The Gail Mills Story
JACKSON, SOUTH CAROLINA - Sitting in my home office writing this, I look around the room that was once Gail's nursery... wonderful memories of bringing this precious little bundle home from the hospital ... the white wicker bassinette sitting just behind where my chair is now. Fast forward with me the pre-school years of being a stay at home mom, dancing across the kitchen floor with Gail standing on my socked feet, piano lessons, tricycles, lemonade stands, bicycles, Brownie scouts, cheerleading, band practice, ball games, children - then teenagers hanging out at our house. Thirty years of holidays, vacations, laughter, a few tears. A special mother/daughter relationship - a bond like no other... unconditional love.
Gail graduated from Silver Bluff High School with honors in 1994 and was attending USC in Columbia when she was diagnosed with ovarian cysts. The cysts were surgically removed and everything seemed perfectly normal for years. Gail continued attending college, transferring to USC-Aiken before graduating in 1999 (she jokingly said she was on the five-year plan). Gail worked at Publix in Aiken during college and her Target career began with the opening of the new store in Aiken shortly after graduation. "Abi" as she was called by her Target team, later made career moves to Charleston, Summerville, then Florence, SC.
While some women may have changed doctors for convenience after they moved, Gail trusted her doctor in Augusta and continued seeing her for yearly examinations. In 2005, when Gail was 29 years old, she wasn't feeling well and thought she had ovarian cysts again. At her next appointment Gail asked the doctor for a sonogram and was told that the pain she was having was "probably scar tissue" from her earlier surgery and a sonogram was "not necessary." Gail and I discussed this at length before she drove back to Florence. I wanted her to make an appointment with her internist for a second opinion, but Gail had been seeing her gynocologist for many years and trusted the doctor's diagnosis of "probably scar tissue." Gail told me, "but mom, she's the doctor" ... and with that confidence she returned to Florence.
The pain and discomfort did not go away. Gail went to a chiropractor near Florence for back pain - and had spa massages, too. Her paternal grandmother had recently been moved to an assisted living facility near Aiken and Gail desperately wanted to be close by to visit - so in the summer of 2006, Gail transferred from Target in Florence to the Aiken Target even though it meant stepping down from an executive position. She was finally nearby - close to family and friends and working five days a week and in retail THAT is practically unheard of. Everything was wonderful... and we were looking forward to the holidays already. No more rushed traveling to spend holidays or days off together. Gail settled in to the new job, enjoyed being within minutes of nieces and nephews, church, friends and family. She joined Curves - and was named their 'biggest loser' of inches and pounds her first month. Gail at times seemed tired, but she attributed that to the new job - at least that's what she told me. She went to a prompt care medical facility with back and body aches the week before her upcoming gyn appointment. A friend and Target team member later told me that Gail was having extreme pain at work the weeks leading up to the appointment. And I was unaware of the over the counter medication Gail was taking for upset stomach, etc.
In October 2006, four months after Gail moved back to Aiken, at what was scheduled as a routine annual physical, a “mass” was found. Within a week, Gail had major surgery - and the mass was soon diagnosed as small cell ovarian cancer, stage IIIc. Rounds of chemo quickly followed and I was thankful that, even though Gail kept her apartment in Aiken, she wanted to stay with me during this time. Gail was able to focus solely on following doctor's orders and family members made sure she had what she wanted or needed. Her faith remained strong and she knew she'd "be ok" regardless of the outcome. Gail asked me one day, "What if the chemo doesn't work?" We discussed not being able to imagine what life would be like without the other one here... how difficult it would be... and that regardless of which of us went first, we'd save a place for the other one in Heaven. That may not have been the perfect answer - not that there is one - but I never expected the two of us to have a conversation like that. The bottom line was we knew that regardless of the outcome of this battle with cancer, we'd see each other again.
On February 14, 2007 -- less than four months after her annual checkup -- Gail, my only child, became one of the estimated 15,250 women who lost their battle with ovarian cancer in 2007. I had a choice - I could grieve myself to death or I could make something positive out of this horrible experience. I did what Gail would've done if the roles were reversed... I chose to make a difference in ovarian cancer awareness.
Two months after Gail passed, a Relay For Life team was formed by family, friends and co-workers in Gail’s memory. The Relay theme that first year was "Night of A Thousand Stars" so we named the team after Gail's favorite television show, Grey's Anatomy -- wearing teal scrubs, tweaking the logo a bit and focusing entirely on ovarian cancer awareness. Our team, Gail's Anatomy, celebrates the cancer fighting warriors; we remember those that have passed; and we fight back by telling others about this disease. Through 2012, our Relay team has raised more than $22,000 for the American Cancer Society. Even though we continue to participate in the Relay For Life each year, we quickly learned that in order to really make a difference, we had to do more. Our initial plan to participate in a one time, one night Relay For Life event grew overnight to a year-round passion to educate others. Each year Gail's Anatomy strives to do more throughout the year to increase the visibility of teal and to educate women of all ages about ovarian cancer signs and symptoms and the importance of early detection. We are successful in doing that because of the generous support of friends, family, schools, colleges, physician's groups, local businesses, local and state government - and the many new friends we have met at our events or who have contacted us after learning about our mission.
Gail did everything right. She had gynecologic exams every year since she was 18 years old. She even went to the same doctor. Gail had none of the risk factors; there was no known family history of ovarian or breast cancer, but this horrible disease introduced itself to our family. Gail discovered after her diagnosis that she had all the symptoms of ovarian cancer except one. We both thought that a yearly physical and pap test would detect any potential female problems. We can't change the past but we can certainly make a difference now by taking steps to educate others. Don't let this happen to you. Pay attention to your body - you know yourself better than any one or any doctor. NEVER take "it's probably" as a diagnosis of anything. If you or a loved one are experiencing symptoms for more than two weeks, follow the recommendation of the National Ovarian Cancer Coalition and see your physician immediately. Insist on a CA-125 blood test and a transvaginal sonogram. Early detection saves lives. Together we can make a difference in the fight against ovarian cancer. Let's begin right now with you.
ORDER A T-SHIRT DESIGNED BY GAIL'S ANATOMY SUPPORTING OVARIAN CANCER AWARENESS!
All donations support the Gail's Anatomy year-round awareness campaign!
$25.00 each if mailed via US Postal Service
$20 each if purchased at local awareness event and requires no shipping
Teal short-sleeve shirt - scan on back directs to this website
dark blue short-sleeve shirt with white palmetto and teal awareness ribbon
(ribbon is actually TEAL, not blue as shown in this picture)
"fight like a girl"
Brown short-sleeve tshirt with teal imprint on front and sleeve
1. Know the symptoms. Awareness and Early Detection saves lives!
2. See your physician if you are experiencing the symptoms daily for more than 2 weeks!
3. Wear our shirts to support the women fighting this disease!
4. Wear our shirts to tell others about the disease!
Member of the Aiken Chamber of Commerce 2010
What is ovarian cancer?
Ovarian cancer is cancer that begins in the ovaries. Ovaries are reproductive glands found only in females (women). The ovaries produce eggs (ova) for reproduction. The eggs travel through the fallopian tubes into the uterus where the fertilized egg implants and develops into a fetus. The ovaries are also the main source of the female hormones estrogen and progesterone. One ovary is on each side of the uterus in the pelvis.
The ovaries are made up of 3 main kinds of cells:
■ Epithelial cells, which cover the ovary
■ Germ cells, which are found inside the ovary. These cells develop into the eggs (ova) that are released into the fallopian tubes every month during the reproductive years.
■ Stromal cells, which form the supporting or structural tissue holding the ovary together and which produce most of the female hormones estrogen and progesterone
Each of these types of cells can develop into a different type of tumor. There are 3 main types of ovarian tumors:
■ Epithelial tumors start from the cells that cover the outer surface of the ovary. Most ovarian tumors are epithelial cell tumors.
■ Germ cell tumors start from the cells that produce the eggs (ova).
■ Stromal tumors start from structural tissue cells that hold the ovary together and produce the female hormones estrogen and progesterone.
Most of these tumors are benign (non-cancerous) and never spread beyond the ovary. Benign tumors can be treated by removing either the ovary or the part of the ovary that contains the tumor.
Ovarian tumors that are not benign are malignant (cancerous) or low malignant potential tumors. These types can spread (metastasize) to other parts of the body and can be fatal. Their treatment is discussed later in this document.
Epithelial ovarian tumors
Benign epithelial ovarian tumors
Most epithelial ovarian tumors are benign, don’t spread, and usually don’t lead to serious illness. There are several types of benign epithelial tumors including serous cystadenomas, mucinous cystadenomas, and Brenner tumors.
Tumors of low malignant potential
When looked at under the microscope, some ovarian epithelial tumors don’t clearly appear to be cancerous. These are called tumors of low malignant potential (LMP tumors). They are also known as borderline epithelial ovarian cancer. These are different from typical ovarian cancers because they don’t grow into the supporting tissue of the ovary (called the ovarian stroma). Likewise, if they spread outside the ovary, for example, into the abdominal cavity (belly), they might grow on the lining of the abdomen but often don’t grow into it.
LMP tumors tend to affect younger women than the typical ovarian cancers. These tumors grow slowly and are less life-threatening than most ovarian cancers. LMP tumors can be fatal, but this isn’t common.
Malignant epithelial ovarian tumors
Cancerous epithelial tumors are called carcinomas. About 85% to 90% of ovarian cancers are epithelial ovarian carcinomas. When someone says that they had ovarian cancer, they usually mean that they had this type of cancer. When these tumors are looked at under the microscope, the cells have several features that can be used to classify epithelial ovarian carcinomas into different types. The serous type is by far the most common, but there are other types like mucinous, endometrioid, and clear cell.
If the cells don't look like any of these 4 subtypes, the tumor is called undifferentiated. Undifferentiated epithelial ovarian carcinomas tend to grow and spread more quickly than the other types. Epithelial ovarian carcinomas are classified by these subtypes, but they are also given a grade and a stage.
The grade classifies the tumor based on how much it looks like normal tissue on a scale of 1, 2, or 3. Grade 1 epithelial ovarian carcinomas look more like normal tissue and tend to have a better prognosis (outlook). Grade 3 epithelial ovarian carcinomas look less like normal tissue and usually have a worse outlook. Grade 2 tumors look and act in between grades 1 and 3.
The tumor stage describes how far the tumor has spread from where it started in the ovary. Epithelial ovarian cancers tend to spread to the lining and organs of the pelvis and abdomen (belly) first. This may lead to the build-up of fluid in the abdominal cavity (called ascites). As it becomes more advanced, it may spread to the lung and liver, or, rarely, to the brain, bones, or skin. Staging is explained in detail in a later section.
Primary peritoneal carcinoma
Primary peritoneal carcinoma (PPC) is a rare cancer closely related to epithelial ovarian cancer. At surgery, it looks the same as an epithelial ovarian cancer that has spread through the abdomen. Under a microscope, PPC also looks just like epithelial ovarian cancer. Other names for this cancer include extra-ovarian (meaning outside the ovary) primary peritoneal carcinoma (EOPPC) and serous surface papillary carcinoma.
PPC seems to develop from cells in the lining of the pelvis and abdomen. This lining is called the peritoneum. These cells are very similar to the cells on the surface of the ovaries. Some experts believe that PPC may start in the cells lining the fallopian tubes.
Like ovarian cancer, PPC tends to spread along the surfaces of the pelvis and abdomen, so it is often difficult to tell exactly where the cancer first started. This type of cancer can occur in women who still have their ovaries, but it is of more concern for women who have had their ovaries removed to prevent ovarian cancer. This cancer does rarely occur in men.
Symptoms of PPC are similar to those of ovarian cancer, including abdominal pain or bloating, nausea, vomiting, indigestion, and a change in bowel habits. Also, like ovarian cancer, PPC may elevate the blood level of a tumor marker called CA-125.
Women with PPC usually get the same treatment as those with widespread ovarian cancer. This could include surgery to remove as much of the cancer as possible (a process called debulking that is discussed in the section about surgery), followed by chemotherapy like that given for ovarian cancer. Its outlook is likely to be similar to widespread ovarian cancer.
Fallopian tube cancer
This is another rare cancer. It begins in the tube that carries an egg from the ovary to the uterus (the fallopian tube). Like PPC, fallopian tube cancer and ovarian cancer have similar symptoms. The treatment for fallopian tube cancer is much like that of ovarian cancer, but the outlook (prognosis) is slightly better.
Germ cell tumors
Germ cells are the cells that usually form the ova or eggs. Most germ cell tumors are benign, but some are cancerous and may be life threatening. Less than 2% of ovarian cancers are germ cell tumors. Overall, they have a good outlook, with more than 9 out of 10 patients surviving at least 5 years after diagnosis. There are several subtypes of germ cell tumors. The most common germ cell tumors are teratomas, dysgerminomas, endodermal sinus tumors, and choriocarcinomas. Germ cell tumors can also be a mix of more than a single subtype.
Teratomas are germ cell tumors with areas that, when seen under the microscope, look like each of the 3 layers of a developing embryo: the endoderm (innermost layer), mesoderm (middle layer), and ectoderm (outer layer). This germ cell tumor has a benign form called mature teratoma and a cancerous form called immature teratoma.
The mature teratoma is by far the most common ovarian germ cell tumor. It is a benign tumor that usually affects women of reproductive age (teens through forties). It is often called a dermoid cyst because its lining looks like skin. These tumors or cysts can contain different kinds of benign tissues including, bone, hair, and teeth. The patient is cured by surgical removal of the cyst.
Immature teratomas are a type of cancer. They occur in girls and young women, usually younger than 18. These are rare cancers that contain cells that look like those from embryonic or fetal tissues such as connective tissue, respiratory passages, and brain. Tumors that are relatively more mature (called grade 1 immature teratoma) and haven’t spread beyond the ovary are treated by surgical removal of the ovary. When they have spread beyond the ovary and/or much of the tumor has a very immature appearance (grade 2 or 3 immature teratomas), chemotherapy is recommended in addition to surgery.
This type of cancer is rare, but it is the most common ovarian germ cell cancer. It usually affects women in their teens and twenties. Dysgerminomas are considered malignant (cancerous), but most don’t grow or spread very rapidly. When they are limited to the ovary, more than 75% of patients are cured by surgically removing the ovary, without any further treatment. Even when the tumor has spread further (or if it comes back later), surgery, radiation therapy, and/or chemotherapy are effective in controlling or curing the disease in about 90% of patients.
Endodermal sinus tumor (yolk sac tumor) and choriocarcinoma
These very rare tumors typically affect girls and young women. They tend to grow and spread rapidly but are usually very sensitive to chemotherapy. Choriocarcinoma that starts in the placenta (during pregnancy) is more common than the kind that starts in the ovary. Placental choriocarcinomas usually respond better to chemotherapy than ovarian choriocarcinomas do.
About 1% of ovarian cancers are ovarian stromal cell tumors. More than half of stromal tumors are found in women older than 50, but about 5% of stromal tumors occur in young girls.
The most common symptom of these tumors is abnormal vaginal bleeding. This happens because many of these tumors produce female hormones (estrogen). These hormones can cause vaginal bleeding (like a period) to start again after menopause. In young girls, these tumors can also cause menstrual periods and breast development to occur before puberty.
Less often, stromal tumors make male hormones (like testosterone). If male hormones are produced, the tumors can cause normal menstrual periods to stop. They can also make facial and body hair grow.
Another symptom of stromal tumors can be sudden, severe, abdominal pain. This occurs if the tumor starts to bleed.
Types of malignant (cancerous) stromal tumors include granulosa cell tumors (the most common type), granulosa-theca tumors, and Sertoli-Leydig cell tumors, which are usually considered low-grade cancers. Thecomas and fibromas are benign stromal tumors. Cancerous stromal tumors are often found at an early stage and have a good outlook, with more than 75% of patients surviving long-term.
An ovarian cyst is a collection of fluid inside an ovary. Most ovarian cysts occur as a normal part of the process of ovulation (egg release) -- these are called functional cysts. These cysts usually go away within a few months without any treatment. If you develop a cyst, your doctor may want to check it again after your next cycle (period) to see if it has gotten smaller.
An ovarian cyst can be more concerning in a female who isn't ovulating (like a woman after menopause or girl who hasn't started her periods), and the doctor may want to do more tests. The doctor may also order other tests if the cyst is large or if it does not go away in a few months. Even though most of these cysts are benign (not cancer), a small number of them could be cancer. Sometimes the only way to know for sure if the cyst is cancer is to take it out with surgery. Cysts that appear to be benign (based on how they look on imaging tests) can be observed (with repeated physical exams and imaging tests), or removed with surgery.
Last Medical Review: 03/21/2013
Last Revised: 03/21/2013
What`s new in ovarian cancer research and treatment?
Risk factors and causes
Scientists continue to study the genes responsible for familial ovarian cancer. This research is beginning to yield clues about how these genes normally work and how disrupting their action can lead to cancer. This information eventually is expected to lead to new drugs for preventing and treating familial ovarian cancer.
Research in this area has already led to better ways to detect high-risk genes and assess a woman's ovarian cancer risk. A better understanding of how genetic and hormonal factors (such as oral contraceptive use) interact may also lead to better ways to prevent ovarian cancer.
New information about how much BRCA1 and BRCA2 gene mutations increase ovarian cancer risk is helping women make practical decisions about prevention. For example, mathematical models have been developed that help estimate how many years of life an average woman with a BRCA mutation might gain by having both ovaries and fallopian tubes removed to prevent a cancer from developing. Studies have shown that fallopian tube cancers develop in women with BRCA gene mutations more often than doctors had previously suspected. However, it is important to remember that although doctors can predict the average outcome of a group of many women, it is still impossible to accurately predict the outcome for any individual woman.
Recent studies suggest that many primary peritoneal cancers and some ovarian cancers (such as high-grade serous carcinomas) actually start in the fallopian tubes. According to this theory, the early changes of these cancers can start in the fallopian tubes. Cells from these very early fallopian tube cancers can become detached and then stick to the surface of the peritoneum or the ovaries. For reasons that are still not understood, these cancer cells may grow more rapidly in their new locations.
This theory has important implications for preventing ovarian cancer because having the ovaries removed early can cause problems from lack of estrogen, such as bone loss, cardiovascular disease, and menopause symptoms. Some experts have suggested recently that some women who are concerned about their ovarian cancer risk (especially those with a strong family history and/or BRCA gene mutations) consider having just their fallopian tubes removed first. They then can have their ovaries removed when they are older. This approach lets women keep their ovaries functioning for longer, but because of that, it might not help breast cancer risk as much. This is an active area of research.
Other studies are testing new drugs for ovarian cancer risk reduction.
Researchers are constantly looking for clues such as lifestyle, diet, and medicines that may alter the risk of ovarian cancer.
Accurate ways to detect ovarian cancer early could have a great impact on the cure rate. Researchers are testing new ways to screen women for ovarian cancer, and a national repository for blood and tissue samples from ovarian cancer patients is being established to aid in these studies. One method being tested is looking at the pattern of proteins in the blood (called proteomics) to find ovarian cancer early.
From time to time, lab companies have marketed unproven tests to look for early ovarian cancer. Because these tests had not yet been shown to help find early cancer, the US Food and Drug Administration (FDA) told the companies to stop selling them. So far, this occurred with 2 different tests looking at protein patterns: OvaSure and OvaCheck. Both were taken off the market at the request of the FDA.
Two large studies of screening have been completed. One was in the United States, and the other was in the United Kingdom. Both studies looked at using the CA-125 blood test along with ovarian (transvaginal) ultrasound to find ovarian cancer. In these studies, more cancers were found in the women who were screened. Some of these were found at an early stage. But the outcomes of the women who were screened were not better than the women who weren’t screened - the screened women did not live longer and were not less likely to die from ovarian cancer.
A test called OVA1 is meant to be used in women who have an ovarian tumor. It measures the levels of 4 proteins in the blood. The levels of these proteins, when looked at together, are used to put women with tumors into 2 categories − low risk and high risk. The women labeled low risk are not likely to have cancer. The women called high risk are more likely to have a cancer, and so should have surgery by a specialist (a gynecologic oncologist). This test is NOT a screening test − it is only meant for use in women who have an ovarian tumor.
Treatment research includes testing the value of currently available methods as well as developing new approaches to treatment.
New chemotherapy (chemo) drugs and drug combinations are being tested. The drugs trabectedin (Yondelis®) and belotecan have shown promise in some studies.
When the drugs cisplatin and carboplatin stop working, the cancer is said to be platinum resistant. Studies are looking for ways (like other drugs) to make these cancers sensitive to these drugs again.
Although carboplatin is preferred over cisplatin in treating ovarian cancer if the drug is to be given IV, cisplatin is used in intraperitoneal (IP) chemotherapy. Studies are looking at giving carboplatin for IP chemo.
Another approach is to give IP chemo during surgery using heated drugs. This, known as heated intraperitoneal chemotherapy or HIPEC, can be effective, but is very toxic. It still needs to be studied and compared with standard IP chemo to see if it actually works better.
Targeted therapy is a newer type of cancer treatment that uses drugs or other substances to identify and attack cancer cells while doing little damage to normal cells. Each type of targeted therapy works differently, but they all attack the cancer cells' inner workings − the programming that makes them different from normal, healthy cells. Bevacizumab (Avastin) is the targeted therapy that has been studied best in ovarian cancer, but other drugs are also being looked at, as well.
Pazopanib (Votrient®) is a targeted therapy drug that, like bevacizumab, helps stop new blood vessels from forming. It has shown some promise in studies.
Poly(ADP-ribose) polymerases (PARPs) are enzymes that have been recently recognized as key regulators of cell survival and cell death. Drugs that inhibit PARP-1 help fight cancers caused by mutations in BRCA1 and BRCA2. In one study, the PARP inhibitor olaparib was also able to shrink tumors in ovarian cancer patients who did not have BRCA mutations. Clinical trials of this type of drug are being done to see who will benefit most from them.
Another approach is to develop tumor vaccines that program the immune system to better recognize cancer cells. Also, monoclonal antibodies that specifically recognize and attack ovarian cancer cells are being developed. These antibodies are man-made versions of the antibodies our bodies make to fight infection. They can be designed to home in on certain sites on the cancer cell. Farletuzumab is a monoclonal antibody that is directed against a protein on the surface of ovarian cancer cells. It has shown promise in treating ovarian cancer in early studies. Another monoclonal antibody being studied in ovarian cancer is called catumaxomab. It binds to a protein that is in some cancer cells and some immune system cells. When it is administered into the abdominal cavity, it can help treat fluid build up (ascites) that can occur when cancer is present.
Last Medical Review: 03/21/2013
What are the key statistics about ovarian cancer?
The American Cancer Society estimates for ovarian cancer in the United States for 2013 are:
· About 22,240 women will receive a new diagnosis of ovarian cancer.
· About 14,230 women will die from ovarian cancer.
Ovarian cancer is the ninth most common cancer among women, excluding non-melanoma skin cancers. It ranks fifth in cancer deaths among women, accounting for more deaths than any other cancer of the female reproductive system. Ovarian cancer accounts for about 3% of all cancers in women. A woman's risk of getting ovarian cancer during her lifetime is about 1 in 72. Her lifetime chance of dying from ovarian cancer is about 1 in 100. (These statistics don’t count low malignant potential ovarian tumors.)
This cancer mainly develops in older women. About half of the women who are diagnosed with ovarian cancer are 63 years or older. It is more common in white women that African-American women.
The rate at which women are diagnosed with ovarian cancer has been slowly falling over the past 20 years.
Source: American Cancer Society www.ocancer.org
Last Medical Review: 03/21/2013
A risk factor is anything that changes your chance of getting a disease like cancer. Different cancers have different risk factors. For example, unprotected exposure to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for a number of cancers.
But risk factors don't tell us everything. Having a risk factor, or even several risk factors, does not mean that you will get the disease. And many people who get the disease may not have had any known risk factors. Even if a person with ovarian cancer has a risk factor, it is very hard to know how much that risk factor may have contributed to the cancer. Researchers have discovered several specific factors that change a woman's likelihood of developing epithelial ovarian cancer. These risk factors don’t apply to other less common types of ovarian cancer like germ cell tumors and stromal tumors.
The risk of developing ovarian cancer gets higher with age. Ovarian cancer is rare in women younger than 40. Most ovarian cancers develop after menopause. Half of all ovarian cancers are found in women 63 years of age or older.
Various studies have looked at the relationship of obesity and ovarian cancer. Overall, it seems that obese women (those with a body mass index of at least 30) have a higher risk of developing ovarian cancer.
Women who have been pregnant and carried it to term have a lower risk of ovarian cancer than women who have not. The risk goes down with each full-term pregnancy. Breastfeeding may lower the risk even further.
Women who have used oral contraceptives (also known as birth control pills or the pill) have a lower risk of ovarian cancer. The lower risk is seen after only 3 to 6 months of using the pill, and the risk is lower the longer the pills are used. This lower risk continues for many years after the pill is stopped.
A recent study found that the women who used depot medroxyprogesterone acetate (DMPA or Depo-Provera CI®), an injectable hormonal contraceptive had a lower risk of ovarian cancer. The risk was even lower if the women had used it for 3 or more years.
Tubal ligation (having your tubes tied) may reduce the chance of developing ovarian cancer by up to two-thirds. A hysterectomy (removing the uterus without removing the ovaries) also seems to reduce the risk of getting ovarian cancer by about one-third.
In some studies, researchers have found that using the fertility drug clomiphene citrate (Clomid®) for longer than one year may increase the risk for developing ovarian tumors. The risk seemed to be highest in women who did not get pregnant while on this drug. Fertility drugs seem to increase the risk of the type of ovarian tumors known as "low malignant potential" (described in the section, "What is ovarian cancer?"). If you are taking fertility drugs, you should discuss the potential risks with your doctor. However, women who are infertile may be at higher risk (compared to fertile women) even if they don’t use fertility drugs. This might be in part because they haven't given birth or used birth control pills (which are protective). More research to clarify these relationships is now underway.
Androgens are male hormones. Danazol, a drug that increases androgen levels, was linked to an increased risk of ovarian cancer in a small study. In a larger study, this link was not confirmed, but women who took androgens were found to have a higher risk of ovarian cancer. Further studies of the role of androgens in ovarian cancer are planned.
Estrogen therapy and hormone therapy
Some recent studies suggest women using estrogens after menopause have an increased risk of developing ovarian cancer. The risk seems to be higher in women taking estrogen alone (without progesterone) for many years (at least 5 or 10). The increased risk is less certain for women taking both estrogen and progesterone.
Family history of ovarian cancer, breast cancer, or colorectal cancer
Ovarian cancer can run in families. Your ovarian cancer risk is increased if your mother, sister, or daughter has (or has had) ovarian cancer. The risk also gets higher the more relatives you have with ovarian cancer. Increased risk for ovarian cancer does not have to come from your mother's side of the family -- it can also come from your father's side.
Up to 10% of ovarian cancers result from an inherited tendency to develop the disease. A family history of some other types of cancer caused by an inherited mutation (change) in certain genes can increase the risk of ovarian cancer. For example, mutations in the genes BRCA1 and BRCA2 increase the risk of breast cancer -- so having a family member with breast cancer can increase your risk of ovarian cancer. Another set of genes increase the risk of colon cancer, so women who have colon cancer in their families may have a higher risk of developing ovarian cancer. Many cases of familial epithelial ovarian cancer are caused by inherited gene mutations that can be identified by genetic testing.
Women with ovarian cancers caused by some of these inherited gene mutations may have a better outcome than patients who don’t have any family history of ovarian cancer.
Genetic counseling, genetic testing, and strategies for preventing ovarian cancer in women with an increased familial risk are discussed in the prevention section of this document.
Personal history of breast cancer
If you have had breast cancer, you may also have an increased risk of developing ovarian cancer. There are several reasons for this. Some of the reproductive risk factors for ovarian cancer may also affect breast cancer risk. The risk of ovarian cancer after breast cancer is highest in those women with a family history of breast cancer. A strong family history of breast cancer may be caused by an inherited mutation in the BRCA1 or BRCA2 genes. These mutations can also cause ovarian cancer.
It has been suggested that talcum powder applied directly to the genital area or on sanitary napkins may be carcinogenic (cancer-causing) to the ovaries. Some, studies suggest a very slight increase in risk of ovarian cancer in women who used talc on the genital area. In the past, talcum powder was sometimes contaminated with asbestos, a known cancer-causing mineral. This might explain the association with ovarian cancer in some studies. Body and face powder products have been required by law for more than 20 years to be asbestos-free. However, proving the safety of these newer products will require follow-up studies of women who have used them for many years. There is no evidence at present linking cornstarch powders with any female cancers.
A study of women who followed a low-fat diet for at least 4 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. The American Cancer Society recommends eating a variety of healthful foods, with an emphasis on plant sources. Eat at least 2 ½ cups of fruits and vegetables every day, as well as several servings of whole grain foods from plant sources such as breads, cereals, grain products, rice, pasta, or beans. Limit the amount of red meat and processed meats you eat. Even though the effect of these dietary recommendations on ovarian cancer risk remains uncertain, following them can help prevent several other diseases, including some other types of cancer.
In some studies, both aspirin and acetaminophen have been shown to reduce the risk of ovarian cancer. However, the information isn’t consistent. Women who don’t already take these medicines regularly for other health conditions should not start doing so to try to prevent ovarian cancer. More research is needed on this issue.
Smoking and alcohol use
Smoking doesn’t increase the risk of ovarian cancer overall, but it is linked to an increased risk for the mucinous type.
Drinking alcohol is not linked to ovarian cancer risk.
Source: American Cancer Society www.cancer.org
Last Medical Review: 03/21/2013
Life changes so quickly....
10/14/06: Gail and her dad, Jimmy, getting ready to enjoy a Saturday afternoon in Athens cheering for the Georgia Bulldogs. Picture taken the weekend before Gail's checkup.
11/14/06: Gail and her mom, Debbie, the day before her first chemo treatment (photo courtesy of Denise Jane Portrait Design).
Go to the subpage tabs (Untitled) to learn more about what is being done to promote ovarian cancer awareness in memory of Gail.