Many people ask about the blood test that detects the genetic defect that can cause cancer of the breast and ovaries. The test is a wonderful tool to help certain people, but it is not a screen for these cancers. In other words, it should only be done on those people who are at a higher risk of developing these cancers.
To start of, I generally recommend that we first do simple and inexpensive screens for any kind of cancer, including cancer of the breast and ovaries. This simple test is the physical exam. During every Well Woman Exam, I feel it is important to check the breasts for any new changes, lumps, masses or inflammation. A mammogram is also recommended every year after the age of 40, and earlier if a suspicious mass is noted.
Although breast cancers can thus be detected rather early by these simple tests, the same does not necessarily pertain to ovarian cancer. In fact, most ovarian cancers are not detected until they are quite far along. The physical exam does not always detect it early enough. Therefore, there is a need to search for further screens if indicated.
Many patients ask me about doing a blood test CA125 to detect ovarian cancer. I can indeed order this test. Unfortunately most of the time insurance does not cover the cost of this test so the patient must pay for the test. It can cost around $275 and, the fact is, it is neither a very accurate nor a very specific test. It has too many false positives and false negatives to be an accurate screen for ovarian cancer and to warrant people spending their money for it.
Therefore, I offer all my patients another screen, called a vaginal ultrasound. It is much less expensive and more accurate. If the vaginal ultrasound detects an abnormal ovary, further testing may then be performed which could include the CA-125. Combined, the two tests do help in detecting ovarian cancer so it can be treated as rapidly as possible.
What can be done to prevent these devastating cancers?
The key here is genetics. Genetic testing can show people if they are at increased risk for breast, ovarian and certain other cancers. If you have a family history of these cancers, a simple blood test called the BRCA1/BRCA2 test can be performed. These are mutations of normal cells which are known to progress to cancers, either of the breasts or the ovaries.
If a woman is positive for a family history of cancer and if she tests positive for BRCA, then she can use this information to plan for prevention of these cancers if she desires. Unfortunately, prevention means that she would have to undergo surgery to either remove both breasts (bilateral mastectomy) or her uterus, fallopian tubes and/or ovaries. Women who choose not to have these surgeries should have close surveillance with mammograms, MRIs, and other more specific tests.
Removal of the ovaries and fallopian tubes substantially lowers the risk of developing ovarian cancer by 96% in women with a positive BRCA gene mutation. It also reduces the risk of developing breast cancer. Having a bilateral mastectomy reduces the risk of developing breast cancer by 98%.
However lifesaving these surgeries may be, they must be weighed against the consequences of performing the surgeries. That is, the breasts will certainly need reconstruction if the woman wants to maintain her feminine shape. In addition, the patient will go into premature menopause if she has her ovaries removed early. Although hormone therapy is available, there is a definite need for a period of adjustment to this new metabolic state.
It is important to note here that a neither a positive family history nor a positive BRCA test guarantees that the patient will develop a cancer. Many people live very long lives and never develop a cancer. The positive tests just tell you that you have a higher risk of developing one or both types of cancers, not that you will develop them. For instance, a middle aged woman with a positive BRCA gene mutation whose mom had breast cancer has a 65% to 87% chance of developing breast cancer, which is higher than the general population.
Another innovative blood test that can help detect 26 different cancers, including breast and ovarian cancers, is the Oncoblot test. Click here to learn more.
In order to understand all these factors, a visit with your doctor is the best way to clarify the best course of action for you. I encourage my patients to discuss these issues and I educate them on all of the options available to them. Ultimately, of course, the decision is the patient’s.