The best way to help women avoid ovarian cancer is to find it as soon as possible. But since there are few standardized screening tests, less than a quarter of patients are diagnosed before the cancer has spread to surrounding tissues and organs.

Mack Barnes, M.D., UAB gynecologic oncologist and co-director of UAB's Multidisciplinary Ovarian Cancer Clinic and the Lynne Cohen Ovarian and Breast Cancer High-Risk Assessment Clinic, is working to change those numbers. Dr. Barnes and his colleagues are improving existing screening techniques and developing new ones.

Current screening techniques leave room for improvement. They have a high degree of inaccuracy and often falsely lead to invasive interventions, says Dr. Barnes. So screening is generally reserved for those women with a strong family history of ovarian cancer and those with genetic abnormalities that are associated with the disease.

Most screening techniques involve an examination of the pelvic area for masses and growths that could indicate cancer. This can be a physical examination of the vagina, uterus, rectum, and ovaries, or it can be an ultrasound, computerized tomography (CT), or magnetic resonance imaging (MRI) scan.

The trouble is that ovarian cancer may be far advanced before these techniques reveal a mass. "We don't see the expansion of a huge ovary that then, late in the process, starts falling off and spreading," says Dr. Barnes. "A lot of times, during surgery, we see a sandpaper-like appearance to the ovarian surface that you would not detect on ultrasound, CT scans, or PET scans. So there may not be an early physical abnormality that can be detected by the methods that are available to us."

Another option is a blood test for CA 125, a protein made by the body in response to different conditions, including ovarian cancer. The test has a high false-positive rate and is not recommended for routine screening. But it can be helpful for screening women already identified as being at high risk for ovarian cancer due to genetic abnormalities or family history.

Early Detection

How does a woman know if she is at high risk? UAB's Lynne Cohen clinic provides detailed screening and assessment evaluations for both breast and ovarian cancer because there is sometimes a demonstrable link between the two. Physicians pay special attention to mutations in two specific genes: BRCA1 and BRCA2. Mutations of these genes can increase a woman's risk for both breast and ovarian cancer by as much as 70 percent. Identifying and addressing these mutations early allows physicians to take the appropriate measures to address and even prevent future problems.

"When BRCA1 and BRCA2 are abnormal, preventively removing the ovaries and fallopian tubes at the right age does reduce the risk of ovarian cancer to almost zero," Dr. Barnes says. "There also appears to be a benefit of reducing the risk of breast cancer in these women. Folks with these mutations have about a 30 percent risk of ovarian cancer and an 80 percent risk of breast cancer over their lifetime."

Prevention

Prevention is, of course, preferable to treatment. Pregnancy, breastfeeding, and past use of oral contraceptives have all been shown to reduce a women's risk of ovarian cancer. New research indicates that calcium may also play a role. Although results from other investigations have been mixed, a 2005 study found that women who consume more than 1,100 milligrams of calcium per day-slightly more than the American Dietetic Association's recommended daily consumption for women under 50-cut their risk of cancer by 54 percent compared to women who consumed half that amount. The benefits were attributed to two to three servings of white milk and other dairy products; calcium supplements had no apparent benefit.

Dairy products (milk, yogurt, and cheese) are an obvious source of dietary calcium, but there are also plenty of non-dairy options, including:

• salmon
• figs
• mustard and turnip greens
• Chinese cabbage (bok choy)
• soy nuts

Caperton Gillett