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(photo credit: courtesy)
A friend of mine who is 50 with two grown children has, sadly, been diagnosed with ovarian cancer. She has no family history of the disease, but she has smoked for years and is overweight. Is there anything she could have done to change her lifestyle to reduce the risk or undergo screening to catch it early? I have not heard of menopausal women being sent for screening of the tumor by having their blood tested or undergoing an abdominal ultrasound. N.D., Haifa
Prof. Uzi Beller, chairman of the gynecology department and an expert in gynecological cancer at Jerusalem's Shaare Zedek Medical Center, replies:
Unfortunately, there is no screening protocol for ovarian cancer that has been proven. A study is now being carried out in the UK by Dr. Ian Jacobs, but the results will be ready only next year, and I am not sure that they will be positive. However, noticing early symptoms of ovarian cancer and seeking help can raise survival rates. Thus women who have abdominal or pelvic fullness, pain, genital bleeding, genital discomfort, persistent feeling of fullness after eating, weight loss, abdominal swelling, excess gas, worsening indigestion, persistent nausea, persistent constipation or diarrhea and/or any vaginal discharge should immediately discuss the problem with their family doctor.
While women cannot change certain factors that contribute to the risk for ovarian cancer such as age, family history or having not borne children, there are some things they can do to reduce the risk. Taking contraceptive pills for at least five years can reduce the risk of getting ovarian cancer by up to 50 percent. This is a very important finding, but of course it will not help women who have already reached menopause.
Although both tubal ligation and hysterectomy may reduce the chance of developing ovarian cancer, experts agree that these operations should only be done for valid medical reasons - not for their effect on ovarian cancer risk. If a menopausal woman is going to have a hysterectomy for a medical reason and has a strong family history of ovarian or breast cancer, she may want to have both ovaries removed as part of that procedure. Women who have a family history of ovarian cancer should go for genetic testing for the BRCA gene mutation and be under supervision. Because the risk of fallopian tube cancer is also increased in women with BRCA1 or BRCA2 mutations, experts currently recommend that women at high risk of ovarian cancer who are having their ovaries removed should also have their fallopian tubes taken out. This operation significantly lowers ovarian cancer risk but does not entirely eliminate it, because some women who have a high risk of ovarian cancer may already have a cancer at the time of surgery or are at higher increased risk of primary peritoneal carcinoma, which can develop after the ovaries are removed.
But there are some lifestyle and dietary changes that can reduce the risk. Retrospective studies have shown that women who drank about two cups of green tea (but not black or other teas) had a significantly lower risk of ovarian cancer. The studies involved not only Asian women who routinely drink this tea, but also non-Asian women, thus a genetic factor was ruled out. In addition, women who eat larger amounts of plant-based foods and drinks with the naturally occurring flavonoid called apigenin may have a decreased risk for ovarian cancer. Apigenin is found in celery, parsley, red wine, tomato sauce and other plant-based foods.
There is growing evidence that vitamin D - in which many Israelis, especially religious women, are deficient - helps protect against colorectal cancer, and now researchers say the same is true for breast cancer and ovarian cancer. They recommend taking 1,000 international units (IU) of vitamin D daily to cut colon, breast and ovarian cancer risk (but consult your doctor first).
Studies have suggested that obese women - those with a body mass index of at least 30 - have a higher risk of developing ovarian cancer. A woman who has had children has a lower risk of ovarian cancer than women who have none, and the risk gets lower with each pregnancy; breast-feeding may lower the risk even further. A recent study of women who followed a low-fat diet for at least four 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.
But risk factors aren't everything. Having one or several risk factors don't automatically mean that a woman will get ovarian cancer, and many will get it without having any risk factors. Still, it is worth reducing one's risk as much as possible.
Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel- Itzkovich at (02) 538-9527, or e-mail it to email@example.com, giving your initials, age and residence.