Ovarian Cancer: A Not-So-Silent Killer

My aunt, who just turned 72 a couple weeks ago, was diagnosed with ovarian cancer about eight weeks ago.  Because I’m a lazy grad student who hasn’t had paid work since mid-May, and because I live about five miles away from my aunt, and because her husband has the early stages of Alzheimer’s, I have been functioning as her chauffeur-cum-support-person for about the past seven weeks.  I spend a few hours a week writing checks for her, driving her to various doctor appointments, driving her to chemo, taking notes at meetings about her treatment, picking up prescriptions, and generally just being there for her as she undergoes treatment and testing for this illness.

I never really knew my aunt before this summer — at least I never really knew her in any useful sense, beyond knowing that she’s my aunt.  I still don’t know her that well; many of our car rides are silent, and I am not the best conversationalist.  But spending so much time together in  has afforded us a few opportunities to talk frankly about what’s happening to her and what it means. In that way, this cancer diagnosis has been a blessing, but otherwise, it’s honestly just a huge fucking bummer that this is happening.  Did I mention that she wasn’t diagnosed until after the cancer had metastasized?  Yeah.  Did I mention that she had gone to the doctor with various complaints of bloating and indigestion for months previous to her diagnosis?  Yeah.  Did I mention that most of these complaints were explained away as symptoms of stress, anxiety, and fatigue?  Yeah — in other words, she’s just a typical woman, not a cancer sufferer, and her complaints mean nothing.  I’ll get to that, though.

A couple weeks ago, we were driving away from yet another doctor’s appointment with a cancer specialist, and my aunt mentioned that she had been reading an article in Ladies’ Home Journal about ovarian cancer (presumably this one, but probably the whole thing, not just the free part).  She said she was frustrated because she felt that her doctors had overlooked her symptoms leading up to this point and explained them away with “psychology” talk instead of really exploring her concerns.  I said, “It’s really weird how the medical profession deals with women.”  She looked at me from the passenger side of the car, her hairless face looking surprised and angry, and said, “They don’t deal with women in the medical profession.”

We talked about how the symptoms of women’s heart attacks are wildly different from men’s and how hardly anyone knows that, how the medical profession generally uses the male body as the default body, and how this leaves women out to dry.  We talked about how easy it is for doctors to chalk women’s complaints up to stress — i.e., “it’s all in your head” — without examining these complaints further, without taking them seriously, without trusting women to know when it’s a “real” problem and when it’s just a “hysterical” problem. She lamented the fact that there are public service announcements for prostate cancer — a cancer that affects only cis-men — but it seems that similar public outreach campaigns about ovarian cancer are rare in comparison.  And she decried the fact that more research hasn’t been done into further developing a screening test for the deadliest gynecological cancer when there’s a blood test to determine the presence of prostate cancer.*

I didn’t know that my 72-year-old aunt, who I thought was just a little nutty and more than a little eccentric, was a de facto feminist.  This is classic Steinem-esque table-turning: If men were afflicted with ovarian cancer, you know it’d be discussed with the same gravity as any other male-only disease.  It’s so obvious that even my aunt who probably hasn’t read a piece of feminist literature/theory in her life can see it.

But, really, ovarian cancer isn’t obvious.  While it’s not the “silent killer” it’s been touted as, it’s certainly a quiet killer.  My aunt, in all seriousness, is not likely to make it to the five-year survivor mark; she’ll be lucky to see the end of next year.  Already, she has asked her doctors to stop their chemo treatments and suggestions of surgery and to instead focus on improving her current quality of life — to help her feel better, even if there’s no improvement of her cancer status.  A lack of information has essentially led to this.

So, in my aunt’s honor, I’d like to take this chance to do some consciousness-raising about this disease with the hope that someone reading this may not end up in the same position she has.

Information About, Symptoms of and Risk Factors for Ovarian Cancer

From OvarianCancerCenter.org:

• Ovarian cancer is the second most common gynecologic cancer after uterine cancer.
• It causes more deaths than any other gynecologic cancer.
• Ovarian cancer is the fourth leading cause of cancer death among women in the United States.
• In 2007, The American Cancer Society estimates 21,650 women in the U.S. who are diagnosed with ovarian cancer, with 15,520 of those women dying from this disease.
• The risk of ovarian cancer increases with age, and family history of the disease is one of the most significant risk factors.
• Close to 80 percent of ovarian cancer patients recently diagnosed with the disease will survive one year and about half will survive five years.  Almost all women with local disease will survive five years, but fewer than 30 percent at this stage.

From “How is ovarian cancer diagnosed?,” some easily explained-away symptoms that may indicate ovarian cancer:

• bloating
• pelvic or abdominal pain
• trouble eating or feeling full quickly
• urinary symptoms, such as urgent or frequent feelings of needing to go
• fatigue
• upset stomach
• back pain
• pain during sex
• constipation
• menstrual changes

Additionally, according to an article on Medscape, “The most common symptoms that have been reported with all cancers, including ovarian cancer, are pain, depression, and fatigue. As many as 90% of cancer patients experience pain in the course of their illness.”

Risk indicators from OvarianCancerCenter.org:

Age
The incidence of ovarian cancer rises with age. Half of all cases are detected in women older than 65, and most are diagnosed after age 60. The American Cancer Society recommends annual pelvic exams for all women over age 40 to increase the chances of early detection.

Genetics
Women with a family history of ovarian cancer face an increased risk. Having one close relative with the disease increases the risk threefold, and the more relatives with the disease, the greater the risk.

Part of the increased familial risk can be explained by genetic mutations in the BRCA1 and BRCA2 genes, which normally help protect against both breast and ovarian cancer. Women who inherit mutations in BRCA1 have a 50 percent risk of developing the disease, while a mutation in the BRCA2 genes results in a 20 percent risk. A mutation in another gene that normally protects against a type of colon cancer called hereditary nonpolyposis colon cancer also raises the risk of ovarian cancer, but to a lesser degree than mutations in BRCA1 and BRCA2.

Families that carry mutations in these genes can come from any background, but a National Cancer Institute study found that the mutations are highest among Asheknazi Jews (whose ancestors came from Eastern and Central Europe); about 2 percent of all Asheknazi Jews carry mutations in BRCA1 or BRCA2.

Read more about Genetic Testing and Risk Assessment

Ethnicity
The incidence of ovarian cancer is highest among white women in Europe and North America and lowest among black women regardless of their location. Incidence is also low among Asian women, but this is probably due in part to environmental factors because their rate rises when they move to Western countries and adopt the lifestyles and diets of their new location.

Diet
Population studies show that ovarian cancer rates are highest in affluent societies where diets tend to be high in fat. Animal fats (the kind found in red meats, whole milk or cheese) appear to be most closely linked to ovarian cancer.

Reproductive history
Risks are greater for women who have no or few children or have delayed childbearing until after age 35. Ovarian cancer is also more common in women who begin menstruating before age 12 or reach menopause after age 50.

It is hypothesized that the longer a woman is exposed to estrogen, the higher her risk of ovarian cancer. Since high levels of estrogen are present only during the childbearing years, the longer the woman menstruates, the higher her risk.

Childbearing may reduce risk by providing nine-month “rests” from ovulation during pregnancy, thereby reducing a woman’s overall exposure to estrogen.

The drugs clomiphene citrate and pergonal, which are commonly used to treat infertility, also appear to increase the risk of ovarian cancer when used for more than three cycles.

Birth control pills
Women who take birth control pills are at lower risk for ovarian cancer, perhaps because the pill suppresses ovulation and reduces exposure to estrogen. The longer a woman is on the pill, the lower the risk. [emphasis added -- I'm really excited about this, since I'm at a moderate level of risk for this cancer myself and this gives me even more reason to stay on the pill. -- L.]

Talcum powder and asbestos
Habitual use of talcum powder on the genital area may increase the risk for ovarian cancer, but the evidence is not strong. A study at Harvard Medical School found that using talc this way doubled the risk, but other studies found no increased risk. Some researchers believe that talc may be carcinogenic because it contains particles of asbestos, a known carcinogen. It’s been shown that rates of ovarian cancer are higher than normal in women whose jobs expose them to asbestos.

Other cancers
Women with a history of breast or endometrial cancer have an increased risk of developing ovarian cancer. This association may be due to genetic mutations or to such factors as diet and estrogen exposure, which also increase the risks for these other types of cancer.

While there aren’t currently a lot of options for the early detection of ovarian cancer, regular gyno check-ups can help physicians identify ovarian masses earlier, and these check-ups can also give physicians the opportunity offer high-risk patients intervaginal sonograms and CA-125 blood tests in the hopes of early detection.

Please, if you have these symptoms, you’re at risk, and you have access to a doctor, go in for a check up and talk with your doctor about ovarian cancer.

*I’m not saying that research should not continue into diseases and cancers that primarily affect men, and I’m sure my aunt wouldn’t argue that either.  I want no one at all, regardless of gender or sex, to be afflicted by cancer and I want all cancers to be treated with the same level of concern.  So all of you MRA assholes can settle the heck down already.