Ovarian Cancer Awareness Month: Prioritizing Early Detection, Bridging Equity Gaps

National Ovarian Cancer Awareness Month provided an opportunity to raise awareness about ovarian cancer risks, the importance of early screening, and the ongoing disparities in care.

September marks Ovarian Cancer Awareness Month, highlighting the importance of early detection and the need for equitable care access. | Image Credit: Rabin - stock.adobe.com

Ovarian Cancer Awareness Month History

President Bill Clinton first recognized ovarian cancer awareness by proclaiming September 13 to September 19, 1998, as Ovarian Cancer Awareness Week.¹ In 2000, the National Ovarian Cancer Coalition expanded this to the entire month of September, an effort formalized the next year by President George W. Bush.^2,3 From then on, the month was annually recognized as such.

In his proclamation, Bush highlighted that experts predicted that more than 23,000 ovarian cancer cases would be diagnosed in 2001 and about 13,900 women would die from the disease. Additionally, he wrote that ovarian cancer is “very treatable when detected early,” but only 25% of US patients are diagnosed in the early stages.

Consequently, when diagnosed in advanced stages, the chance of 5-year survival is about 25%. Therefore, about 50% of women with ovarian cancer die within 5 years; in particular, only 48% of Black women with ovarian cancer survive 5 years or more. This is because diagnoses often occur after the cancer has spread beyond the ovaries. Therefore, Bush emphasized the need for early detection, encouraging women to educate themselves on ovarian cancer symptoms and risk factors.

Today's Ovarian Cancer Statistics

Compared with the 2001 predictions, experts estimated that about 19,680 women will receive a new ovarian cancer diagnosis this year and about 12,740 women will die from it.⁴ Therefore, ovarian cancer diagnoses have been slowly decreasing.

More specifically, the incidence rate declined by 1% to 2% per year from 1990 to the mid-2010s and by almost 3% per year from 2015 to 2019. The experts hypothesized that this is due to the increased use of oral contraceptives and the decreased use of menopausal hormone therapy.

Overall, the ovarian cancer death rate has decreased by 40% since 1975, with most of the progress happening since the mid-2000s. The experts hypothesized this is likely due to the decreasing number of diagnoses and better treatments available.

Potential Early Detection Methods

While ovarian cancer diagnoses have decreased since 2001, the need for early detection remains critical; the earlier the cancer is caught, the better the survival outcomes. Though ovarian cancer often shows no early symptoms, regular pelvic exams, awareness of symptoms, and screening tests can improve early detection rates.⁵

Pelvic exams involve health care professionals feeling the ovaries and uterus for shape, size, and consistency. Although most early ovarian tumors are difficult or impossible to feel, these exams may help find other cancers or female conditions.

Experts also urge women who experience ovarian cancer symptoms to see a doctor; the most common symptoms include bloating, pelvic or abdominal pain, urinary urgency or frequency, and trouble eating or feeling full quickly.⁶

However, early ovarian cancer often causes no symptoms, so the cancer has likely already spread if it is considered a possible cause of these symptoms.⁵ Despite this, paying attention to symptoms may improve the odds of earlier diagnosis and successful treatment. Therefore, experts instruct that patients report their symptoms to a health care professional if they experience them almost daily for more than a few weeks.

Because symptoms often do not manifest for those with early ovarian cancer, experts suggested using screening tests. The 2 most commonly used are transvaginal ultrasound (TVUS) and the cancer antigen (CA)-125 blood test. TVUS uses sound waves to look at the uterus, fallopian tubes, and ovaries with an ultrasound wand; it can help find a tumor in the ovary, but it cannot determine if it is cancerous.

Additionally, the CA-125 blood test measures the amount of CA-125 protein in the blood; many women with ovarian cancer have high CA-125 levels. However, experts do not consider it an effective screening test since high CA-125 levels can be caused by other conditions and are not present in all patients with ovarian cancer. Conversely, it can be useful during treatment for those with high CA-125 levels; treatments could be considered successful if the CA-125 levels decrease.

Extensive research has been initiated to develop an effective ovarian cancer screening test, but there has not yet been much success.

Various Treatment Options Now Available

Treatment varies by patient, depending on the type, stage, and grade of ovarian cancer, as well as their overall health and personal preferences.⁷ Therefore, it may include surgery, chemotherapy, targeted therapy, or a combination.

Experts noted that surgery aims to remove as much of the tumor as possible, while chemotherapy is used to kill any remaining cancer cells. On the other hand, targeted therapies offer a more personalized approach by focusing on preventing cancer cells from growing.

Other treatment methods include immunotherapy and hormone therapy.⁸ In immunotherapy, doctors assist the immune system in recognizing and attacking cancer cells; immune checkpoint inhibitors, like pembrolizumab, are often used in ovarian cancer treatment.

Also, hormone therapy uses hormones or hormone-blocking drugs to slow or stop the growth of cancers that use hormones to grow. For patients with ovarian cancer, this treatment is most often used in cancers that are sensitive to hormones like progesterone or estrogen.

Ovarian Cancer Care Disparities Persist

Despite the availability of these treatments, care disparities still exist. Ovarian cancer incidence remains higher in White women, but Black and Hispanic women continue to experience disparities in survival and recurrence rates, underscoring the urgent need for equitable access to care.⁹

The overall 5-year survival rate for Black women is 41% compared with 49% among White women. Black women are more likely to be diagnosed with advanced disease and more aggressive tumors, and when ovarian cancer is diagnosed at a late stage, the 5-year survival was 23% in Black women and 34% in White women.

Conversely, on average, Hispanic women are diagnosed at an earlier stage, but they tend to be diagnosed at a younger age than White women. Also, inequitable health care access remains an ongoing challenge for Hispanic women. Consequently, social determinants of health are considered key contributors to ovarian cancer disparities as they impact how patients navigate within the health care system.

Diane Mahoney, PhD, DNP, FNP-BC, WHNP-BC, APRN, of the University of Kansas Medical Center, said in an interview with The American Journal of Managed Care^® that health care professionals “can no longer live in silos" and promoted a multidisciplinary approach to help mitigate these disparities.¹⁰

“...it can’t be health care professionals carrying the torch of doing everything,” Mahoney said. “...I think it has to be multidisciplinary, but it needs to be centered around the patient, it needs to be centered around the community. The key thing, I think, is prevention.... Because if we can come together to prevent the disease in the first place, if there’s these factors that we could collaboratively work together on, I think that could really revolutionize things and it can change how we look at these approaches.”

References

1. Ovarian Cancer Awareness Week, 1998. Federal Register. September 16, 1998. Accessed September 27, 2024. https://www.federalregister.gov/documents/1998/09/16/98-24945/ovarian-cancer-awareness-week-1998
2. History. National Ovarian Cancer Coalition. Accessed September 27, 2024. https://ovarian.org/about-nocc/history/#
3. National Ovarian Cancer Awareness Month, 2001. Federal Register. August 30, 2001. Accessed September 27, 2024. https://www.federalregister.gov/documents/2001/09/05/01-22474/national-ovarian-cancer-awareness-month-2001
4. Key statistics for ovarian cancer. American Cancer Society. Revised January 19, 2024. Accessed September 27, 2024. https://www.cancer.org/cancer/types/ovarian-cancer/about/key-statistics.html#:~:text=The%20American%20Cancer%20Society%20estimates,new%20diagnosis%20of%20ovarian%20cancer.
5. Can ovarian cancer be found early?. American Cancer Society. Revised July 24, 2020. Accessed September 27, 2024. https://www.cancer.org/cancer/types/ovarian-cancer/detection-diagnosis-staging/detection.html
6. Signs and symptoms of ovarian cancer. American Cancer Society. Revised April 11, 2018. Accessed September 27, 2024. https://www.cancer.org/cancer/types/ovarian-cancer/detection-diagnosis-staging/signs-and-symptoms.html
7. Treatment options for ovarian cancer. National Ovarian Cancer Coalition. Accessed September 27, 2024. https://ovarian.org/about-ovarian-cancer/treatment-options-for-ovarian-cancer/
8. Other treatments for ovarian cancer. National Ovarian Cancer Coalition. Accessed September 27, 2024. https://ovarian.org/about-ovarian-cancer/treatment-options-for-ovarian-cancer/other-treatments-for-ovarian-cancer/
9. Mahoney DE, Mukherjee R, Thompson J. Elucidating the influences of social determinants of health on perceived overall health among African American/Black and Hispanic ovarian cancer survivors using the NIH All of Us Research Program. Gynecol Oncol. Published online July 9, 2024. doi:10.1016/j.ygyno.2024.06.027
10. McCormick B. Dr Diane Mahoney on tackling ovarian cancer care disparities. July 25, 2024. Accessed September 27, 2024. https://www.ajmc.com/view/dr-diane-mahoney-on-tackling-ovarian-cancer-care-disparities