Did you know that around 300,000 women worldwide are diagnosed with ovarian cancer every year, and approximately 200,000 of these women do not survive? It remains one of the most lethal diseases in women. This article will help you understand what ovarian cancer is and discuss ways in which you can prevent it.

What is ovarian cancer?

Ovaries are glands of the reproductive system in women, with a standard woman containing two ovaries, one on each side of the uterus. These glands produce the female hormones oestrogen and progesterone, and ova or eggs, involved in reproduction. Ovarian cancer occurs when cells in the ovaries or surrounding areas become abnormal, causing uncontrolled growth and division, leading to the formation of a tumour. One of the reports by GLOBOCAN, the World Health Organisation Cancer Observatory, estimates that ovarian cancer cases and deaths will increase by 36% and 47%, respectively, over the next 20 years.¹ Often, ovarian cancer is diagnosed in later stages. This makes it difficult to treat, decreasing the survival rate. With such an alarming rate of existing and future cases, we must focus on ways to tackle the surge and look for prevention strategies. 

Risk factors 

Age

Ovarian cancer is mainly diagnosed in older women and is widely considered to be a post-menopausal disease, with research suggesting that women above 65 years of age have higher chances of ovarian cancer. Older women also have a lower survival rate as the treatment type is less effective in them, due to their age.² 

Genetic mutations

Family history

Women with a family history of breast, uterus, or ovarian cancers have a higher risk of developing ovarian cancer. Such women may have an immediate family member, such as a mother, sister, aunt, or grandmother, affected with either of the above-mentioned cancers. 

BRCA gene mutations

Breast Cancer (BRCA) genes are generally involved in DNA damage repair. When there is a mutation or harmful alteration in these genes, it leads to an increased risk of breast and ovarian cancers. The chances of getting breast or ovarian cancer are sometimes doubled or even higher when there is a change in the BRCA gene.³ BRCA mutations can also lead to other types of cancer. 

Lynch syndrome

Lynch syndrome is a genetic mutation in one of the DNA mismatch repair genes, such as MLH1, MSH2, MSH6, and PMS2. This increases your risk of developing cancer, and you can develop cancer before the age of 50. It can lead to different types of cancer, including ovarian, stomach, liver, and skin cancer.⁴

Hormonal factors

Hormone replacement therapy (HRT)

When women are nearing menopause, uncomfortable symptoms such as hot flashes, night sweats, and insomnia creep up. This happens because of low levels of the female hormone oestrogen in the body. HRT helps treat these symptoms by providing the hormones either by oestrogen therapy or combination (oestrogen and progesterone) therapy. But, when HRT is taken over a long time, there is an increased risk of ovarian and breast cancer, along with other diseases.

Infertility treatments

Women who cannot become pregnant may choose infertility treatments, such as clomiphene. These medications induce egg formation, helping women conceive. There have been reports associating these medications (ovulation-inducing drugs) with ovarian cancer. A study indicated that a higher dosage of clomiphene leads to a higher risk of ovarian cancer.⁵

Lifestyle and environmental factors

Nutrition and diet

Studies have shown the association of a high-cholesterol or fat diet with increased risk of ovarian cancer. Consumption of fruits and vegetables along with calcium, vitamin D, and lactose considerably reduces the risk of ovarian cancer.⁵

Obesity

Excess weight and obesity have been shown to increase the risk of ovarian cancer. However, there is not enough data to support this statement. Physical activity is always recommended to stay active and fit. 

Alcohol, caffeine consumption, and smoking

Alcohol, caffeine consumption, and smoking are all shown to be associated with increased risk of ovarian cancer in some way. A recent study showed that caffeine and coffee consumption lead to a higher risk of ovarian cancer in women before menopause.⁵

Preventative measures

Being one of the most lethal forms of cancer in women, it is imperative to focus on the prevention of ovarian cancer. There are different strategies employed for this.

Surgical and medical interventions

Bilateral salpingo-oophorectomy (BSO)

This procedure, also called risk-reducing salpingo-oophorectomy (RRSO), is the surgical removal of both the ovaries and fallopian tubes. It is considered effective for ovarian cancer prevention in women who have BRCA gene mutations. 

Bilateral salpingectomy with ovarian retention (BSOR)

This is another surgical procedure that removes only the fallopian tubes without affecting the ovaries. This is intended for women who are at high risk for ovarian cancer. Salpingectomy in a Swedish study was associated with a 35% reduction in ovarian cancer risk.⁶

Tubal ligation

This is a common method to prevent pregnancy, where the fallopian tubes are cut and tied up or blocked with a suture or clamp.  It prevents the eggs from travelling to the uterus and fertilising with the sperm. This procedure has been shown to help prevent ovarian cancer.

Hysterectomy

The removal of the uterus is called a hysterectomy. It is associated with a lower risk of ovarian cancer by preventing endometriosis. Uterus removal limits the ability of affected tissue to access the fallopian tubes, thereby decreasing the risk of ovarian cancer.

Oral contraceptives

Oral contraceptives, which are hormone-regulating prescription drugs, are responsible for reducing the ovarian cancer risk. It has been reported that these drugs reduce the risk of ovarian cancer in women with BRCA gene mutations and average-risk women.⁶ However, there are conflicting results too.

Early detection and screening

One of the reasons why ovarian cancer is lethal among women is that it is diagnosed at later stages due to a lack of specific symptoms. This can be prevented by employing strategies for early cancer detection. 

Biomarkers

Biomarkers are measurable indicators that help us detect deviations from the norm. Two biomarkers are extensively used in ovarian cancer research: cancer antigen 125 (CA-125) and human epididymis protein 4 (HE-4). CA-125 levels are high in women with advanced stages of ovarian cancer when compared to earlier stages. HE-4 is also similar to CA-125, with higher levels in late-stage ovarian cancer, but it has higher accuracy in differentiating between benign and malignant tumours.⁶

Imaging technologies 

Ultrasound imaging or transvaginal sonography is used for examining your pelvic organs. Biomarkers, or other advanced ultrasound imaging techniques, are used in combination with transvaginal sonography for ovarian cancer screening. Magnetic resonance imaging (MRI) is used in ovarian cancer screening to identify the malignancy of masses involved. Another imaging technique is a glucose-based Positron emission tomography (¹⁸F-FDG-PET), which is combined with a computed tomography (CT) scan to detect the growing masses and their malignancy. These imaging technologies are less invasive and provide us with fine-resolution images.

Genetic testing

Women with a family history of ovarian cancer are encouraged to consult their doctor to discuss the occurrence and consequences of the condition within their family. The doctor can also provide guidance, which can help them make informed decisions about preventive measures. Genetic testing can be done to learn and understand the cancer treatment or prevention plan. This, in turn, reduces the morbidity (illness) and mortality (death) rates associated with ovarian cancer.

Lifestyle modifications

A healthy diet and eating well

We should be mindful of what we eat and include a lot of fruits, vegetables, and whole grains in our diet. Excluding unnecessary food items is equally important; high-fat foods and meat should be consumed in moderation. 

Physical activity and weight management

Women are advised to be physically active and monitor their body weight, as it can be related to a higher risk of ovarian cancer. A sedentary lifestyle can also contribute to cancer, though strong evidence has not been reported. 

Alcohol and smoking

Alcohol and smoking are directly or indirectly related to higher risks of ovarian cancer. It is always recommended to minimise your consumption or stop completely. Positive lifestyle changes will always lead to better health outcomes.

Summary

Ovarian cancer is one of the most lethal cancers among women. This is partly because there are no particular symptoms, and therefore it is often not diagnosed until the later stages. Ovarian cancer does not have any specific known causes and has varied risk factors associated with it, including genetic mutations and lifestyle factors. The morbidity and mortality resulting from ovarian cancer can be reduced by being more aware of the disease and following different strategies for its prevention. Early detection and screening methods coupled with surgical interventions and lifestyle modifications can help prevent ovarian cancer. It can save the lives of thousands of women if adopted at the right stage and time.