Chris Evert and ovarian cancer: Why early detection doesn’t help

“As with her original diagnosis,” the story says, “early testing was critical – a message Ms. Evert eagerly spreads.”

However, there is a small problem: there is no early detection of ovarian cancer.

“There is no recognized screening. There is no method for early detection,” says Sarah DeFeo, program director of the Ovarian Cancer Research Alliance (OCRA). Assets“It is a rare disease” that occurs with a risk of 1 in 87 people over the course of a lifetime. “So it is not something that is done as part of a woman’s preventive medical examination, neither by a gynecologist nor by a regular internist.”

That’s because, says Dr. Gillian Hanley, a member of the OCRA’s scientific advisory committee and associate professor of obstetrics and gynecology at the University of British Columbia, “all screening methods tried so far have failed to reduce mortality. That’s the only way to determine whether a screening method is effective or not.”

While there are some standard methods of monitoring for ovarian cancer when it is suspected – including a CA-125 blood test that may detect tumor markers and a transvaginal ultrasound that may help identify tumors – they are inaccurate and are not indicated or available for women who either have no symptoms – which usually do not show until the cancer is well advanced – or who have a high-risk factor – that is, a patient who has already tested positive for genetic markers that significantly increase the likelihood of ovarian cancer.

“If you’re a normal, average-risk person going through the world, a doctor might say that a routine screening is not medically indicated. That’s not necessary… There’s no evidence that ultrasounds are effective,” says DeFeo. “So that’s not something that’s recommended. It’s not neutral — it’s like, ‘No, don’t do it.'”

Instead, she believes women should be tested for genetic markers. Evert has spoken about this before – after her sister’s death, she tested positive for the BRCA-1 gene and underwent a preventative hysterectomy with removal of her ovaries and fallopian tubes. Only then did she learn from the pathology report that she had stage 1 ovarian cancer (which returned even after surgery, as microscopic cancer cells sometimes remain in the abdomen).

None of these details were disclosed in the recent New York Times articles – but actually they are the most important, says DeFeo.

“She talked a lot about getting tested early, but for me it’s really about the importance of knowing your risk and managing risk,” she says. “I think that’s the important takeaway from her story.”

Why there is no reliable method to test for ovarian cancer – and what is recommended instead

Much of the current evidence on screening is based on the disappointing results of a 2021 British clinical trial that followed 200,000 women for more than 20 years and concluded that screening and symptom awareness do not save lives.

The study, the largest of its kind in the world, randomly assigned patients to three groups: 1) no screening, 2) annual screening with ultrasound, and 3) annual screening with ultrasound and CA-125 blood test. No evidence was found that lives were saved in the groups tested. “We therefore cannot recommend screening for ovarian cancer using these methods for the general population,” lead researcher Dr. Usha Menon said at the time.

“That’s the insidious and devastating thing about ovarian cancer, that we think it needs to be detected so much earlier for it to impact mortality,” says DeFeo. “It’s not about detecting it three months earlier… We need to find a way to detect this disease Years earlier.”

But that’s not possible right now. “The technology doesn’t exist yet,” she says. Plus, Hanley adds, most cases of ovarian cancer seem to arise in the fallopian tubes, which aren’t easy to reach or biopsy.

That’s why last year the OCRA’s recommendation officially changed from symptom awareness and early detection to something completely different: preventive removal of the fallopian tubes, a so-called salpingectomy. This approach has been recommended by the American College of Obstetricians and Gynecologists (ACOG) since 2015.

The recommendation applies not only to those who have tested positive for a high genetic risk, such as BRCA-1 or BRCA-2 gene mutations, but also to all women plan to have further pelvic surgery (such as a hysterectomy, endometriosis or cyst removal) when they are finished or do not want to have any more children. (For women at higher risk, an oophorectomy, or prophylactic removal of the ovaries, is also recommended.)

“So we’re not saying that every normal woman on the street needs to have this elective surgery,” DeFeo says. “But we know that hundreds of thousands of women every year have surgery for some other reason, and may have their fallopian tubes removed at the same time. That’s something they should talk to their doctor about, and that’s something doctors should be thinking about.”

Procedure for genetic testing

In addition to salpingectomy, another effective way to prevent ovarian cancer is genetic testing. You can start by examining your family history. “I know that can be difficult in many families,” says DeFeo. “But to the extent that you can examine your family history and determine if there is a history of cancer in your family, particularly breast and ovarian cancer, and particularly at a young age… those are warning signs.”

Hanley adds that it’s important to look at both sides of the family. “There’s a misconception that family history is only relevant on the mother’s side, but you can inherit a BRCA mutation from your father as well,” she says. “So if there’s a history of breast or ovarian cancer on both sides of your family, possibly even prostate or pancreatic cancer, then a BRCA test is a very good idea.”

Then talk to your doctor about induction.

DeFeo points out that genetic testing is more accessible than ever. “Many insurance companies will cover the cost. It really depends on the individual’s situation, but the cost of testing has come down dramatically over the years,” she says. “So it’s increasingly accessible. And OCRA, for example, offers a free genetic testing program.”

If you test positive, prophylactic surgery is then recommended, as was the case with Evert.

“She would never have shown symptoms,” Hanley says. “There’s no screening method that could have detected that. The only reason cancer was diagnosed is because her fallopian tubes were removed and then examined very, very carefully by a pathologist … and that only happens with a BRCA mutation.”

But Hanley and everyone else in the field are hoping that this will change. “We all hope that with technology and better understanding, we might one day be able to develop a screening method that works,” she says. “But we are still a long way from that.”