ref: American Cancer Society
Most women have one or more risk factors for ovarian
cancer. But most of the common factors only slightly increase your risk, so
they only partly explain the frequency of the disease. So far, what is known
about risk factors has not translated into practical ways to prevent most cases
of ovarian cancer.
There are several ways you can reduce your risk
of developing epithelial ovarian
cancer. Much less is known about ways to lower the risk of developing germ cell and stromal tumours of the
ovaries. The remainder of this section refers to epithelial ovarian cancer
only. It is important to realize that some of these strategies reduce the risk
only slightly, while others decrease it much more. Some strategies are easily
followed, and others require surgery. If you are concerned about your risk of
ovarian cancer, you may want to discuss this information with your health care
professionals. They can help you consider these ideas as they apply to your own
situation.
Oral
contraceptives
Using oral contraceptives (birth control pills)
decreases the risk of developing ovarian cancer, especially among women who use
them for several years. Women who used oral contraceptives for 5 or more years have about a 50% lower risk
of developing ovarian cancer compared with women who never used oral
contraceptives. Still, birth control pills do have some serious risks and side
effects. Women considering taking these drugs for any reason should first
discuss the possible risks and benefits with their doctor.
Gynaecologic
surgery
Both tubal
ligation and hysterectomy may reduce the chance of
developing ovarian cancer, but experts agree that these operations should only
be done for valid medical reasons -- not for their effect on ovarian cancer
risk.
If you are going to have a hysterectomy for a
valid medical reason and you have a strong family history of ovarian or breast
cancer, you may want to consider having both ovaries and fallopian tubes
removed (called a bilateral salpingo-oophorectomy) as part of that
procedure.
Even if you don’t have an increased risk of ovarian
cancer, some doctors recommend that the ovaries be removed with the uterus if a
woman has already gone through menopause or is close to menopause. If you are
older than 40 and you are going to have a hysterectomy, you should discuss the
potential risks and benefits of having your ovaries removed with your doctor.
Prevention
strategies for women with a family history of ovarian cancer or BRCA mutation
If your family history suggests that you (or a
close relative) might have a syndrome linked with a high risk of ovarian
cancer, you might want to consider genetic counseling and testing. During
genetic counseling (by a genetic counselor or other health care professional
with training in genetic risk evaluation), your personal medical and family
history is reviewed. This can help predict whether you are likely to have one
of the gene mutations associated with an increased ovarian cancer risk.
The counselor will also discuss the benefits and
potential drawbacks of genetic testing with you. Genetic testing can help
determine if you or members of your family carry certain gene mutations that
cause a high risk of ovarian cancer. Still, the results are not always clear
cut, and a genetic counselor can help you sort out what the results mean to
you.
For some women with a strong family history of
ovarian cancer, knowing they do not have a mutation that increases their
ovarian cancer risk can be a great relief for them and their children. Knowing
that you do have such a mutation can be stressful, but many women find this
information very helpful in making important decisions about certain prevention
strategies for them and their children.
Using oral
contraceptives is one way that many women can reduce their risk of
developing ovarian cancer. Oral contraceptives also seem to reduce this risk
for women with BRCA1 and BRCA2 mutations. But birth control pills
can increase breast cancer risk in women without these mutations. This
increased risk continues for some time after these pills are stopped. Studies
that have looked at this issue in women with BRCA mutations haven’t agreed
about what effect birth control pills have on breast cancer risk. Some studies
have shown an increased risk of breast cancer, while some have not. Research is
continuing to find out more about the risks and benefits of oral contraceptives
for women at high ovarian and breast cancer risk.
It isn’t clear if tubal ligation effectively
reduces the risk of ovarian cancer in women who have BRCA1 or BRCA2
mutations. Studies that have looked at this issue haven’t agreed about this.
Researchers do agree that removing both ovaries and fallopian tubes (salpingo-oophorectomy) helps protect
women with BRCA1 or BRCA2 mutations against ovarian (and
fallopian tube) cancer.
Sometimes a woman has this surgery to reduce her
risk of ovarian cancer before cancer is even suspected. If the ovaries are
removed to prevent ovarian cancer, the surgery is called risk-reducing or prophylactic. Generally,
salpingo-oophorectomy is recommended only
for very high-risk women after they have finished having children. This operation lowers ovarian cancer risk
a great deal but does not entirely
eliminate it. That’s because some women who have a high risk of ovarian
cancer already have a cancer at the time of surgery. These cancers can be so
small that they are only found when the ovaries and fallopian tubes are looked
at under the microscope (after they are removed). Also, women with BRCA1
or BRCA2 gene mutations have an increased
risk of primary peritoneal carcinoma. Although the risk is low, this cancer
can still develop after the ovaries and fallopian tubes are removed.
The risk of fallopian tube cancer is also
increased in women with mutations in BRCA1 or BRCA2. Sometimes
early fallopian tube cancers are found unexpectedly when the fallopian tubes
are removed as a part of a risk-reducing surgery. In fact, some cancers that
were thought to be ovarian or primary peritoneal cancers may have actually
started in the fallopian tubes. That is why experts recommend that women at
high risk of ovarian cancer who are having their ovaries removed should have
their fallopian tubes completely removed as well (salpingo-oophorectomy).
Research has shown that premenopausal women who
have BRCA gene mutations and have had their ovaries removed reduce their
risk of breast cancer as well as their risk of ovarian cancer. The risk of ovarian cancer is reduced by 85% to 95%,
and the risk of breast cancer cut by 50%
or more.
Another option for women who do not wish to have
their ovaries removed because they don’t want to lose ovarian function (and go
through menopause early) is to have just the fallopian tubes removed (a
salpingectomy). They may choose to have their ovaries removed later. This has
not been studied as well as removing both the ovaries and fallopian tubes at
the same time, so it isn’t clear how much this affects the risk of cancer. It
is clear that to have the greatest effect on breast cancer risk, the ovaries
need to be removed by the time the woman is 35.
Some women who have a high risk of ovarian
cancer due to BRCA gene mutations feel that having their ovaries and
fallopian tubes removed is not right for them. Often doctors recommend that
those women have screening tests to try to find ovarian cancer early. These
tests are discussed in the next section.
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