By Donnica L. Moore, MD
Ovarian cancer is the ninth most common cancer in women (excluding non-melanoma skin cancers) and the fifth leading cause of cancer death in women. While it can affect women at any age, the average age of diagnosis is 63; the average age of death from ovarian cancer is 71. Yet nearly 5% of women diagnosed with ovarian cancer are 34 or under. According to American Cancer Society data, 21,880 American women were diagnosed with ovarian cancer in 2010 and 13,850 women died as a result.
Fewer than 20% of ovarian cancers are caught early, in stage 1, when they’re most treatable and the patient has the highest survival rate. Unfortunately, most women with ovarian cancer have progressed to stage 3 by the time they’re diagnosed, when the prognosis is much lower. This is why the motto of many ovarian cancer advocates is, “Until there’s a test, awareness is best.”
Know the "Silent" Symptoms
Ovarian cancer was once considered a “silent” disease because it was thought that it didn’t have any noticeable symptoms in its early stages. We now know that women diagnosed with early ovarian cancer frequently noticed several symptoms in common: bloating or increased abdominal girth; pelvic or abdominal pain (or pain with intercourse); frequent or urgent urination; and either difficulty eating or a sense of feeling full very quickly.
These symptoms may be subtle, but they are not silent, so it is important to listen to your body. While these symptoms are often signs of other less serious medical problems, doctors don’t expect you to make your own diagnosis. If you have any medical symptoms that cause concern, interfere with your daily activities, or persist beyond two weeks, it’s time to consult your physician.
Click here for a chart you can use to track your symptoms.
Understand the Risk Factors
We don’t really know what causes ovarian cancer per se, but several risk factors have been identified. The risk of ovarian cancer increases with increasing age; family history of ovarian or breast cancers; personal history of breast cancer; infertility (with or without taking infertility medications) or never having been pregnant by choice; endometriosis; postmenopausal hormone replacement therapy use; and genetic factors (particularly BrCA1 or BrCA2 mutations). The risk of ovarian cancer is also lower among women whose first child is born before she turns 30 years old. Risk also decreases with each successive pregnancy and with breastfeeding for at least one year.
The Role of Oral Contraception
While women don’t choose to have children to reduce their health risks, choosing to take birth control pills may be the single most impactful choice you can make to reduce your risk of ovarian cancer. An analysis of 45 epidemiological studies from 21 countries found that, compared with women who had never used oral contraceptives, ANY oral contraceptive use was associated with a significant reduction in risk of developing ovarian cancer. These studies showed that women who take birth control pills for more than 5 years reduce their risk of by 50%. This risk reduction benefit persists for up to 30 years after discontinuing oral contraceptive use as well.
Low-dose oral contraceptive pills had a stronger risk reduction effect than higher-dose oral contraceptives. The proposed mechanism is that suppressing ovulation reduces inflammation and microtrauma in the ovarian tissue. Having had a tubal ligation may also reduce ovarian cancer risk by up to 67%; having had a hysterectomy (without removal of the ovaries) may reduce ovarian cancer risk by 30%.
As with many cancers, women who smoke also have an increased risk of one type of ovarian cancer. Obese women – those with a BMI of over 30 – also have a significantly higher risk of ovarian cancer; this is another important health reason to maintain a healthy weight. While many women may need to exercise more and eat fewer calories to reduce their risk of ovarian cancer, what you eat – and drink – may also have a risk reduction benefit.
Reducing Your Risk: Diet and Lifestyle
A landmark report on diet and cancer risk published by the American Institute for Cancer Research in 2007 noted that non-starchy vegetables may offer protection against ovarian cancer. This protection could come from any of several families of phytochemicals, as well as dietary fiber, vitamins and minerals. Some studies suggest a Western diet high in fat, refined sugar and red meat increases the risk of ovarian cancer. One study showed that women who ate more fruits and vegetables in their daily diets had a reduced ovarian cancer risk compared with women who did not consume sufficient amounts of dietary carotene and lycopene.
Increase your consumption of these two foods: tomato sauce and raw carrots. Kaempferol – a flavonoid found in tea, broccoli, kale and spinach, and luteolin, which is provided by peppers, carrots, cabbage and celery, have both been identified as cancer protective. Women who consumed the most of these two flavonoids were 40% and 34% less likely, respectively, to develop ovarian cancer compared to women who consumed the least. While there is no specific dietary recommendation for kaempferol, foods with high concentrations of this flavonoid have numerous health benefits and should be eaten as often as possible.
Whole grains are another nutritional category that may offer ovarian cancer risk-reduction benefits. The fiber and phytochemicals in whole grains such as oats, quinoa, barley, spelt and others are believed to block the reabsorption of estrogen in the gut, which reduces the risk of ovarian and other hormone-related cancers.
The Benefits of Black Tea
The most surprising data on ovarian cancer risk reduction comes from a large group of over 61,000 Swedish women, those who drank at least two cups of black tea a day. These women were 46% less likely to develop ovarian cancer than non-tea drinkers. Women in this study who drank one cup of tea per day were 21% less likely to develop ovarian cancer. In another study, daily green tea drinkers were 60% less likely to develop ovarian cancer, and those who were tea drinkers for more than 30 years had a more than a 75% lower risk. In preliminary results from the ongoing Iowa Women’s Health Study, women who drank just one cup of tea per week demonstrated a significantly decreased risk of ovarian cancer after 8 years. There was no further benefit shown to drinking more than 1 cup of tea per day.
There are some caveats to these studies. First, tea drinkers tend to have healthier lifestyles in many Western cultures than the general population; they tend to exercise more, drink less alcohol, practice better weight control, and eat more vegetables. But laboratory studies suggest that tea could protect against ovarian cancer, as well as other cancers, in several ways. The most promising theories focus on the powerful antioxidants in tea that may help prevent and repair damage to cells’ DNA that could otherwise lead to cancer.