a useful leaflet called How to stop worrying.

Other risk factors

Other risk factors usually play a bigger role in the development of cancer than family history. For example, the main risk factor for ovarian cancer is age. The older you are, the more likely it is that you might develop ovarian cancer. Nine out of ten (90%) of ovarian cancer cases are in women over 45, and half of ovarian cancers happen to women over 65.

Child bearing Women who have never had children are twice as likely to get ovarian cancer as women who have given birth.

Hormone levels Women who had their first period early (under 12) and their menopause late (after 50) are slightly more likely to get ovarian cancer.

Fertility treatments There is some evidence that the use of fertility treatments (hyper-ovulation drugs) increases the risk of ovarian cancer. But it may also be that being infertile is what increases ovarian cancer risk, rather than any treatment you may have for this. There is more research going on to try to clarify this.

Other possible risk factors

Hormone Replacement Therapy (HRT) There is limited data in this area but currently no firm evidence of a link between combination HRT (containing oestrogen and progesterone) and ovarian cancer.

There is no good evidence for claims that talcum powder, particular diets, or supplements, affect a woman’s ovarian cancer risk. Scientists are studying many different possible factors, but so far the risk factors listed above are the only ones where there is good evidence.

Reducing your risk

There is good evidence that the contraceptive pill decreases women’s risk of getting ovarian cancer. But the pill is associated with a slight increase of breast cancer risk. Having children, particularly before the age of 30, and breastfeeding them, decreases the risk of ovarian cancer.

Apart from the above, there is not much evidence that women can do a lot to decrease their ovarian cancer risk. But here are some suggestions that might help to reduce your overall risk of getting cancer and other serious diseases:

Stop smoking Smoking is responsible for about 30% (1 in 3) of all cancers and for 90% of lung cancers alone. If you smoke, giving up is the healthiest decision you can make. If you want help, ask your GP or call the NHS smoking helpline on 0800 169 0169 or visit www.gosmokefree.co.uk

Take up some regular exercise You don’t need to go to the gym. Walking, cycling or gardening, done regularly, can be enough.Take up some regular exercise You don’t need to go to the gym. Walking, cycling or gardening, done regularly, can be enough.

Try to maintain a healthy weight It can help to eat a balanced diet, which contains plenty of fruit and vegetables.

Be safe with alcohol It is recommended that women drink no more than 2–3 units a day, a maximum of 14 units a week. A unit is 1 half-pint of ordinary strength beer, lager or cider or 1 small glass of wine or 1 single measure of spirits.

Although making these changes may reduce your risk of developing cancer, this does not guarantee that you won’t get ill. But all of the above strategies are good for you anyway, and can make you feel better in many ways.

Signs and symptoms

Ovarian cancer can be difficult to treat because it is often only found relatively late. Ovarian cancer that is found earlier is easier to treat successfully. Unfortunately, the early signs and symptoms of ovarian cancer are unclear and can also be caused by many, often harmless problems that have nothing to do with cancer.

You should see your GP if you have:

  • Prolonged swelling of the abdomen (tummy)
  • Pain in the abdomen/lower back/pelvis
  • Digestive problems such as indigestion, bloating, constipation, loss of appetite, nausea
  • Weight loss
  • Frequent need to urinate
  • Unusual bleeding from the vagina
  • Ongoing excessive fatigue

It is important to remember that in the vast majority of women these symptoms occur for reasons other than cancer. But it is worth seeing your doctor, if these symptoms continue and you are worried. You are not wasting your doctor’s time.

Regular checks and screening for breast cancer

We do not know if screening women for ovarian cancer (through blood tests and ultrasounds) works. A big screening study is under way that is trying to find out if regular check-ups for women without any symptoms would save lives or if it would only lead to unnecessary worry and tests without actually helping much. The study is called UKCTOCS, which stands for UK Collaborative Trial of Ovarian Cancer Screening. You cannot volunteer to join this study, but you might get chosen at random. You would get a letter from the UKCTOCS team asking whether you want to take part in this trial, if you were chosen.

Women with a strong family history of ovarian cancer can join a screening study that investigates whether regular check-ups for women who have a higher risk of developing ovarian cancer are helpful. The study is called UKFOCSS, which stands for UK Familial Ovarian Cancer Screening Study.

Via: http://www.cancerbackup.org.uk

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