Partner with Your Healthcare Provider
When it comes to living healthfully, your healthcare provider is a key partner in developing and adapting a health management plan. See your doctor at least once annually, even when you feel perfectly healthy, to proactively manage your breast and ovarian health.
Finding the Right Partner
It’s important to find a medical professional that you trust. He or she should listen to your questions, pay attention to your concerns, and provide clear recommendations. Once you’ve “shopped around” and found a doctor you like, you should plan on seeing him or her annually for a well-woman exam.
The Well Woman Exam
These annual exams, which are covered in all insurance policies, should include a clinical breast exam that thoroughly covers all the breast tissue and typically takes several minutes. If your doctor offers this exam, say yes—and if your doctor doesn’t bring it up, make sure you do.
Your doctor may also perform a pelvic exam, during which he or she will actually feel your ovaries. Your doctor is looking for an enlargement or swelling in the pelvic region. Some pelvic masses can be a sign of ovarian cancer, but don’t be too alarmed- most women will develop a pelvic mass or ovarian cyst at some point in their lives and many go away on their own during the course of your menstrual cycle. You may also receive a pap smear, but it’s important to know that this only checks for cervical—not ovarian—cancer.
Pap smears check for cervical—not ovarian—cancer.
You should have your first mammogram by age 40, or sooner if you have a blood relative who was diagnosed with breast cancer before age 50. In those cases, you should schedule your first mammogram when you are 10 years younger than the age at which your relative was diagnosed.
Don’t be afraid to ask your doctor questions, have him or her explain the risk factors, and recommend a personalized prevention and screening plan. You can also find out how to reduce your risk through lifestyle changes, and what symptoms to monitor for between visits.
Risk Reduction for Increased-Risk Women
For women at increased risk for breast and/or ovarian cancer, in addition to healthy living guidelines, there are other early detection and risk reduction tactics to consider. In addition to practicing Breast and Ovarian Self-Aware we encourage you to discuss the following options with your doctor.
Chemoprevention—the use of medications to prevent, suppress or reverse cancer—presents an option worth considering to women of increased risk. For those for whom there are no surgical recommendations for breast cancer risk-reduction, chemoprevention can be an important component of a comprehensive risk-reduction strategy.
You might not think of oral contraceptives as a type of chemoprevention, but they are, when used specifically to reduce the risk of ovarian cancer. As mentioned above, taking birth control pills for 5 years—even non-consecutively—in your 20s and 30s can reduce your ovarian cancer risk by nearly half, so if you’re at increased risk, having a conversation with your doctor about the potential risks and benefits of oral contraceptives is an important step in determining your risk management strategy.
SERMs (Selective Estrogen-Receptor Modulators) are a specific type of medicines that modulate how cells respond to estrogen. Tamoxifen is a well-known and the most commonly-prescribed SERM, best known as a drug used to help avoid cancer recurrence in women who have already been treated for breast and ovarian cancer. But it can also be used to reduce the risk of breast and ovarian cancer before they develop, so it’s a viable option to consider.
It’s important to know that chemoprevention can have some serious side effects, including possible damage to your ovaries, loss of fertility, and blood clots. Be sure to talk with your doctor about the pros and cons of this risk-reduction option.
Surgical Risk Reduction
Risk-reducing surgeries remove body tissue most likely to be at risk for cancer and are therefore a viable risk-reduction strategy for some women. Though most risk-reducing surgeries are thought to be appropriate only for women at high risk, it’s worth talking to your doctor about the “intermediate step” surgical options for ovarian cancer, below, to see if they might be appropriate strategies to reduce your increased-level risk. There are no surgical breast cancer risk-reduction recommendations for women in the Increased-Risk category.
Tubal ligation is a procedure in which the fallopian tubes are tied off or blocked, and is a viable option for increased-risk patients who aren’t ready to remove their ovaries. The procedure can reduce the risk of ovarian cancer by as much as 34%, likely because many ovarian cancers actually originate in the fallopian tubes. Salpingectomy is the surgical removal of the fallopian tubes and is recommended for any woman undergoing hysterectomy because of the benefit of reducing ovarian cancer risk without altering hormonal function.
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Risk Reduction for High-Risk Women
For women at high risk for breast and/or ovarian cancer, it’s recommended to engage in additional risk-reduction tactics, as described below, as well as increased screening strategies. We strongly encourage you to discuss the following options with your doctor.
Chemoprevention is the use of medications to prevent, suppress or reverse cancer. For women at high risk, these chemoprevention options can be important components of a comprehensive risk-reduction strategy alongside surgical risk-reduction.
You might not think of oral contraceptives as a type of chemoprevention, but they are, when used specifically to reduce the risk of ovarian cancer. As mentioned above, taking birth control pills for 5 years—even non-consecutively—in your 20s and 30s can reduce your ovarian cancer risk by nearly half, so if you’re at High Risk, having a conversation with your doctor about the potential risks and benefits of oral contraceptives is an important step in determining your risk management strategy.
SERMs (Selective Estrogen-Receptor Modulators) are a specific type of chemoprevention that modulate how cells respond to estrogen. Tamoxifen is a well-known and the most commonly-prescribed SERM, best known as a drug used to help avoid cancer recurrence in women who have already been treated for breast and ovarian cancer. But it can also be used to reduce the risk of breast and ovarian cancer before they develop, so it’s a viable option to consider. One study shows that Tamoxifen decreased breast cancer occurrence by 62% in women with a BRCA2 gene mutation. (Unfortunately, there was no reduction in those women with a BRCA1 gene mutation.)
It’s important to know that chemoprevention can have some serious side effects, including possible damage to your ovaries and loss of fertility. Be sure to talk with your doctor about the pros and cons of this risk-reduction option.
Many young women who are at high risk for breast and ovarian cancer decide, together with their medical team, to have one or more risk-reducing surgeries. This kind of operation removes body tissue most likely to be at risk for cancer and can be done on both breast and ovarian tissue.
These surgeries can never give you 100% protection from cancer, because it’s impossible to remove every single breast and ovarian cell. But, they can significantly reduce your chances of developing breast and ovarian cancer. This is a big, and very personal, decision, so be sure to learn as much as you can, and discuss all your options with your doctors.
It’s also important to follow through with increased screening recommendations for high-risk women if you’re deciding not to have a risk-reducing surgery, or until you do.
Some women who are at high risk for breast cancer have their breast tissue surgically removed through a prophylactic (or risk-reducing) mastectomy. Studies show you can reduce your risk of developing breast cancer by 95%, and you have options for reconstructive surgery afterward. You will also want to consider that you will likely lose normal sensation in the breast, and won’t be able to breastfeed. If you decide to have a risk-reducing mastectomy, you may find these tips helpful.
To make the best decision about whether to have a prophylactic mastectomy, you should understand your options for breast reconstruction. This surgery can closely rebuild the natural shape of your breast—though not exactly. It’s also important to understand that breast reconstruction is a major procedure that includes a series of surgeries. You and your doctor should work together to make decisions about the best procedure for you, including whether to use saline or silicone implants, or borrow tissue from somewhere else in your body.
There are also risk-reducing surgeries for women at high risk for ovarian cancer:
A prophylactic oophorectomy is the removal of one or both healthy ovaries. Surgeons should also remove the fallopian tubes (called a bilateral salpingo-oophorectomy, or BSO), due to the risk of similar cancer there.
Young, pre-menopausal women will go through menopause after the operation, which is a major side effect. So, to make the best decision for you, talk to your doctor about your unique situation and be sure to weigh all the pros and cons.
You may also want to talk to your doctor about fertility preservation options if you know or think you may want to have biological children in the future. These steps have to be taken before your ovaries are removed.
Interest has recently been piqued in the idea of salpingectomy (removal of the fallopian tubes) with delayed oophorectomy (removal of the ovaries) as an ovarian cancer risk-reduction strategy for high-risk women that would delay the onset of menopause. While appealing, this approach should still be considered experimental, given the lack of data from clinical trials that have assessed the risks and benefits in high-risk patients.
Some high-risk patients having their ovaries and tubes removed wonder if they should also have a hysterectomy–the surgical removal of the uterus and cervix—but current research does not support it for risk-reduction alone. Hysterectomy is an extensive surgery, with increased risk of complications and longer recovery times by comparison to salpingo-oophorectomy, so the pros and cons should be carefully weighed with your doctor when considering this procedure in addition to risk-reducing surgery.
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“I’m actually at the age when I would have been having my first mammogram—thanks to Bright Pink, I knew to start earlier because of my family history of cancer.”