Health First Oncologist Dr. John Bomalaski: Ovarian Cancer Is No Longer a ‘Silent Killer’

By  //  February 2, 2023

American Cancer Society: ovarian cancer ranks fifth among all cancer deaths in women

ACCORDING TO DR. JOHN BOMALASKI, a Health First gynecologic oncologist, ovarian cancer needn’t be “silent.” Among the top risks is genetics and heredity. And the good news is that these can be identified early. (Health First image)

Among deadly cancers, ovarian cancer rates are low. Fewer than 20,000 women will get an ovarian cancer diagnosis this year. But it’s long been called a “silent killer” because a staggering number – more than 2 in 3 – succumb to the disease.

The American Cancer Society says ovarian cancer ranks fifth among all cancer deaths in women, accounting for more deaths than any other cancer of the female reproductive system.

A woman’s risk of getting ovarian cancer in her lifetime is about 1 in 78, but about half of these women are 63 years or older.
According to Dr. John Bomalaski, a Health First gynecologic oncologist, ovarian cancer needn’t be “silent.”

There are four key measures that can give women an advantage to potentially avoiding – or beating – the disease: fully understanding risk, maintaining a healthy lifestyle, early detection, and rapid treatment following diagnosis.

The Risk Factors

Here are some of the risks that raise the likelihood of an ovarian cancer diagnosis:
■ Age (most ovarian cancers occur in women over 60)
■ Bearing children later in life (or never having a full-term pregnancy)
■ Hormone therapy after menopause; and,
■ Lifestyle factors, including above-average weight

Among the top risks is genetics and heredity. And the good news is that these can be identified early.

“We know that Ashkenazi Jewish heritage, for instance, accounts for a good number of people at risk.  But other means of determining somebody’s risk is family history. And we know that approximately 20% of ovarian cancers are hereditary – it’s probably even higher than that. But that’s what we know for certain,” said Bomalaski.

By identifying those with elevated risk, the opportunity to choose proactive prophylactic surgery becomes available.
Then, “there’s an association of oscillatory cycles that result in decreased risk.”

These include the late-onset or menarche and early onset of menopause. Taking birth control pills, previous pregnancies and breastfeeding have all been correlated with decreased ovarian cancer rates.

“And of course, there’s environmental – all things that can reduce somebody’s risk. Maintaining a healthy weight. Diet and exercise. I think those are very important to not overlook.”

A WOMAN’S RISK of getting ovarian cancer in her lifetime is about 1 in 78; half of these women are 63 or older. Dr. John Bomalaski, a Health First gynecologic oncolo­gist, says there are four key measures that can give women an advantage to poten­tially avoiding – or beating – the disease: fully understanding risk, maintaining a healthy lifestyle, early detection, and rapid treatment following diagnosis.

No Early Screenings

Dr. Bomalaski says there are currently no standard screening tests – such as a PAP smear test, colonoscopy or mammogram.

“We don’t have a really good screening test and there is no known pre-cancer. So a lot of it has to do with suspicion, with early valuation of symptoms that persist of understanding somebody’s genetic risk. If somebody has a personal history of cancer or family history of cancer, as I mentioned earlier, it’s important for that patient to discuss that with their health care provider,” Bomalaski said.

“But it’s very important for women to talk among their families, too. It’s not uncommon for me to have a patient with a new diagnosis of gynecologic cancer, and I ask them about their family history, and they say, ‘Well, I just found out yesterday after I knew about my cancer, I talked to my sister and learned she had breast cancer.’

“Getting that word out and people talking is important to understanding what somebody’s own risk of cancer is.”

Stages and Survivability

There are four stages of cancer, and the survival rate is dramatically affected by that stage, said Bomalaski. Stage 1 (early detection) has a 90% survival rate. By stage 4, the rate of survival falls to 20%.

“Unfortunately, 75% of ovarian cancers are found at stage 3 and stage 4,” Dr. Bomalaski said. “So, any means that we can try to find them at an early stage would be great. But again, we don’t have that screening test, so the real benefit, I think, is trying to decrease the risks of that cancer.”

Don’t Ignore the Symptoms

Ovarian cancer has long been thought of as a ‘silent’ cancer because its symptoms are unnoticed or dismissed. However, Dr. Bomalaski says most patients do have symptoms. The key is to not dismiss them.

“Some symptoms are not what someone might consider ‘serious.’ Sometimes they’re not shouting out as obvious signs.”

These are:
■ Abdominal pain, cramping, pressure, bloating or constipation
■ Decreased appetite, feeling “full”
■ Intermittent diarrhea
■ A mass in the abdomen – a distended abdomen
■ General cancer signs like unexplained weight loss and fatigue
■ Urinary issues

These symptoms are more frequently from other things besides ovarian cancer, but if they persist for two weeks, or if there is a strong belief it is unordinary and doesn’t improve with conventional treatments, “ovarian cancer should be considered – and quickly addressed.”

“When ovarian cancer is suspected, the next steps should be an abdominal exam, a pelvic exam, and probably an ultrasound or a CT scan,” said Dr. Bomalaski.

“Again, we know that those patients who have the quickest start of their treatment are the ones that have the highest survival, even in higher stages.”

A Total Cancer Cure?

“Sometimes I’m asked if I think we’re going to cure cancers. All cancers? I don’t think that in my lifetime, at least, we’re going to find that cure of all cancers. But I do think what we’re going to do is we’re going to find treatments that are able to suppress that cancer and control that cancer so that people have normal lives.

“We’ve seen that with diabetes, with cystic fibrosis, and most recently with HIV patients that now with treatment, they’re living normal lives. We’re not there with cancers, but we are approaching it, and the treatments that are associated with knowing the molecular makeup of those cancers allow us to direct specific treatments for them now that we didn’t have available before.”

Key Takeaways

Avoiding – or defeating – ovarian cancer boils down to vigilance and awareness.

“Ovarian cancer is highly treatable and successful in early stages, and we can no longer consider it a silent killer. Knowing your risk earlier in life, talking with family members, possibly taking proactive action like prophylactic surgery if the risk is high … avoiding other risks by maintaining a healthy lifestyle, these are key. Question when something doesn’t seem right and quickly seek medical attention,” said Bomalaski.

Ovarian cancer mortality has been declining for the last 20 years, Dr. Bomalaski said, and awareness and acting early help explain that positive trend.

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