Although ovarian cancer awareness and research have improved over the past decade, a lack of biological understanding and screening options still result in one of the deadliest cancer outcomes.
Lan Coffman, M.D., Ph.D.
Medical Oncologist and Gynecologic Cancers Specialist; Assistant Professor of Medicine, University of Pittsburgh Department of Medicine; Scientific Advisory Board Member & Funded Researcher, Tina’s Wish
Why is it so difficult to detect ovarian cancer early?
I think the really challenging part of detecting ovarian cancer early is that there are no symptoms until the cancer is at an advanced stage, meaning it’s already spread throughout the abdomen and is already metastatic. That’s why it’s called a silent killer — by the time you actually develop symptoms from it, you have the disease all throughout the abdomen.
The other challenge is that the most common type of ovarian cancer, which is high-grade serous ovarian cancer, actually starts in the fallopian tube and not in the ovary. We don’t have a good way to image the fallopian tube. We can’t do things like mammograms or colonoscopies, so you have these little tumors starting in the fallopian tube that we have no way to detect. Then they spread to the ovary and beyond, and that is the only time when we actually develop symptoms from it.
Why is it important to research ways to better detect ovarian cancer early on?
We know from ovarian cancer and the vast majority of other cancers that if we catch it early, we can save people’s lives. That is how we can actually cure cancer. However, if we find cancer when it’s already spread, like when we normally diagnose ovarian cancer, the chances of cure are much lower. If you are diagnosed with ovarian cancer at stage 1, your chances of cure are greater than 90%. If you catch ovarian cancer at late stages like stage 3 or stage 4, your chances of cure a much lower, in the 30% range. To actually improve survival and improve cures for ovarian cancer, we have to either find ways to prevent this disease or to find it early.
Have there been any recent breakthroughs in early detection of ovarian cancer or anything on the horizon that you’re intrigued by?
I think one of the most important discoveries is actually finding that most of these high-grade serous ovarian cancers actually start in the fallopian tube. By understanding how these cancers start, we can then focus on the biology behind them. Where should we be looking for early detection strategies?
Understanding that it starts in the fallopian tube is really important because it also gives us opportunities to intervene. Once a woman is done childbearing, the fallopian tubes are not necessary for her health, so there is a push to towards doing things like opportunistic salpingectomy, which simply means taking the fallopian tubes out anytime you’re in the belly for another reason, such as a gallbladder surgery or hysterectomy. If you’re going to have your tubes tied for contraception, instead of tying the tubes, actually take out the fallopian tubes entirely. Then you’re taking out the source of these cancer cells. I think that is a really interesting and important opportunity. It’s something that is relatively low risk if you’re having surgery anyway, and it doesn’t impact your hormonal status. It doesn’t put you into menopause.
What can our readers do to increase their chances of detecting ovarian cancer earlier, before a screening is available?
Awareness is critical. We need to understand that all women are at risk for this. Be aware of your body. Talk to your doctor if you’re done with childbearing. If you’re having another surgery, talk to your doctor about having your fallopian tubes removed.
I think the other important thing is knowing your family history. We know the biggest risk factor for ovarian cancer is having a BRCA mutation that’s passed down from your mom or your dad. See if someone in your family had ovarian cancer or early-onset breast cancer. Ask your doctor about the need for genetic testing.
Not only does genetic testing impact the treatment of a woman that has ovarian cancer, but if you find one of these mutations, then you can test family members, both men and women. If you were found to have one of these mutations, there are things you can do about it. In those cases, we can take out both the tubes and the ovaries, which dramatically decreases your risk of actually getting ovarian cancer. We can prevent the development of these cancers if we know that you have this high risk gene. I think that’s one of the most critical things that you can do for yourself.
How did you get involved with Tina’s Wish?
When I was a fellow, I started doing ovarian cancer research, and there was a grant opportunity for what’s called a Rising Star Grant. It was a very provocative grant opportunity, and after getting the grant, I started to focus on earlier and earlier stages of ovarian cancer and saying, you know, “Let’s tackle the hardest question there is here.” Can we prevent it or find an early diagnosis?
That’s how my path took me to be involved with Tina’s Wish, and they’ve just been fantastic in terms of bringing clinicians and scientists together. They have great advocacy programs. I have a daughter who’s very interested in genetic counseling, and she’s asking questions like, “Why isn’t this available for everyone? Why aren’t women getting the genetic testing they need?” So, she’s become involved as a teenage Wish ambassador. It’s become a whole family thing now, and they’ve been great. I really enjoy working with them, and it’s pushed me to think about the hardest questions in ovarian cancer research. I very much I wouldn’t be studying the earliest stages of ovarian cancer without them.
Is there anything else you want to add?
Women’s health in general — and particularly gynecologic cancers — are understudied. The way that we can improve women’s health and reduce their cancer risk — reduce their chances of dying from cancer — is through research and awareness. I think it is critically important that we get the message out, hopefully fund more of the basic research, and translate it into clinical advances.
