Ovarian cancer, hormone replacement therapy and the contraceptive pill

Introduction
 

Ovarian cancer is rife amongst women.  Close to a quarter of a million of women globally are diagnosed with ovarian cancer annually[1]. Ovarian cancer is responsible for 140 000 deaths each year[2].  About 90% of tumours of the ovary are epithelial. Epithelial ovarian cancer means the cancer started in the surface layer covering the ovary[3].

Some of the symptoms of ovarian cancer are increased abdominal size, persistent bloating, difficulty eating, abdominal or pelvic pain and the need to pass urine more urgently[4]. These symptoms can easily be confused with less serious gastro intestinal disorders so it is advisable to go and get these symptoms checked by a doctor.

Early detection is key, as it will improve a women’s chance of survival.  

Risk factors
 

Certain factors may increase your risk of ovarian cancer:

- Age: Ovarian cancer can occur at any age but is most common in women ages 50 to 60 years.

- Inherited gene mutation: A small percentage of ovarian cancers are caused by an inherited gene mutation.

- Estrogen hormone replacement therapy: especially with long-term use and in large doses.

- Age when menstruation started and ended: If you began menstruating before age 12 or underwent menopause after age 52, or both, your risk of ovarian cancer may be higher.

- Never having been pregnant.

- Fertility treatment.

- Smoking.

- Use of an intra-uterine device.

- Polycystic ovary syndrome[5].

The impact of hormone replacement therapy and the contraceptive pill
 

Experts at the University of Milan who led a global study found that ovarian cancer rates in the UK fell from 7.51 per 100 000 women in 2002 to 5.86 per 100 000 women in 2012[6]. This is a significant drop of 22 %[7].  They said that falling use of HRT (hormone replacement therapy)[8], the increased use of the pill and a better detection rate and treatments had been seen when used in combinatio, to inhibit the cancer deaths[9].   The scientists, who compared ovarian cancer statistics across the world, found Britain had shown one of the steepest declines. This, they said, was because more women in the UK had previously used HRT than in most other countries[10]. 

By contrast, deaths fell by 16 percent in the United States, 10 percent in the 28 European Union nations excluding Cyprus, for which there was no data, and 8 percent in Canada.  There was considerable variation across European countries.  In Japan, which has a lower ovarian cancer rate than many other countries, the death rate fell by 2 percent. In Australia and New Zealand, deaths declined 12 percent from 2002 to 2011 – the most recent year for which data was available.  In Latin America, deaths decreased in Argentina, Chile and Uruguay, but rose in Brazil, Colombia, Cuba, Mexico and Venezuela.  No data is available for Africa[11].  The variation across countries could be due to a variety of factors such as the extent of early detection, access to treatment plans and the quality of treatment.

It is generally accepted that the use of oral contraceptives reduces the risk of ovarian cancer.  The pill works by suppressing the hormones that naturally stimulate the ovaries and thereby reduces the risk of ovarian cancer.   Other research, though, has linked the contraceptive to an elevated risk of cancer of the breast, as well as heart attack and stroke[12].

South African perspective
 

In South Africa 504 new cases of ovarian cancer diagnosed histologically were reported in 2011.  These cases represented 1.53% of all new cancer cases among women diagnosed histologically[13].  Although ovarian cancer is not as common in women as breast or cervical cancer, it is the 9^th leading cancer faced by women in South Africa[14].  If a woman experiences any of the above mentioned symptoms, she should get them checked as soon as possible.

Conclusion
 

Ovarian cancer can be reduced by decreasing the use of HRT, increasing the use of the pill, and greater awareness of the risks leading to early detection. It is also advisable for women to have regular check-ups to ensure early detection of ovarian cancer and other forms of cancer such as cervical cancer.

Arvitha Doodnath
Legal Researcher
arvitha@hsf.org.za