By John Morgan, Spotlight Health
With medical adviser Stephen A. Shoop, M.D.

Miss USA Susie Castillo is representing the United States in the annual Miss Universe pageant.  Whether or not she gets that crown,  she'll still be a winner. Castillo knows that her health is far more important in life.

That's why Castillo and the Miss USA organization are helping promote ovarian cancer awareness through a partnership with 1-800-Flowers.com and the joint sponsorship of the annual Bring Your Mom to Work Day. The event held every May has raised nearly $150,000 for ovarian cancer research.

"Breast and ovarian cancer awareness are the official causes of Miss USA," Castillo says. "I am the fifth title holder to promote this cause. I'm working with the Ovarian Cancer Research Fund to help raise money and awareness."

"Ovarian cancer affects so many lives each year," Castillo says. "Not just the women who have the disease but their families as well. With the support of companies like 1-800-Flowers, we can facilitate the advance of ovarian cancer research and save the lives of thousands of women across our country."

The most serious of the female reproductive malignancies, ovarian cancer kills approximately 14,500 of the estimated 25,000 women who are diagnosed every year. According to the OCRF, a woman's lifetime risk of developing ovarian cancer is 1 in 55.

Ovarian cancer usually develops in the thin layer of cells covering the ovary. As the tumor grows and the ovary swells, cancer cells shed into the abdominal cavity and can spread to other intra-abdominal organs.

And virtually all the time, this cancer develops silently -- without symptoms.

"There are often no obvious symptoms so we really need to increase understanding about ovarian cancer," Castillo notes. "Most ovarian cancer patients catch it too late. This is a really frustrating and terrible disease because there is no screening for it."

"The most important thing for women is to know your body," Castillo adds. "Because ovarian cancer is a silent killer, women need to be almost intuitive about their body and any changes they feel."

Silent killer

"Unfortunately, most of the women are diagnosed with advanced disease," says Andrew Berchuck, a cancer specialist and professor of gynecologic oncology at Duke University Medical Center. "With improved surgery and chemotherapy women are living longer but we're really not curing a lot of people. The ultimate survival rate is still pretty poor."

The OCRF reports that less than 46% of all ovarian cancer patients survive more than five years after diagnosis. But like all cancers, survival rates increase dramatically if the disease is detected and treated early. The five year survival rate is 95% given a timely diagnosis.

"The biggest problem is we don't have a screening test," Berchuck notes. "We don't have the means of identifying the high risk population. We have a long way to go here. For the women who do have a strong family history, genetic testing is certainly recommended - but that is a small minority of women."

The good news for those 10% of patients with the hereditary form of ovarian cancer is researchers have identified two genes - BRCA 1 & 2 - responsible for this type of malignancy.

"The identification of BRCA 1 and 2 as genes responsible for hereditary ovarian cancer is very exciting," Berchuck says. "We can do genetic testing in families and this may give us the opportunity to prevent ovarian cancer. In women who carry these mutations, the ovaries can be removed at about age 40 prior to the development of ovarian cancer."

Other possible risk factors besides a strong family history of breast or ovarian cancer are:

• Infertility
• Use of fertility drugs
• Talcum powder on sanitary napkins
• Smoking

But certain factors decrease the risk of ovarian cancer including:

• Childbearing
• Use of oral contraceptives
• Tubal ligation, a sterilization procedure to prevent pregnancy
• Hormone replacement therapy

Using protection

"One of the most important points is that many women don't understand the protective effect of the pill," Berchuck stresses. "Women need to understand that oral contraceptives have an additional side benefit of some ovarian cancer protection."

"We know from epidemiologic studies that birth control pills and pregnancy are profoundly protective against ovarian cancer," Berchuck explains. "One of the focuses of our research is to understand at a molecular level why pregnancy and the pill have this effect."

According to Berchuck, a woman who has three children or uses the pill for five years has half the ovarian cancer risk.

"That's pretty dramatic," Berchuck says. "We need to understand what is happening at the molecular level and learn to exploit it better. We think it's a direct effect to some extent of the progestin on the ovaries."

Progestin is the hormone produced by the placenta during pregnancy. Half the birth control pill is progestin, the other half is essentially estrogen.

While much of the ovarian cancer news can seem bleak, Berchuck puts a positive spin on it.

"Twenty years ago the average woman with ovarian cancer only lived about a year and a half," Berchuck says. "Now they are living about 3.5 - 4 years because the surgery and chemotherapy has gotten a lot better. And we're learning a lot about the genetics of ovarian cancers. There is definite, measurable progress occurring in our understanding of the disease."

While Berchuck readily admits there's still a long research road ahead, he credits OCRF as having been instrumental in raising money for ovarian cancer research. Over the past few years OCRF has annually funded about $1.25 million in research.

Castillo is hopeful that a cure will emerge.

"This year's Bring Your Mom to Work Day was a lot of fun and it's something I encourage everyone to do," Castillo says. "But even though the events are over we need to care our mothers and our own health every day. I hope people will contribute throughout the year so that hopefully we can find a way to screen for the disease and ultimately a cure."

• Ovarian Cancer Research Fund

• American Cancer Society

Spotlight Health is the leading creator of celebrity-featured health-issue awareness campaigns, connecting consumers with impassioned celebrities whose personal health battles can open eyes, dispel myths and change lives. Spotlight Health helps sufferers and caregivers meet the challenges of difficult health circumstances with understandable, in-depth medical information, compassionate support and the inspiration needed to make informed healthcare choices.

Created: 6/5/2003  -  John Morgan & Stephen A. Shoop, M.D.
Reviewed: 6/5/2003  -  Donnica Moore, M.D.