Ovarian cancer often elusive in early stages; docs urge regular exams

Sep. 23—JOHNSTOWN, Pa. — There are few clear warning signs and no screening tool for ovarian cancer, the fifth-leading cause of cancer deaths in women.

"Unfortunately, ovarian cancer is a disease that, by the time you find it, it's often too late," obstetrician and gynecologist (OB/GYN) Dr. Abid Khouzami said from Conemaugh Memorial Medical Center in Johnstown.

September is National Ovarian Cancer Awareness Month, and one of that campaign's goals is to have women watch for early symptoms and get regular pelvic examinations.

"I call upon the people of the United States to speak with their doctors and health care providers to learn more about ovarian cancer," President Joe Biden said in a proclamation designating September for ovarian cancer awareness. "I encourage citizens, government agencies, private businesses, nonprofit organizations, the media and other interested groups to increase awareness of what Americans can do to detect and treat ovarian cancer."

Early symptoms can be subtle and confused with other conditions, gynecologist Dr. Tracy Gemmell said at Indiana Regional Medical Center.

"Ovarian cancer does not have specific symptoms," Gemmell said. "Most of the time, it seems like (gastrointestinal) problems."

One key sign is a sudden increase in abdominal girth, she said.

"It can happen over four weeks to four months," she said. "It's where the person hasn't gained weight anywhere else but the abdomen."

An annual exam by a gynecologist increases the chance of early detection, Khouzami said. While many women associate gynecologist exams with the annual pap test for cervical cancer, he stresses that the exam is more than just a screening. Gynecologists use the visit to examine other parts of the reproductive system and include an overall health checkup.

"For many women, this is the only time they see a physician," he said. "As an OB/GYN, you are also a primary care physician. Not only do we do the pelvic examination, but also make sure the patient has normal blood pressure, make sure that her weight is appropriate and make sure she doesn't have any other health issues."

Recent research has changed the recommendations for pap tests, Khouzami said. The test is now combined with a test for human papillomavirus, or HPV, which is known to cause cervical cancer. If a woman's pap test and HPV test are negative, she doesn't need to be screened every year, Khouzami said.

The doctors stress that it is still important for women to see a physician every year.

"The annual visit is not only a pap smear," Khouzami said. "If they aren't coming to see me, I hope they are seeing their primary care physician."

The change also emphasizes the family doctor's role, said Dr. Jeanne Spencer, chairwoman of family medicine at Conemaugh Memorial Medical Center. Family doctors and other primary care physicians help patients keep track of recommended screenings for a variety of cancers and other conditions.

"It becomes more important for family medicine doctors to remind patients when we see them for other things," Spencer said.

While most ovarian cancer seems to strike women at random, there are a few ways to reduce the risk. The American Cancer Society's website says that women who used oral contraceptives for five or more years have about a 50% lower risk of developing ovarian cancer.

Maintaining a healthy weight and not taking hormone replacement therapy after menopause will also reduce the risk slightly.

Those with a history of cancer among close relatives may carry gene mutations known to increase the risk of ovarian cancer and other cancers.

Kimberly Knapp, a genetic research nurse at Joyce Murtha Breast Care Center in Windber, said that anyone with two or more close relatives who have cancer may want to ask their primary care doctor about genetic counseling and genetic testing.

The tests look for dozens of gene mutations known to be linked to various cancers. Mutations of the BRCA1 and BRCA2 genes, for example, increase women's risk of both ovarian and breast cancer.

The cost of testing has fallen dramatically over the past decade, Knapp said at the Joyce Murtha center.

"Insurance is more lenient, but even without it, it's only $250 out of pocket," Knapp said. "It used to be $4,000, and that only tested two genes."

Those found to be at risk can reduce their chance of getting cancer with surgical removal of the breasts and ovaries — called a bilateral prophylactic mastectomy and an oophorectomy. Typically, doctors suggest waiting until a woman has reached menopause or has decided she does not want any more children, Khouzami said.