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Sunday, February 28, 2016

Is It Your Genetics, The Age You Had Your Babies or Your Use of Talc Powder that Gives You Higher Ovarian Cancer Risk?

Ovarian Cancer Found Near the Left Fallopian Tube
The link between talcum powder and ovarian cancer is back in the news. There have been some legal cases that have been brought against the parent company for some powder brands, but a law suit is not always decided by science, and the issue is not resolved scientifically.

Cancer awareness increases when it arouses our sympathy, and it's not just news stories about the science we remember most. Most of us are fortunate enough to have not had ovarian cancer strike close to home happen, have been connecting through our favorite shows, characters and actors with this devastating disease. In the final season of the recent incarnation of 90210 had a young main character who was told she had BRCA mutations and was considering removal of her ovaries. And then the ScyFy Channel show Warehouse 13 has the female lead recently diagnosed with ovarian cancer. Last year Pierce Brosnan’s 41-year-old daughter passed away of ovarian cancer on 6/28/2013 and her mother died of the same disease in 1991 at age 43. If a family member had the disease, we urge you to come in to discuss screening. Many good sources of information exist, but an excellent place to find facts about ovarian cancer would be http://www.cdc.gov/cancer/ovarian/index.htm

It is possible that other factors than talk, such as the age you had children or the year of your menopause that may really be producing risk. The current highlighted media story is whether the talc link is an important cause, or just a bystander with respect to women being at risk for ovarian cancer. Ovarian cancer is very serious, but not the most common female cancer. 22,000 women are diagnosed in the US each year, and it causes over 14,000 deaths each year. . As the number one gynecologic deadly cancer ovarian cancer is a very serious disease mostly because there is no meaningful way that we can catch this cancer in it's earliest and most curable stage. Treatments are more successful than they used to be but it is sill, best strategy is still to prevent  if this would be possible. So the strategies have been to identify risk factors, especially those to modify, and risk factors we cannot modify. For those who have significant risk factors, other than talc use, they should be watched a bit more closely, potentially have screening ultrasounds and blood tests, and hope that, at least for some women, if she gets cancer it will be caught early.

Other, more clearly linked risk factors for ovarian cancer include history of breast, colon, or prior ovarian cancer; possessing a known genetic link such as the BRCA or RAD51C genes; late menopause (over age 52),; and having your first baby after the age of 30. All the 'generally' recommended anti-cancer strategies are important: don't smoke for starters. Specific advice to avoid ovarian cancer would also include: taking birth control pills, having more than one child, breast feeding your babies, normalizing your and probably eating the right diet high in vegetables. Now there's another possible protective factor: some soy consumption. There is some reason to believe this is more than just a quirk of a type of diet studied. New studies tells us that there is basis for believing soy foods can protect as against ovarian cancer.

And what of the question of talc specifically producing ovarian cancer? There are at least three good reasons to steer away from body powder use near the private parts for gals: .If  your powder contains talc  it used to be thought to lead to ovarian cancer (here's the latest link on this), 2. It is drying to your skin, and  3. Actually the fine grains can cause micro tears in sensitive tissues, so for the vaginal regions this makes STDs easier to catch. Older talcum powder had asbestos which is a known cancer producing substance, but it no longer contains this.

  Generally gynos will say stay away from genital use of talc, but most do not firmly know if talc is harmful as noted in this 2011 story. Medical News: AACR: Talc Use Linked to Ovarian Cancer Risk - in Meeting Coverage, AACR from MedPage Today

We have not decided about the absolute link between talc and ovarian cancer. Scientifically it is porve that powders used in the vaginal opening can  make their way from the vaginal opening, up through the cervix and into the abdomen through the fallopian tubes. Although we feel it is in very minute fragments, and it is a question whethere these powders  could be linked to infections, endometriosis or ovarian cancers. Read this study to see the link with ovarian cancer. Note that the use of talc-based powder increased ovarian cancer risk by 30%...but the question is when was actual "TALC" removed from most powders that you would be in contact with.But it is still in many make up brands.

Hormone therapy in menopause is not likely to significantly reduce ovarian cancer risk and in some studies hormone therapy is linked to greater risks of ovarian cancer. New Studies link ovarian cancer and hormone therapy published in the Lancet by the Collaborative Group on Epidemiological Studies of Ovarian Cancer. Although we know that progesterone is protective against uterine cancer, and estrogen alone may be protective against breast cancer, an ideal hormone therapy combination in menopause which would decrease ovarian cancer risk has never been conclusive.. If you are taking hormone therapy, or considering hormone therapy we have a few bits of gyno advice:  First you need to establish your baseline risk of ovarian cancer with your gyno. Next you should monitor your risks. After that weigh your risks and benefits of any therapies with how they might impact on your overall risk of ovarian cancer, finally you should have any subtle symptoms monitored for actual ovarian cancer. If you know you have some family history, or if you have no family history at all perhaps at the same time as following basic risk reducing strategies you should draw blood for  genetic testing , but we do not generally do extra ovarian cancer testing in women who have used menopausal hormone therapy.

Blood tests to determine ovarian cancer are most often done if a woman has a mass on her ovary. For years only the CA125 has been the blood test used, but there are new ones. Blood test for markers and risk factors for ovarian cancer have been combined to produce a better prediction model for women with ovarian cancer. The new test is called ROMA, and it is available through either Covance lab or Quest Diagnostics. And if you have been diagnosed with a mass or cyst of the ovary, and are planning surgery, this test may help your gyno plan treatment and prognosis for your condition. In this case it meant having a laparoscopy that was able to establish the early diagnosis of ovarian cancer in a patient with vague abdominal discomfort. Other new blood tests are just useful if you are being followed for an actual ovarian cancer diagnosis. New biomarkers  like the HE4 at Fujirebio Diagnostics  is a one of the newst markers of ovarian cancer

If you have genetic risk, some women will contract breast or ovarian or even fallopian tube cancer. Those who carry these genes have a greater than 50% chance of recurrence of breast cancer, a greater chance of ovarian cancers, and there are risks of other cancers in their family. In 2013 it has come out that carriers are at risk for fallopian tube cancers as well as cancers of the peritoneum (the tissue lining the abdomen). In fact about 60% of the cancers that are labeled serous tumors actually come from the fallopian tubes rather than the ovaries. The average age of onset of ovarian cancer for a BRCA positive carrier is over the age of 55. Once someone tests positive they can inform family members who can then be screened and either will be negative: thus treated normally, or positive for the gene: and precautions can be taken. Precautions may mean more ultrasounds and blood tests as mentioned or the more radical step of removing your ovaries or fallopian tubes. 

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