Walter Reed National Military Medical College, BETHESDA, Md  –   National Ovarian Cancer Awareness Month is observed in September to increase the public’s knowledge about the disease and its prevention.

“Walter Reed’s Gynecologic Cancer Center of Excellence (GYN-COE) includes renowned surgeons, researchers, and nurse navigators who focus on comprehensive and precision oncology for gynecologic malignancies. The GYN-COE also collaborates with leading cancer centers throughout the nation to offer contemporary clinical trials to our patients. We are recognized by our ability to care for patients throughout the continuity of their cancer journey, from diagnosis to survivorship,” said U.S. Army Lt. Col. (Dr.) Christopher Tarney, a gynecologic oncologist at Walter Reed National Military Medical Center.

Tarney is the associate program director for the National Capital Consortium Fellowship in Gynecologic Oncology, and assistant professor for the Uniformed Services University’s Department of Gynecologic Surgery and Obstetrics.

In addition to Tarney, two other gynecologic oncologists are on staff at the GYN-COE at Walter Reed -- U.S. Army Lt. Col. (Dr.) Kristen Bunch and U.S. Air Force Maj. (Dr.) Susan Folsom. All agree that early detection is essential in beating ovarian cancer, which according to the Centers for Disease Control and Prevention (CDC), is the deadliest cancer of the female reproductive system. It's also the second most common gynecologic cancer in the United States, CDC officials stated.

“Ovarian cancer is the eighth most common women's cancer worldwide, with the highest mortality rate of any gynecologic malignancy. On a global scale, there are over 300,000 cases annually with approximately 200,000 deaths,” said Folsom.

“The deadliness of ovarian cancer can be attributed, in part, to the fact that we do not have effective screening. It typically presents at advanced stages (stage III/IV) and requires a combination of aggressive surgery and chemotherapy. Even with these aggressive treatments, there is a very high likelihood that the cancer will recur, and at recurrence, it is notoriously difficult to treat,” she explained.

Folsom shared that there continues to be ongoing research into the causes of ovarian cancer. In recent years, evidence has supported that the disease originates from abnormal cells in the fallopian tubes.

“The cells typically undergo DNA mutations that eventually allow those cells to metastasize and rapidly spread throughout the abdominal cavity. Given that the cancerous cells come from DNA mutations, it is not surprising that approximately 20 percent of ovarian cancers are heritable through genetic mutations,” Folsom continued. “The most common genetic causes of ovarian cancer are the BRCA1 and BRCA2 mutations, which are genetic mutations with an approximately 40 percent (BRCA1) and 20 percent (BRCA2) lifetime risk of ovarian cancer, respectively,” she added.

“The biggest known risk factor for ovarian cancer is a family history of it. The general population has an approximately 1 percent risk of developing ovarian cancer in their lifetime,” Folsom said. “Patients with a first-degree relative have an approximately 5 percent risk of developing ovarian cancer, and those with deleterious mutations, such as BRCA1, can have as high as a 40 percent risk of developing ovarian cancer.”

According to the CDC, other risk factors include inherited gene changes, hormone use, smoking, or being overweight.

“Beyond genetic risks, patients' reproductive health history is important in determining their risks. Those with early menarche, late menopause, and low parity (meaning few pregnancies) are all at increased risk of ovarian cancer. Patients who take oral contraceptive pills are actually at a lower risk of developing ovarian cancer, and those with a history of endometriosis are at a higher risk of developing specific types of ovarian cancer. Most patients with ovarian cancer are older, so increasing age increases risk, and most patients diagnosed are postmenopausal,” Folsom said.

The CDC states that some screenings can detect ovarian cancer in its earliest stages before a doctor can feel it during an exam. Folsom said that symptoms for the disease are “nonspecific” and that it can be difficult to diagnose ovarian cancer. “Most patients present with abdominal bloating/fullness and early satiety. They may experience pelvic pain, and many patients report fatigue. Ultimately, for postmenopausal patients complaining of these symptoms, there should be a low threshold for medical providers to obtain imaging, whether that includes a transvaginal ultrasound to evaluate the ovaries or a CT scan of the abdomen and pelvis,” she explained.

“We know there are factors that are protective against ovarian cancer, but many of them are difficult to control, and their reliability in preventing ovarian cancer is unclear. The most important preventative practice for ovarian cancer is to ensure that patients with a family history of cancer get genetic testing, and if needed, risk-reducing surgery,” shares Folsom. She said this may include patients with BRCA1 and BRCA2 mutations having their fallopian tubes and ovaries removed once childbearing is complete, at age 35-40 and 40-45, respectively.

“These surgeries are our best tool for ovarian cancer prevention and ensuring that patients receive appropriate genetic counseling can help patients and their families get the necessary screening and prevention for many other cancers as well,” she added.

The CDC also states that some studies suggest women who breastfeed for a year or more may have a modestly reduced risk of ovarian cancer.

“Once patients have a new diagnosis of ovarian cancer, it is treated with a combination of chemotherapy and surgery,” said Folsom. Following these treatments, patients are monitored closely for recurrence of the disease, she added.

This year’s White House proclamation for National Ovarian Cancer Awareness Month states, “Let us resolve to doing all we can together to provide patients, survivors, and their families the treatments, care, and support they need and deserve. Let us rededicate ourselves to the urgent work in increasing awareness about ovarian cancer so that we can save more lives more quickly. And let us never lose hope or waver in our resolve to ending cancer as we know it – for all the lives lost and all those we can still save.”

For more information about the Gynecologic Cancer Center of Excellence (GYN-COE) at Walter Reed, call the center at 301-400-1257/8.