Silence is Violence: Black Women and Ovarian Cancer

September is Ovarian Cancer Awareness Month. Ovarian cancer is the 5th leading cause of cancer deaths among U.S. women — more than any other cancer of the female reproductive system. It accounts for 3% of cancers in U.S. women. A woman’s lifetime risk of developing ovarian cancer is 1/70. Ovarian cancer rates are highest in women aged 55-64. Approximately 21,000 women are diagnosed with ovarian cancer each year. 10% of these cases are attributed to hereditary BRCA 1 & 2 mutations. Approximately 14,000 women die from ovarian cancer each year.

We sat down with Dr. Tiffany Woodus, MD, FACOG – Owner and Lead Physician of Woodus Obstetrics and Gynecology in Cedar Hill, and here is the latest need-to-know on the subject.

Fast facts Black women need to know about ovarian cancer:

● White women have a higher incidence of ovarian cancer (12.8 new cases per 100,000) compared to black women (9.8 new cases per 100,00).

● Black women tend to present with more advanced stage ovarian cancer compared to White women.

● Black women are less likely to have access to quality care and standardized, evidence-based treatment.

● Black women suffer worse outcomes. With the implementation of aggressive surgical and chemotherapeutic management, overall survival of ovarian cancer improved from 36% to 45% from the 1970s to 2010. However, the survival rate for black women decreased from 42% to 36% during that same period of time. From 2002-2011, the mortality rate associated with ovarian cancer decreased by 2% per year for White women and 1.4 % per year for Hispanic women, but stayed the same among Black women.

Being proactive about your health may help you take the necessary steps to lower your ovarian cancer risk.

Here’s what Black women can do about it:

1. Know your family history. Some cancers run in families. A family history of cancer may increase your risk of developing certain cancers. Understanding your cancer risk is an important component of cancer surveillance and prevention. Create a record of your family’s history of cancer. Write down who had cancer, age of diagnosis, and what type of cancer.

2. Implement healthy lifestyle choices to help decrease your cancer risk.

a. Don’t smoke. Studies have shown smoking appears to increase the risk of certain types of ovarian cancer and decreases survival in women with ovarian cancer.

b. Prioritize regular physical activity. Studies have suggested obesity may moderately increase ovarian cancer risk. The American Heart Association recommends that adults get 150+ minutes/week of moderate-intensity exercise like brisk walking or bicycling or 75+ minutes/week of vigorous exercise like jogging or swimming laps, ideally spread over multiple sessions throughout the week.

c. Implement a healthy diet. While there is no specific diet that has been associated with ovarian cancer risk, obesity has been. In addition, being healthier at baseline will decrease your risk for comorbidities (hypertension, diabetes, cardiovascular disease, etc.) that can impact your prognosis and survival.

3. Listen to your body. Ovarian cancer is a deadly disease with no effective screening. Because of this, the majority of ovarian cancer cases are detected at an advanced stage which leads to poor outcomes. Ovarian cancer symptoms can be vague and common, and therefore often get overlooked. Some potential signs and symptoms you should pay attention to include: bloating, early satiety (feeling full quickly), unusual or persistent pelvic/abdominal/back pain, changes in bowel habits, menstrual changes, and pain with intercourse. These symptoms are not specific to ovarian cancer, but if you experience worsening or persistent symptoms that do not respond to common pain remedies (rest, warm bath/compresses, over-the-counter pain meds) you should discuss your concerns with your provider.

4. Be consistent about your routine well woman exams. The changes in pap smear screening guidelines have left many women confused about the need to continue yearly well woman exams. Most do not understand the difference between the pap smear (screening for cervical cancer) and the pelvic exam which evaluates the health of EVERYTHING else in the pelvis including the vagina, uterus, tubes, and ovaries. The annual pelvic exam can be a valuable tool in enabling us to identify a problem and implement further evaluation.

5. Be picky about your provider.

a. Pick a provider who gets it. One who understands & respects that your cultural nuances inform your medical decisions.

b. Check the bedside mannerisms. Choose a provider who invites you to actively participate in the decision-making process, presents options/opinions (not mandates/directives), and asks for and respects your opinions in return.

“As a physician, I don’t care how many books I’ve read or cases I’ve seen, I’ve not spent a single day in your shoes,” Woodus adds. “Unless we have history, I’m using a 15-20 minute interaction with you to make the best informed decision I can. The bottom line is nobody knows your body like you do. Show up. Don’t be a spectator. Use your voice. Be persistent. Make your thoughts, concerns and questions known.”

c. Help me, Help you. Educate yourself. Equip yourself to actively participate in your care. Lack of education leads to loss of options. This leaves you at the mercy of what somebody tells you. And what that somebody chooses to tell you (or withholds from you) is informed by their implicit bias. Find out everything you can about your health from reliable resources. Take notes. Seek out a second opinion (or even a third or fourth opinion) if necessary.

d. Don’t be afraid to switch providers. You have options. Find a provider who sees you, hears you and has a plan to optimize you.

More info on Dr. Woodus, the services she provides and her practice can be found at WoodusOBGYN.com.

Sources: American Cancer Society, Centers for Disease Control and Prevention, PubMed, Journal of Ovarian Research, Frontiers Journal