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Dr. Jones: Let's talk about ovarian cancer awareness. Let's talk about what you can do to decrease your risk of ovarian cancer. This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah ÐÇ¿Õ´«Ã½ Care and this is The Scope.

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's ÐÇ¿Õ´«Ã½" with Dr. Kirtly Jones on The Scope.

Dr. Jones: Ovarian cancer is one of the deadliest of gynecologic cancers. We don't have an early detection test like the Pap smear, which is very good at early detection of cervical cancer. Ovarian cancer doesn't have an early warning sign like abnormal bleeding, which gives us a heads-up about early uterine cancer. Ovarian cancer is sneaky. The symptoms of ovarian cancer, bloating, abdominal fullness with eating, pelvic discomfort, all come when the cancer has spread at least a little bit. And these symptoms are pretty common in women so that makes it difficult to know exactly who you should work up.

We've talked before about the fact that cancers, in general, are about one-third genes, one-third environment and behavior, and one-third bad luck. We know we cannot change our genes and changing our luck is sort of a cosmic thing, but what can you do to decrease your risk of ovarian cancer? The most common kinds of ovarian cancers arise from the cells on the surface of the ovary. Some of these might actually be coming from the fallopian tubes with some types of ovarian cancers that just seem to arise from the uterine lining cells that find themselves in the pelvis.

A jillion years ago when I was on a GYN cancer service in Boston, we used to say that ovarian cancer was a nun's cancer. Boston had a lot of nuns and it seemed as if these lovely women had ovarian cancer more often than we would expect. Well, we do know that nuns have a slightly increased risk of ovarian cancer, compared to women in the general population.

What is true is that there's an increased risk of ovarian cancer in women who have never had children. This has been looked at a number of ways. First, there's a decrease in the risk of ovarian cancer by 50% in women who have had their tubes tied. Women who have had their tubes tied usually have had a bunch of kids. Two, there's an increase in ovarian cancer in women who are infertile. Is it being pregnant and having kids that protects you? Is it infertility treatment, all of those hormones and things that put you at risk? Is it the cause of infertility, like endometriosis, that both makes women infertile and puts them at risk? It might be all of these.

Having said all that, I don't want women to rush out and have a bunch of kids that they might not be prepared for just to decrease their risk of ovarian cancer. It turns out that the Centers for Disease Control did a big study on contraception, and hormones, and gynecologic cancers and lo and behold, taking birth control pills lowers the risk of cancer by as much as 50%. It even lowers the risk of ovarian cancer if you have the family genes like the BRCA mutations that put you at risk for ovarian cancer. How do hormonal birth control pills do that? We don't exactly know, but it could be that ovulation, which disrupts the surface of the ovary each month, is a little bit risky with respect to ovarian cancer.

So how do you decrease your risk of ovarian cancer? If you're thinking about contraception, you may want to consider birth control pills. We don't seem to find the same protection with IUDs or implants, at least not yet as implants haven't been around that long yet for us to really know.

Another ovarian cancer prevention strategy, because there's some suggestion, and it's controversial, but that cells from the fallopian tubes may play a role in ovarian cancer. There's some suggestion that women who have their fallopian tubes removed, not their ovaries, just their tubes, have a decreased risk of ovarian cancer. So if you're thinking about having an operation to have your tubes tied, either immediately after a baby is born or later with the laparoscopy, maybe you should talk to your gynecologist of having your tubes removed. Importantly, if you have a BRCA mutation in your family and you have that mutation that is one of the genetic causes of an increased risk in ovarian cancer, you may choose to have your ovaries removed.

Now, there are some other things that may have an association with an increased risk of ovarian cancer. We don't know if these are a cause, but it seems to be an increased risk. There's a slight increased risk of ovarian cancer in women who take hormone replacement therapy after menopause. The risk is small and we don't understand the cause, but it's there to think about. And there seems to be a small increased risk of ovarian cancer in women who use talcum powder down there, on their perineum, on their lady parts. Even if the risk is low, it probably isn't necessary and we don't suggest it.

So I'm not suggesting that nuns should take birth control pills, although that has been suggested by some. And I'm not suggesting that women have more children that they're unprepared for. But there are some other health benefits of birth control pills: lighter periods, lower risk of uterine cancer, and if you're having your tubes tied or operated on to end your fertility, maybe taking the tubes out isn't a bad idea. And talcum powder on your lady parts isn't a good idea.

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