The Ovarian Cancer Conundrum

0.cached.png

By Anne Underwood

See more of our trusted coverage when you search.Prefer Newsweek on Googleto see more of our trusted coverage when you search.

What did comedienne Gilda Radner, singer Laura Nyro and actress Jessica Tandy have in common? All three were great performers--and all three died of ovarian cancer. Fortunately, the disease is far rarer than breast cancer. A woman's lifetime risk of developing it is only 1 in 57, versus 1 in 8 for breast cancer. But when it strikes, ovarian cancer is much deadlier. Though only 25,000 women are diagnosed each year, nearly 15,000 die. That's because just 25 percent of cases are detected early, when the cure rate is excellent. By Stage III, when half of ovarian cancers are found, a woman has only a 20 percent chance of surviving five years. "At Stage IV, they tell you to go home and get your affairs in order," writes survivor Liz Tilberis, editor in chief of Harper's Bazaar, in her book "No Time to Die." Why is ovarian cancer so hard to spot? The symptoms--abdominal bloating, constipation, indigestion, frequent urination, feeling full after eating very little--are not specific to the disease. And there is no routine screening exam that can equal, say, the Pap smear for cervical cancer. The so-called CA-125 test renders so many false positives and false negatives for early ovarian cancers that doctors compare its accuracy to a coin toss. "Too often, ovarian cancer gets diagnosed in operating rooms, when patients are having surgery for something else," says Ann Kolker, executive director of the Ovarian Cancer National Alliance. Under the circumstances, the best defense is simply to know your own body. Says Kolker, "If you have symptoms that are persistent and unusual for you, see a gynecologic oncologist."

There are many risk factors for ovarian cancer--heredity and a high-fat diet among them--but one stands out. A woman's risk seems to correlate roughly with the number of times that she ovulates during her lifetime. Every time an egg is released, it ruptures the surface of one of the ovaries. Cells have to replicate to repair the damage--and the more they do, the greater the odds that a cancer-causing mutation will occur. Pregnancy, breast-feeding and oral contraceptives all interfere with ovulation--and all three diminish the risk of developing ovarian cancer. "Women on the pill for five years cut their risk by half," says Dr. David Fishman, director of the Northwestern Ovarian Cancer Early Detection Program in Chicago. Fertility drugs increase the number of eggs released. Some studies suggest that those drugs may boost the risk, but the link is unproven.

The good news is that better tests and treatments are in the works. Researchers at the Cleveland Clinic are developing a blood test that could someday provide an effective screening tool. In one preliminary study it was 90 percent effective in detecting early-stage ovarian tumors. On the treatment side, gene therapies look promising. Scientists at the University of Pennsylvania are hoping to start clinical trials next year on a so-called suicide gene that could be inserted into cancer cells, causing them to self-destruct. The team at Penn is also testing genetically engineered herpes viruses that seek out and destroy ovarian-cancer cells--at least in mice. These innovations may be a decade away from common use. But together, they could rob ovarian cancer of its deadly reputation.

Read More on News