Sonographer Erin Neward performs ultrasounds on patients enrolled in the Markey Cancer Center's ovarian cancer screening program. The program is free to all women over the age of 50 and women over the age of 25 with a family history of ovarian cancer. (Photo by Rachel Gilliam)
By Rachel Gilliam
When 16-year-old Lauren Weyl showed up at the emergency room in 2009 with severe abdominal pain, doctors thought they were dealing with an ovarian cyst. The Lexington teen underwent surgery to repair a ruptured ovary and was sent home.
But three months later, the pain was back, and the diagnosis was something altogether different. This time, doctors realized Lauren had ovarian cancer, and she underwent surgery again to remove an ovary and both fallopian tubes.
Lauren was lucky. Ovarian cancer kills more women than all other gynecological cancers combined, primarily because it’s not detected early enough, according to the University of Kentucky’s Markey Cancer Center.
That’s a statistic Dr. Ed Pavlik and Dr. John van Nagell are not willing to accept. Just ask the more than 42,000 Kentucky women who have received free ovarian cancer screenings, thanks to their research program at the Markey Center.
“Our major goal is to show ovarian cancer can be detected in its early stages with screening because early stages are highly curable,” Pavlik said.
Any woman in Kentucky over the age of 50, or any woman over the age of 25 with a family history of ovarian cancer, is eligible for an annual screening. For women over 50, screenings will be conducted even without personal risk factors or the presence of symptoms.
“I think the majority view (from Kentucky, British and Japanese trials) is that it (ultrasound screening) works,” Pavlik said.
Dr. Ed Pavlik directs the ovarian cancer screening program at the University of Kentucky's Markey Cancer Center. (Photo by Rachel Gilliam)
Although ovarian cancer can usually be treated successfully in the early stages, diagnosis often occurs in late stages, Pavlik said, because there are no symptoms or they are dismissed as routine gynecological or gastrointestinal problems.
Patients are screened using transvaginal ultrasound. A sonographer takes pictures of the ovaries and uterus, which are then evaluated by van Nagell, who also directs the Division of Gynecological Oncology at Markey. If the ultrasound reveals abnormalities, patients are notified within two weeks and reports are sent to their personal physicians.
Typically, Pavlik said, patients are urged to have a repeat screening in four to six weeks or six months, depending on the type of abnormality, before seeking any kind of treatment or surgery. Cysts can often go away on their own, he added.
So far, early stage cancer has been detected in 85 women through the screening program. A study conducted by Pavlik and van Nagell found that of the women who had disease, about one in five reported having symptoms, though some studies have shown that as few as one in 100 women experience symptoms. It can be difficult to determine if symptoms are actually caused by the disease, or if women have symptoms they do not report, meaning there is no definitive statistic.
“Information is your ally,” Pavlik said.
Opponents of routine screenings argue that it could lead to over treatment. Some women may not want to wait six weeks for a second screening, Pavlik said, and seek treatment before it is really necessary. He and van Nagell argue that their research shows that the benefits outweigh the risks, published in the January 2013 edition of the journal “Women’s Health.”
Women at the highest risk for ovarian cancer are those who have never had children, started menstruating at an early age, never marry or have a family history. Pavlik compared ovulation to a “wound,” meaning that the body has to “remodel” the ovary after each cycle. The more times this process occurs, the higher the likelihood an error leading to malignancy will eventually occur. Women who have at least two children and take oral contraceptives for two years have the highest amount of protection against the disease.
Many women, like Lauren Weyl, seem to be the picture of health. A junior at Tates Creek High School, she also was an athlete, playing on the school’s volleyball team. Prior to her ruptured ovary, which led to her Stage 2 cancer diagnosis, Lauren did not have any unusual symptoms.
Because of Lauren’s experience, her father, John Weyl, has become an unlikely ovarian cancer activist, serving on the board for the Bluegrass Ovarian Cancer Support Group and spreading the word about the free screening program at Markey.
“This is just such a horrible illness women are afflicted with. A lot of them don’t heed the warning signs. So much of what a woman goes through on a monthly cycle are a lot of the symptoms you have to be aware of. They just write it off as no big deal. They put off getting it checked,” John Weyl said.
Although Lauren has made a full recovery and now attends Asbury College, John Weyl said he has seen firsthand how often the scenario plays out differently.
“Unfortunately, like so many women that get ovarian cancer, we’ve lost so many of the members (of the support group), because of late diagnosis or recurrence,” Weyl said. “It kills me. Women tell me, I get my Pap smear done yearly. Well, that’s not really going to tell you if you have ovarian cancer.”
Eventually, Pavlik said he would love to see women receiving regular ovarian cancer screenings, either by ultrasound or a new technology not in place yet, as part of routine gynecological care.
To help make the program more accessible for women across the state, sonographers and ultrasound equipment are taken to Prestonsburg, Somerset, Maysville and Elizabethtown. Women also can receive screenings at the health departments in Paducah and Greenup.
“It’s a free service that they offer, and you should really take advantage of it,” John Weyl said.
So far, approximately 220,000 screenings have been provided.
“We believe it works. We’ve published data,” Pavlik said.
For more information on the program, click here.
Rachel Gilliam is a reporter and editor at The WInchester Sun and lives in Winchester with her husband, Brandon, and daughter, Anna.