A Case for Keeping Ovaries

I've been hanging out over at HysterSisters and have been noticing a trend - women asking for advice about whether or not to keep their ovaries. Without a strong indication for them to be removed (existing ovarian cancer or strong genetic link, endometriosis, persistent cysts) I'd like to advocate keeping them. And instead of my opinion, I did some research to make a realistic, fact-based case.

First of all, ovarian cancer is not common. In fact, as female cancers go, it's downright rare. And when it is found, the women are most likely over the age of seventy. Yes, it is called the most deadly women's cancer, but that is largely because the pap test now catches early cervical cancer and regular mammograms and breast exams have been catching breast cancer sooner.

In 1994, there were an estimated 24,000 new cases and 13,600 deaths from ovarian cancer in the United States (Boring et al., 1994). Since 1973, incidence has increased slightly while mortality has declined. The 1987-91 age-adjusted incidence was 14.8 cases per 100,000 women; the incidence increases with age until age 75 when rates decline (Ries et al., 1994). Five years after a diagnosis of ovarian cancer, survival is approximately 42 percent (Ries et al., 1994). link

* Have 2 or more relatives who have had ovarian cancer

* Have a family history of multiple cancers: ovarian, breast or colon cancer
* Were diagnosed with breast cancer under the age of 50
* Have a personal history of multiple exposures to fertility drugs
* Are of Ashkenazi Jewish decent
* Have had uninterrupted ovulation (never used birth control pills, or no pregnancies)
* Have the BRCA1 or BRCA2 gene mutation
* Are over the age of 50
link

* Multiple children-women with children have a 45% decrease in risk of ovarian cancer relative to those women who have not borne children. Each child is associated with a 10-15% reduction in risk. * Breast feeding-a reduction in lifetime risk for ovarian cancer of nearly 1% for each month of lactation has been reported. * Oral contraceptive use-OC use appears to reduce the risk of ovarian cancer by 30-60% depending upon the duration of use. * Tubal ligation (sterilization)-33% decrease in risk * Removal of the ovaries (Prophylactic oophorectomy)-this is only considered in patients proven to carry the following inherited cancer syndromes: familial site-specific ovarian cancer, familial breast/ovarian cancer, Lynch II syndrome. The benefits are as yet unproven and should be discussed with a genetic counselor. * Hysterectomy link

Did you see that last one listed? Yes, you read correctly, hysterectomy reduces the risk. I did a little checking and found this that perhaps explains it:

The risk of ovarian cancer goes down if the ovaries remain after hysterectomy. The reason for this is not clear, but it may be that the path for potential carcinogens from the vagina to the ovaries is interrupted when the uterus is removed. Thus, the risk of a woman developing ovarian cancer after hysterectomy is probably closer to 1 in 300 rather than 1 in 80 for women who have not had a hysterectomy. The benefit of removing ovaries for ovarian cancer prevention has been overstated in the medical literature and is, therefore, misunderstood by most physicians. link

What do you do if you're afraid of ovarian cancer?

Get regular gynocological exams. Even if you've had a hysterectomy, continue to visit your gynecologist and discuss your hormonal health, your bowels, your bladder and any other indications of your hormone levels (breast changes, appetite, weight loss and gain, bloating, distended belly). There is a blood test, the CA125 test that measures the CA-125 antigen in the blood, which rises in the presence of ovarian cancer. It's not foolproof, but it's relatively painless and an easy test. It's not foolproof though and can give false negatives and false positives. There are also new tests on the way.

What Kills Women?

Yes, ovarian cancer is serious. But far more menacing as cancer goes are lung cancer, breast cancer, colon cancer and in African-Americans pancreatic and cervical cancer also out-pace ovarian cancer mortality.

I'm not trying to minimize the risk of ovarian cancer. But let's face it, ovarian cancer is not what kills women. Obesity related diseases kill women - diabetes, strokes and most of all, heart attacks.

Here's a little breakdown for the year 2000:

The Important Things

Yes, sometimes genetics gives us a raw deal, but instead of worrying taking out functioning organs, concentrate on the things that you do have control over. Keep fit, watch your diet, stay out of the sun, get a positive attitude, expand your mind, spend time with the people you love, make other's existence better. Enjoy life.

Any questions or feedback? Feel free to email me.

Posted by Elizabeth M. on September 9, 2004 6:56 PM