By Holland Sweet
Ovarian cancer is the deadliest gynecological cancer and the fifth leading cause of cancer death in women — with around 22,000 new diagnoses in the United States a year, most of them in women over 50. Unlike cervical cancer, which has the pap smear, or breast cancer, which has mammography, ovarian cancer has no reliable, widely available screening test.
The core challenge with this deadly cancer is early detection. Only 20 percent of ovarian cancers are found at an early stage — but when it’s found early, about 92 percent of patients live longer than five years. For those diagnosed at a later stage, the picture is grimmer: five-year survival rates drop to around 20 percent for stage 4.
“Currently, the only available test, the CA-125 blood test, developed decades ago, is considered a poor screening tool because it often delivers false positive results and has a highly flawed detection rate,” says Elena Ratner, M.D, M.B.A., who heads the Gynecologic Oncology department at Yale School of Medicine. Dr. Ratner also runs the Peter E. Schwartz Discovery to a Cure Program, which was launched in 2003 to provide women with new methods in prevention, detection, and treatment of gynecological cancers. Dr. Ratner and her team run clinical trials and study cancer mutations in the lab and apply that knowledge in real time to the patients they treat.
The good news, according to Dr. Ratner, is that more reliable and advanced blood, urine, and specialized pap smear-based tests are in the works. “We are currently developing these tests and using them in early clinical trials. I am hopeful they will be available in the near future.”
It’s Not Actually Silent
While improved detection methods are critical, the most important thing a woman can do is to understand her risk factors, to listen to her body, and know her family history. For years, ovarian cancer earned its grim nickname by being famously hard to detect. But researchers like Dr. Ratner have begun pushing back on this idea. Ovarian cancer does send signals. The trouble is they’re easy to dismiss — as digestive issues, aging, stress, hormones, or just ‘how things are.’
“The message must get out that women are not being heard,” says Dr. Ratner. “Reports show that a typical woman visits four or five medical doctors, including a gastroenterologist, urologist, primary care physician, etc, before seeing a gynecologist.” One of the first doctors may, in fact, be a gastroenterologist because early ovarian cancer symptoms can present as digestive problems. However, if a colonoscopy is clear but symptoms persist, it’s important to seek more answers and to take these indicators seriously.
Watch For These Signs & Symptoms:
- Bloating
- Any pelvic or abdominal pain
- Difficulty eating or feeling full quickly
- Urinary symptoms (urgency or frequency)
- Fatigue
- Indigestion
- Back pain
- Pain during intercourse
- Constipation
- Menstrual irregularities
° Source: Discovery to a Cure at Yale School of Medicine
Individually, these symptoms may not be alarming, but if they persist for more than seven to fourteen days, it’s important to talk to your doctor. Don’t wait. Don’t minimize. Speak up.
Monika G’s story is a case in point. “My husband and I went on a two-week vacation in January 2024 and we both came down with a serious case of RSV. Urgent Care prescribed antibiotics. My husband improved quickly; I did not,” says Monika, who returned home to see her primary care doctor. “They put me on another course of antibiotics.” Monika started to feel worse and developed severe bloating and GI symptoms, so her doctor suggested she see a gastroenterologist. She had recently had a clean colonoscopy, so they tested her for SIBO (small intestinal bacterial overgrowth). Over a four-month period, Monika’s symptoms worsened. She gained 18 pounds and had no energy.
“I went back to the GI office three more times,” says Monika. “The SIBO results took forever and were positive and I was given yet another antibiotic.” The antibiotics only made her feel worse and the PA told her the bloating was probably just hormones. “When I mentioned the weight gain at another visit the PA said it was gas,” remembers Monika, who began to question herself. “I thought maybe it’s just part of the aging process. Frankly, I didn’t have the energy to push back.”
It wasn’t until Monika’s husband accompanied her and insisted that something was drastically wrong with his wife that they ordered a blood test. The test showed Monika’s numbers were off the charts – 3888 units per milliliter (35 and lower is considered a “normal” range). The blood test, along with an ultrasound, confirmed Monika had stage 4 cancer in her fallopian tubes and that the cancer had spread to her liver and other parts of her body. “With my advanced cancer stage, I had to undergo chemotherapy and surgery,” said Monika. “I am one of the fortunate ones. I was dying and Dr. Ratner literally saved my life. Despite the advanced stage of my cancer, I have a good prognosis, with regular monitoring.”
Monika’s story underscores how important it is not only to advocate for yourself, but also to find a doctor who listens to you. Don’t be afraid to get a second opinion. The key word is persistence. Don’t keep guessing whether it’s just bloating or hormones — call your gynecologist. And do what you can do to have annual gynecological exams. Currently, Medicare is only covering exams every other year, which is a travesty. If you are at risk, be sure to let your doctor know as you may qualify for more frequent checkups.
Recognizing that these symptoms are often missed or dismissed, Dr. Ratner’s foundation spearheads a global ovarian awareness program. She attends medical conferences in a variety of fields to educate doctors on the symptoms of ovarian cancer. The program also hosts educational events designed to spread the word to women about the disease within their communities.
Know Your Risk
About 15-20 percent of ovarian cancers are hereditary. If you have a family history of cancer on either your maternal or paternal side, it is advisable to consult with your doctor and ask about genetic counseling. A genetic counselor will do a deep dive into your family history; and if you are at risk, may recommend a simple genetic blood test that could transform your medical future.
If you carry the gene mutation for ovarian cancer (most commonly BRCA1 or BRCA2) you have inherited a significantly higher lifetime risk of developing ovarian and breast cancer. This does not necessarily mean you have cancer. Knowing you have an increased risk means you can take preventive action, such as regular screening or risk-reducing surgeries.
A decade ago, the actress and advocate Angelina Jolie made headlines when she tested for the BRCA1 gene and had her ovaries and fallopian tubes proactively removed. While she sparked a medical debate at the time, Jolie also shattered the stigma of genetic testing and shed light on proactive, preventative care.
Beyond genetics, your reproductive history is a factor. The more ovulatory cycles you’ve had, the higher your baseline risk – which is why women who have never been pregnant face greater risk. Endometriosis roughly doubles your risk.
Other risk factors include age (women over 55 are at greater risk) and obesity.
Treatment: Reasons For Real Hope
If there is a silver lining in the ovarian cancer story, it’s this: treatment has genuinely improved. Surgery plus chemotherapy forms the foundation, but the entire approach has become more targeted, more personal, and more advanced. There’s a new class of drugs called PARP inhibitors that have transformed the landscape.
“Five years ago, a woman would have surgery and have a huge incision in her abdomen and would be in the hospital for a week,” says Dr. Ratner. “Now, with minimally invasive procedures, some women can leave the hospital the same day.”
Chemotherapy is no longer used as a “blanket” treatment. Specialists don’t just target the type of cancer; they can pinpoint the specific mutation. This not only improves the efficacy of the treatment, but it decreases side effects and minimizes down time.
Science is moving fast. The ovarian cancer environment is improving and will look meaningfully different in a few years. The best way to benefit from tomorrow’s breakthroughs is to be informed today.
You’ve spent decades learning to read your own body. Trust that skill. Push for answers when something feels off. And make sure the women in your life — daughters, sisters, friends – know what you know.
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