Ovarian cancer can pose treatment challenges, but women faced with the disease have options. In the second entry of our two-part discussion on ovarian cancer (read part one), medical oncologist Mihaela Cristea, M.D., offers information on causes, risk factors and steps women can take to help shield themselves from this “silent killer.”

eHope: What causes ovarian cancer?

Mihaela Cristea (Photo by p.cunningham)

Mihaela Cristea, M.D.: The causes of ovarian cancer are unknown, but the thought is that ovarian cancer is a hormone-related disease. “Continual ovulation,” a condition where women produce one egg after another with little or no pause between, may play a role in the development of ovarian cancer. Excessive production of gonadotropin, a hormone that stimulates the ovaries, may be another factor involved.

EH: What are the risk factors for the disease?

MC: Reproductive history, menstrual characteristics, the use of estrogen-based medications (including supplements) and family history have been identified as risk factors. 

Being young (25 years or under) at first pregnancy and birth, breastfeeding and using oral contraceptives all are associated with a reduced risk of ovarian cancer.

Nulliparity (having never given birth), older age (35 years or more) at first pregnancy and birth and the use of fertility drugs have been associated with increased risk of ovarian cancer.

Family history is an important risk factor and has been associated with developing cancer at an early age. Of women with ovarian cancer, 5 to 10 percent have hereditary disease. Patients having two or more first-degree relatives (sibling or parent) with ovarian cancer, or having immediate family members with breast and gastro-intestinal cancers, may have a hereditary ovarian cancer. Genetic testing is available for women at high risk.                   

EH: What preventive measures can a woman take?

MC: In women who have a genetic predisposition to ovarian cancer (such as mutations in the BRCA1 or BRCA2 genes), removing both ovaries appears to reduce the risk of ovarian cancer substantially, although there is a residual risk of peritoneal cancer, which occurs on the lining of the abdominal cavity.

Also, an analysis of several studies reported in 2008 concluded that women who have taken oral contraceptives lowered their risk of ovarian cancer by 20 percent for every five years they took the pill. This reduction in risk persisted for many years after they stopped taking the pills but lessened over time. The benefit of decreasing the risk of ovarian cancer should be balanced of course with potential side effects of oral contraceptives, such as blood clots and cardiovascular events.

EH: Are there any actions women can take to give themselves the best chance to fight the disease, if they're diagnosed with it?

MC: Most women diagnosed with ovarian cancer will require both surgery and chemotherapy. They should be well-informed regarding available treatment options. I would encourage them to talk with their treating physicians about both standard therapy and clinical trials.