Published September 26, 2007 in the North Island Weekender

Megan, aged 35, came to see me when her sister, aged 50, was diagnosed with ovarian cancer one year ago. Up until this time there had been no cancer in the family. Luckily her sister was diagnosed early because she had some uncharacteristic spotting after a Pap smear. Her gynecologist caught it early, had her ovaries removed followed by chemotherapy. She has been cancer free since. Megan was seeking the professional advice of a naturopathic physician to see if there was something she could be doing to prevent a similar cancer happening to her.

Ovarian cancer is often called the “silent killer” or “Canada’s most fatal gynecological cancer”, because the symptoms are vague and when it is finally found it is often in the later stages leading to the five year survival rate of 20% down from the 80-90% if it is caught in the early stage. The Gynecologic Cancer Foundation in June of 2007 concluded that the symptoms that most women with ovarian cancer have are bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly and urinary frequency or urgency. If a woman experiences these for more than three weeks she should see a gynecologist.

Megan said she had none of these symptoms but she has had the CA-125 blood test. The CA 125 is not a test for ovarian cancer. This test is a tumor marker and is best used in combination with a manual vaginal rectal exam and transvaginal ultrasound. It may be affected by pregnancy, menstruation and endometriosis. Even though Megan knows this she will still get this test once per year just as a precaution. Megan had heard from her friends that the new HPV vaccine prevented ovarian cancer. I referred her to the National Ovarian Cancer Association (NOCA) website where it is stated that 35% of women think this but it is NOT true It is effective against 70% of cervical cancers but offers no protection against ovarian cancer. The Pap smear is also NOT a test for ovarian cancer, it detects cervical abnormalities only.

A report from the “Million Women Study” of the Cancer Research UK Epidemiology Unit, Oxford, UK, has shown a link between the use of HRT (Hormone Replacement Therapy) and an increased risk of ovarian cancer. They found that current HRT users were on average 20% more likely to develop and die from ovarian cancer than those who had never received HRT. It amounts to hundreds more women being diagnosed with ovarian cancer each year in North America, and about 30 per year in Canada. The research suggests that the incidence of ovarian cancer increases with longer duration of HRT use - up to 30% in women with 10 years or more of HRT use. According to the study, past users of HRT are not at an increased risk of ovarian cancer. The total incidence of breast, endometrial and ovarian cancer increased by 63% in current HRT users, so the impact is not restricted to ovarian cancer. Megan’s sister had been on HRT for 5 years prior to her diagnosis.

In some of the latest research on vitamin D there is promising findings that having a normal 25(OH) serum level of vitamin D reduces the risk of developing ovarian cancer as well as many other types of cancer. The optimal level of 25(OH) is 100-120nmol/liter much higher than was formally thought. Exercise of more than 6 hours per week reduced the incidence by 27% compared to those who exercised less than one hour per week, in all age groups from age 20-69. In 2004 a study of 61,000 women aged 40-76, done in Sweden found that drinking black or green tea each day significantly reduced ovarian cancer risk. One cup lowered the risk by 24%, two cups lowered risk by 50% and each additional cup was associated with an 18% lower risk.

One in 70 women in Canada develops ovarian cancer and 60% of those diagnosed will die from it. It is estimated that 2300 women will be diagnosed with it in 2007. The risk increases among women who have a family history of ovarian, breast or colon cancer, have never had children, are over 50 and are of Ashkenazi Jewish or French Canadian descent.

Megan was also interested in my article on estrogen dominance and learning new ways to eliminate exogenous sources of estrogen in her diet and life style. Her 2/16 hydroxyestrogen ratio was normal implying that she was metabolizing estrogen in a healthy non inflammatory way. Her 25(OH) was low however and by getting her on cod liver oil year round we were able to correct that very easily. She was happy to switch to green tea from her coffee habit.

The big message to Megan was to watch for bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly and urinary frequency or urgency that lasts for more than three weeks.