DR. HOOK- Ovarian cancer: Early detection not so easy

"Friends come and go, Talking of Michelangelo" is my adaptation of T.S. Eliot's The Love Song of J. Alfred Prufrock. I never really got into poetry, so to challenge myself, at Denison University I enrolled not just in a poetry class, but in an honors poetry class. 

Ho ho ho... hum. In a normal poetry class, I'm sure every poem would have rhymed, which is the way I think it should be. The best songs have lyrics that rhyme, unlike Andrew Lloyd Webber's songs that drive me crazy. Rhyme in time, don't be sublime! 

In this honors poetry class, none of the poems rhymed, and I just didn't get it. It was like cake without icing. However, we did get to read The Love Song of J. Alfred Prufrock, and I was tickled pink. A good friend of mine, an English major, thought that was rather amusing. But then again, she loved Jane Austen books.

I have found it true that college friends are often life-long friends. However, before the age of email, we lost touch when she moved to Europe. Nineteen years later, we finally met again, and she told me an eerie story. She had seen a vision or ghost of her deceased father holding her mother's hand– happy to be together again. A few hours later, her mother succumbed to her five-year battle with ovarian cancer. (Patricia Arquette as the psychic in Medium, eat your heart out.) 

Ovarian cancer occurs in over 22,000 American women a year, and more than 16,000 of them will die from it. That's more deaths than from cervical and uterine cancer combined. Most ovarian cancers are detected in the later stages, so the five-year survival rate is only 20 percent. If detected in an early stage, the five-year survival rate rises to 90-95 percent. So why isn't it detected sooner?

Screening for ovarian cancer isn't cost effective, mostly because the positive predictive value is only 10-20 percent in the general population. That means in an average woman, a positive screening test by both transvaginal ultrasound and the blood test CA-125 will detect ovarian cancer only 10-20 percent of the time.

The other 80-90 percent of women with these positive screening tests will undergo unnecessary surgery to find out they don't have ovarian cancer. Plus, the emotional distress might cut as deep as the scalpel. 

Most women who have ovarian cancer do not have risk factors, such as older age, infertility problems, never pregnant, family history, Ashkenazi Jewish descent, or the BRCA 1 or 2 gene. Only 10-15 percent of women with ovarian cancer have a family history. 

On the other hand, women with the BRCA 1 or 2 gene have a 40 percent lifetime risk of ovarian cancer. This gene is associated with breast cancer and ovarian cancer, so prophylactic mastectomies and complete hysterectomy with removal of Fallopian tubes and ovaries are considered in these women. (Egads, and we men complain about stupid genes we inherit, like pattern baldness.)

Ninety-five percent of women with ovarian cancer have vague symptoms a few months before diagnosis. The most important symptoms include pelvic pain, bloating, increasing abdominal girth (due to fluid buildup in the abdominal cavity), and urinary urge and frequency. 

Sounds like PMS, or me when my irritable bowel syndrome acts up, and that's the problem. Doctors don't order ovarian cancer tests because the symptoms could be GI related. We also don't know for sure if looking for ovarian cancer in symptomatic women will detect earlier stages of the disease.

Treatment involves surgery and possibly chemotherapy afterwards. It is an awful disease, and we need better screening tools to detect it earlier. 

As far as my college friend's mother is concerned, there is no rhyme or reason why she struggled with ovarian cancer, but from what I know, her life was still poetry.

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