After the shocking discovery that her mum had stage 4 ovarian cancer, Monash University research scientist Dr Daniella Brasacchio was forced to make some life-changing decisions.
Her mum was 53 at the time and had not shown any clear symptoms – but some uncomfortable sensations like fatigue and bloating prompted a check-in with a doctor who then discovered a tumour the size of a grapefruit in her abdomen.
Dr Brasacchio wasn’t aware of any history of ovarian cancer in the family, however, her aunt died of breast cancer at the age of 49.
The risk of having ovarian or breast cancer increases significantly if a person inherits mutations in the BRCA1 and BRCA2 genes.
A close blood relative suggested this may be the case, so an oncologist recommended that Dr Brasacchio’s mum get genetically tested.
“Once they discovered mum’s BRCA1 mutation, they suggested that I get tested, because at the time, I was 27,” said Dr Brasacchio.
She then learned her risk of breast cancer was around 80 per cent and her risk of ovarian cancer was about 40 per cent higher than average.
Due to historically limited funding and a lack of advancement in ovarian cancer prevention research, significantly lowering Dr Brasacchio’s risk would mean undertaking life-altering surgery.
After speaking with medical professionals and weighing up her options, Dr Brasacchio chose to have her ovaries, fallopian tubes and uterus removed to eliminate the risk of ovarian cancer.
“It was quite confronting at the time,” she said.
There’s no early screening method for ovarian cancer, like mammogram screening that exists for breast cancer or preventative measures, like the HPV vaccine for cervical cancer. Therefore, the burden unfortunately currently lies with each individual to look into their own unique situation in consultation with a trusted medical professional to identify their risks and determine whether risk-reduction steps are advisable.
It’s an important health issue to investigate given ovarian cancer is typically asymptomatic in its early stages and often caught in the advanced stages, largely contributing it to have the lowest five-year survival rate among all gynecologic cancers.
According to the World Ovarian Cancer Coalition, the incidence of ovarian cancer is expected to rise by close to 65 per cent in our region over the next 25 years.
After tragically watching her mother lose her battle, Dr Brasacchio decided to move ahead with a full hysterectomy.
Although she was giving up some of her reproductive organs, she found some comfort in knowing she had a young son.
“Unfortunately, it was the only way of significantly reducing my risk,” she said.
“I didn’t think I really had any other option.”
Looking back, Dr Brasacchio says the whole experience felt isolating at times and this is what led to her working with the Ovarian Cancer Research Foundation (OCRF).
“It’s a small physical recovery from the surgery but it’s a lifelong management program,” she said.
“You feel very isolated as a person, as a woman, and I was only 39, so pretty young. I’m 43 now, but you’re very young to have to go through all this.”
Dr Brasacchio, who is on the OCRF Consumer Representative Panel – an important committee consisting of people with lived experience who support the OCRF to fund the most promising research projects – says she continues to share her story today so it can help others in similar circumstances.
“We really need increased awareness about ovarian cancer – because it’s silent,” she says.
“The treatments haven’t really advanced unfortunately in the last 10 years. It’s a long way to go for women’s health in general so we really need to push for it.”
Did you know?: emerging research indicates there is an increased risk of ovarian cancer for endometriosis sufferers. More research is required to understand associations between key diseases that predominantly impact women.
Read more causes and risk factors for ovarian cancer.
Reducing ovarian cancer risks
While some cases of ovarian cancer can be linked to genetic changes (ranging between 15 and 25 per cent), such as the BRCA1 and BRCA2 variants, the cause remains unknown in many people.
As research continues, there have been new developments and insights into reducing the risk of developing ovarian cancer.
Associate Professor Orla McNally, a specialist in gynaecological oncology, says new research reveals that many forms of contraception can reduce the risk of ovarian cancer.
“Particularly things like the oral contraceptive pill,” says Professor McNally.
“If you use the pill for anything up to 10 years, then you significantly reduce your risk of ovarian cancer, and that’s not something that’s well known out there.
She says lifestyle choices like being active, maintaining a healthy weight and not smoking can also contribute to reducing the risk.
Removing the ovaries obviously reduces the risk of ovarian cancer, but it’s important to understand that this procedure puts women into menopause.
“What has come out again in relatively recent times is that we know that many of these cancers actually start in the fallopian tubes,” she says.
“It is now a standard recommendation that if you’re having your uterus (womb) removed, say for heavy periods, that the fallopian tubes are taken as well.
In addition, an increasing number of younger women are electing to have just their fallopian tubes removed, to try to reduce their risk, and delay removing ovaries until they are older. After menopause, other women may choose to have their ovaries and fallopian tubes removed opportunistically, at the time of another planned surgery.
Dr Brasacchio says women should consult with a medical professional about the best options for them, considering the hormonal effects and other changes that can impact on each individual differently.
And if you are diagnosed with ovarian cancer, she says the best thing to do is to speak with a gynaecological specialist.
“One of the first things I always say to patients in this situation, here in Australia, is that they’re in one of the best places in the world to be treated,” she says.
“Our outcomes are amongst the best in the world, and part of that is because women are referred to multidisciplinary teams and to gynecological cancer centres, where their care is managed by a group of specialists in gynecological cancer.
“It’s really important to have that specialty expertise”.
Finding comprehensive information to empower you to make decisions about your own risk can be difficult. Learn more about the causes and risks of ovarian cancer.
The Ovarian Cancer Research Foundation (OCRF) is Australia’s leading independent funder of ovarian cancer research, dedicated to transforming outcomes for the most lethal women’s cancer. In Australia, less than 50 per cent of women and girls diagnosed with ovarian cancer will survive more than five years.
The OCRF is rewriting this story and accelerating progress by increasing awareness, advocating for greater investment and equity, collaborating nationally and internationally, and strategically funding high impact medical research.
Learn more: www.ocrf.com.au