Ovarian options

"It was as if someone had knocked me over," recalls Paula Thompson of her ovarian cancer diagnosis three years ago. When a suspected bladder infection hadn't cleared up with antibiotics, the 32-year-old nurse and mother of three from outside of Cornwall, Ont., went to the ER. There, a CAT scan revealed what looked like a benign tumour on her right ovary, later confirmed as an aggressive form of ovarian cancer. Within two months, Paula had a hysterectomy, followed by chemotherapy.

Caught early and treated—as in Paula's case—ovarian cancer has a survival rate as high as 90 per cent. But about three-quarters of cases are not detected at this early stage, due to vague symptoms and no single effective test. "Every 5 1/2 hours, another Canadian woman dies of the disease," says Evelyn Lazare, executive director of Ovarian Cancer Canada in Vancouver. That's why women need to know about accessible screening and prevention options.

Ovarian cancer screening is available to women with symptoms or a family history of ovarian or breast cancer. Yet, these high-risk individuals only account for about 10 per cent of cases (other risk factors include infertility, endometriosis and possibly early-onset menstruation). There is considerable debate about the accuracy of screening methods such as rectovaginal pelvic exams, transvaginal ultrasounds and the CA-125 blood test. Trials of these methods underway in the U.S. and U.K. may ultimately advise routine screenings for the general population, but currently, experts say they won't necessarily save more lives.

The challenge with the CA-125 test is that blood levels of this antigen aren't always high, and other conditions, such as pelvic inflammation and pregnancy, can raise readings, explains Claudine Rancourt, an ovarian cancer researcher at the Université de Sherbrooke in Quebec. More accurate detection tools are on the horizon. A new DNA test that detects cancer-gene mutations overlooked by standard tests is now available for some women. Researchers are also studying unique blood proteins that may reveal early-stage tumours.

Dr. Jim Paupst, a physician in Toronto, insists that a transvaginal ultrasound, manual pelvic exam and CA-125 test together are the best strategy for early detection. "Eighty per cent of women with ovarian cancer will have elevated CA-125 levels," he says. He advises pushing for ovarian cancer screening as part of your annual checkup.