On the frontlines in the war against ovarian cancer


September is Ovarian Cancer Awareness Month. Many people already are aware that ovarian cancer is difficult to detect early, and many know that the disease is more prevalent in Jewish women of Ashkenazic descent.

However, few people are aware that ovarian cancer is a rare disease. The National Cancer Institute reports just 22,000 cases in 2010. “What also may be news to many is that most women with ovarian cancer can now expect to live a long life,” says Dr. Israel Zighelboim. “With aggressive treatment, the median survival is now more than five years.”

Zighelboim, 36, was brought up in Venezuela, where his family migrated from Romania after the Holocaust. “I am in a challenging line of work,” he says. “We don’t cure every cancer, but we cure more than we used to. Even those we cannot cure live longer and much better lives, and that is very rewarding.”

Beth Shalom Cemetery ad

Zighelboim made time recently to talk about ovarian cancer.

In the past, women were told there are no symptoms that warn of the presence of ovarian cancer. Now some research shows that nearly all women who are diagnosed with the disease had experienced bloating, abdominal or pelvic pain, difficulty eating, feeling full quickly and changes in urination. Talk a bit about that research.

Studies from the University of Washington suggest that there is a constellation of symptoms frequently associated with ovarian cancer, but there are some problems with the research. In fact, 75 percent of women with ovarian cancer present with advanced-stage disease – including women with these symptoms.

Why is that?

When a tumor is tiny, it probably does not cause these symptoms. You need the bulk of the tumor in place, an advanced cancer, to cause these symptoms. People do need to listen to their bodies – but most of us think that screening for these symptoms will not necessarily translate in early diagnosis or in better outcomes.

Talk a bit about the incidence of ovarian cancer in Jewish women of Ashkenazic descent.

We are a somewhat secluded community, and we do have a higher incidence of some genetic disorders. We have found that some specific mutations in the BRCA genes are exceedingly common among Ashkenazic Jews. That said, only 10 percent of ovarian cancers in Jewish women have a genetic driver.

Then what causes it?

We think that most everyone who gets ovarian cancer gets it randomly – not because of genetic mutations. We call these ‘sporadic cases’ – or I should say we think they are random because we don’t yet know what causes them.

What can be done to protect women from ovarian cancer?

We need to do better at screening families that could have a genetic mutation. Sadly, even in women who have a family history of the disease, physicians don’t pick up on it. For instance, if you are an Ashkenazic Jew and you or a family member has ovarian cancer, you should seek an expert’s opinion and consider genetic counseling.

How would that help?

If more women were tested, we could detect more mutations and screen other family members. With that information, we could decrease the incidence of ovarian cancer and breast cancer by more than 90 percent. We must screen the at-risk population to identify people with the BRCA gene – and yet we are failing to do that.

If you have genetic screening and you have the gene mutation, what can you do?

It depends on your history, age and specific situation. However, risk reduction strategies can include increased surveillance by imaging methods and blood work, use of medications to decrease risk and even risk-reducing surgery with removal of the ovaries and/or breasts.

So the picture for many women with ovarian cancer is brighter than in the past?

There is a lot more hope out there, and we keep getting better at it every day. It is key that women with a gynecologic cancer seek care from a gynecologic oncologist. Survival is better in patients treated by experts familiar with aggressive surgical protocols, novel chemotherapeutic regimens and with access to clinical trials.

Any other words of advice?

The number one killer of women in this country is still heart disease. All women need to eat right and exercise, and make meaningful lifestyle changes.

For information on St. Louis Ovarian Cancer Awareness and events in recognition of Ovarian Cancer Awareness Month, see www.sloca.org/

HealthWatch – Israel Zighelboim, M.D.

WORK: Physician and assistant professor in gynecologic oncology at Washington University School of Medicine

HOME: Clayton

FAMILY: Married to Valeska Kaminski-Zighelboim, a chemical engineer now rearing the couple’s children, Noah, 3, and Ari, 7 months

HOBBIES: Spending time with family