Q: I went to my doctor with severe pain in my lower abdomen. She found a mass on my ovary. I’m only 30 – could I have cancer?
A: At 30, it is very unlikely that you have ovarian cancer. Age is the most important independent risk factor for ovarian cancer in the general population, with the incidence increasing sharply after the onset of menopause.
The median age at ovarian cancer diagnosis was 63, and 70 percent of patients were 55 or older.
Most ovarian masses in postmenopausal women are also benign, but the risk of malignancy is much greater than in premenopausal women.
An ultrasound will show if the mass looks benign or, possibly, malignant. More likely it is a simple cyst, which is common and generally causes no symptoms unless it ruptures, causing considerable pain. Cysts that are larger than 10 centimeters should be surgically removed. Otherwise, they can cause the ovary to twist on its blood supply, which can be painful.
Most cysts can be monitored to see if they resolve or grow. One study showed that all malignant masses tended to grow about seven months after diagnosis.
The most important personal risk factor for ovarian cancer is a strong family history of breast or ovarian cancer. A 35-year-old woman who has one family member with ovarian cancer has a 5-percent lifetime probability of developing the disease. The risk in the general population is 1.6 percent.
However, the risk increases significantly for a woman with familial gene mutations. Her lifetime risk of ovarian, fallopian tube or peritoneal cancer can be as high as 41 to 46 percent by age 70.
Additional factors that increase your ovarian cancer risk include: never giving birth, starting your menstrual period at an early age, late menopause, being white (Caucasian), primary infertility and endometriosis.
Ovarian cancer is much rarer than other gynecological malignancies; therefore, if you have one family member with this type of cancer, your family should consider genetic testing.
Also, if there is a cluster of breast, colon or endometrial cancers in your family – especially in women who are younger than 50 – genetic testing should be considered. This is a blood test that is often covered by insurance.
Talk to your doctor about whether or not you should pursue genetic testing, based on your family history.
Dr. Joanne Williamson is an obstetrician-gynecologist at Memorial Health University Physicians, Provident OB/GYN Associates in Okatie.
