Ask the Expert: Discussing Diet, Exercise and Risk

Michael Seiden, MD, PhD
President & CEO Fox Chase Cancer Center, Ovarian Cancer National Alliance Scientific and Medical Advisory Board

Q: How do I know if I am at high risk for developing ovarian cancer?

There are three basic groups of risk stratification:
- High risk
- Moderate risk
- Normal risk

People who are in the high risk category are those who were born with a BRCA1 or BRCA2 mutations. A BRCA1 mutation increases your lifetime chances of developing ovarian cancer to 40 – 50 percent, compared to a 1.5 percent chance in the general population. A BRCA2 mutation increases that lifetime risk to 25 – 30 percent.

There also is a group of women who have a lifetime risk around two or three percent—still an increased risk, but a moderate one. Those women may have a high body mass index, a personal history of breast cancer, a family history of breast cancer (without a BRCA mutation) or Lynch syndrome. Other modest risk factors include never having children or using talcum powder in the genital area.

If you know you’re at high risk or are worried about ovarian cancer, there is good evidence that using birth control pills reduces your risk of ovarian cancer.

Learn more about risk factors associated with ovarian cancer.

Q: If my risk of developing ovarian cancer is higher than average, should I be screened for the disease? Are there any new screening tools, like biomarkers, that will help detect ovarian cancer in the early stages?

Even for women at markedly elevated risk, the data suggests that there is no adequate screening protocol. Anecdotally, there are some women in trials who are at high risk and keep their ovaries. These women have been followed closely with the tools we have (ultrasounds, CA-125 blood tests and pelvic exams). Even under very careful surveillance, as expected some of these high risk women have developed ovarian cancer with many presenting in late stage (IIIC), not unlike women in the general population who are not screened. Also, the recent NCI-sponsored PLCO trial demonstrated that yearly CA-125 with pelvic ultrasound did not reduce the incidence or death rate associated with ovarian cancer. What this means is that we just don’t have very good screening tools for ovarian cancer at the current time.

Although pelvic exams and ultrasounds are not good screening tools, in slender women we can feel the ovaries, which is one more benefit of having a body mass index in the normal range.
Recent research looked at the blood samples of women one year before they were diagnosed with ovarian cancer. These women had normal CA-125 levels at that time. The researchers looked at a number of other biomarkers in the blood of these women, and with very few exceptions they were all in the normal range one year before diagnosis. So there’s no evidence, currently, that any known biomarker will rise significantly ahead of the disease.

Q: Who should have a risk-reducing salpingo-oophorectomy (removal of the fallopian tubes and ovaries)? When?

A risk reducing salpingo-oophorectomy (RRSO) should be strongly considered in women who have BRCA mutations and probably should be considered in women with Lynch syndrome. It can be safely postponed for most women until after childbirth. For women with a BRCA1 mutation it is uncommon to have ovarian cancer before age 40, and for women with the BRCA2 mutation it is uncommon before 50. However, some physicians recommend surgery 10 years before the youngest family member with ovarian cancer developed their cancer—so if your mother had ovarian cancer at 63, and you have a BRCA mutation, you should consider an RRSO prior to age 53.

There is data suggesting that the fallopian tube may serve as the origin of “ovarian cancer.” When a woman ovulates, a wound is formed on the ovary. Cancerous cells from the fallopian tube can fall into that wound, and we think that the ovary might be a nutrient-rich place where these cells grow quickly.

There are trials underway where the fallopian tube is removed and the ovary is left intact; however, this surgery is still experimental and there is no proof yet that this protects a woman from cancer. Anyone interested in considering this option should do it as part of a clinical trial.

RRSO reduces the risk of ovarian cancer by up to 85 percent, but it is still possible to develop peritoneal cancer which resembles ovarian cancer.

Q: Are there any specific foods or supplements I can take to reduce the risk of developing ovarian cancer? Are there any foods I should avoid to reduce the risk of developing ovarian cancer?

There are no diets or foods that we know of that will prevent ovarian cancer. There’s no good data on it, and there’s only a moderate amount of data on the topic. There is very good data on diet and exercise reducing the risk of breast cancer, but we can’t extrapolate that to ovarian cancer.

There is data showing a potential link between ovarian cancer and some types of painkillers, and ovarian cancer and dairy products. Likewise there are studies looking at teas, fruits, vegetables, fish and omega-3 fatty acids. Most of the studies show no link, although a few have shown associations with some of the foods listed above. However, these links are weak and there is no data to suggest that if you actively change your diet you can appreciably alter your risk of getting ovarian cancer.

There are data showing that women who have lower body mass index have lower risk of ovarian cancer. Those women likely have a diet high in vegetables and a lifestyle that includes exercise.

There are other health benefits to eating a diet low in fats and high in fruits and vegetables in association with regular aerobic exercise. Although once again there is no evidence that this will reduce the risk of getting ovarian cancer.

Q: Is getting a lot of exercise a good way to prevent ovarian cancer? Are there specific non-traditional interventions I can take to reduce my risk of developing ovarian cancer (e.g. reducing stress, yoga, meditation, acupuncture)?

There is some evidence that relaxation techniques like meditation can affect brain processes which control the immune system. There is a growing body of data to show that chronic over-activation of the immune system has some link to heart disease and some link to cancer. Therefore, things that reduce stress might help reduce the risk of cancer. However, there is no proof that any specific intervention directly affects the risk of ovarian cancer.

It should be noted that there is a growing body of research that demonstrates that moderate aerobic exercise for 45 minutes, three or more times per week, lowers your risk of breast cancer. There is no equivalent data yet for ovarian cancer.

That said, it’s pretty hard to come up with a reason not to eat healthily, exercise and reduce stress. These are really good lifestyle choices. The only problem we have is that these lifestyle choices aren’t a substitute for medical interventions—just because you do yoga doesn’t mean you shouldn’t consider traditional approaches.