Pierce Bros­nan’s daugh­ter is the third gen­er­a­tion of women in her fam­ily to die from ovar­ian can­cer, which of­ten de­fies early di­ag­no­sis. Lisa Salmon re­ports

Friday - - Living -

Twenty-two years af­ter his first wife, ac­tress Cassandra Har­ris, died from ovar­ian can­cer, film star Pierce Bros­nan has lost his daugh­ter Char­lotte to the same dis­ease. The mother-of-two was just 41, two years younger than her mother, whose own mother also died of the dis­ease.

Ovar­ian can­cer is di­ag­nosed an­nu­ally in nearly a quar­ter of a mil­lion women glob­ally, ac­cord­ing to fig­ures from Ovari­an­cancer­, and is re­spon­si­ble for 140,000 deaths each year. Al­though there are sparse statis­tics on ovar­ian can­cer in the UAE, Dr Mia Branch, ob­ste­tri­cian/ gy­nae­col­o­gist at Amer­i­can Hos­pi­tal Dubai, says that ac­cord­ing to her sources, “Ovar­ian can­cer is the fourth most com­mon and the third lead­ing cause of can­cer- caused deaths in women in the UAE.”

The dis­ease is known as the ‘silent killer’, be­cause early symp­toms can eas­ily be missed or passed off as some­thing mi­nor. “The use of the term ‘silent killer’ is a suc­cinct way of con­vey­ing the fact that, when it’s con­fined to the ovary in its early stages, this can­cer doesn’t cause many symp­toms, and those that it does cause – like bloat­ing and feel­ing full – are hard to dis­tin­guish from symp­toms that women get ev­ery day,” says Pro­fes­sor Ian Jacobs, a pro­fes­sor of Women’s Health and Can­cer at the

Univer­sity of Manch­ester in the UK. “The key is when symp­toms per­sist, and there’s no ob­vi­ous rea­son, to get them checked by a doc­tor.”

Pro­fes­sor Jacobs, who is also med­i­cal ad­viser to The Eve Ap­peal, a UK-reg­is­tered char­ity that funds re­search into gy­nae­co­log­i­cal can­cers, says that while more than 80 per cent of women with breast can­cer will be alive five years af­ter di­ag­no­sis, only 30-40 per cent of those di­ag­nosed with ovar­ian can­cer sur­vive that long. The dis­ease is of­ten seen as hered­i­tary, as two spe­cific genes – BRCA1 and BRCA2 – are known to in­crease the risk of both ovar­ian and breast can­cer (see ‘Should you get tested for the can­cer gene?’, Fri­day, July 19).

But in the ma­jor­ity of cases, no ge­netic link is found. For the most com­mon form of ovar­ian can­cer (epithelial – on the sur­face of the ovary), the BRCA1 or BRCA2 gene mu­ta­tion is only ac­tu­ally found around 10-13 per cent of the time. Al­though age is the big­gest risk fac­tor – it gen­er­ally only oc­curs in older women – most ovar­ian can­cers de­velop for un­known rea­sons.

It’s un­clear whether Char­lotte Bros­nan had been tested for the gene mu­ta­tions, and her mother and grand­mother died be­fore such test­ing was avail­able.

How­ever, BRCA1 or 2 aside, ovar­ian can­cer can still strike re­peat­edly in fam­i­lies that aren’t car­ri­ers. Helen Kay’s mother, Ann, and aunt Chris­tine died within months of each other, Chris­tine first in July 2009 and Ann in March 2010, from ovar­ian can­cer, yet nei­ther were BRCA1 or BRCA2 car­ri­ers. Helen, 42, and her sis­ter Lynn, 45, from the UK, felt they could take no chances that an as-yet-undis­cov­ered gene was lurk­ing within them so last year Helen had her ovaries and Fal­lop­ian tubes

Ev­i­dence sug­gests ovar­ian can­cer could be picked up in 90 per cent of cases be­fore symp­toms oc­cur

re­moved, and Lynn had a hys­terec­tomy. “We were told that al­though we weren’t BRCA1 or 2 car­ri­ers, there could still be a ge­netic link and we might want to have surgery,” ex­plains Helen. “We chose that op­tion so we’ll be around for our chil­dren – we saw how our mum and aunt died and didn’t want to go through what they went through.”

The sis­ters each have two daugh­ters, and Helen says that when the girls grow up, they’ll have to de­cide if they want to un­dergo ge­netic test­ing – by then, other can­cer genes may have been iden­ti­fied. “It’s a shadow that you just can’t get away from, and we’ve still got this nag­ging doubt that there’s some­thing ge­netic some­where,” she says. “It’s too much of a co­in­ci­dence for two sis­ters to be di­ag­nosed with it and there not to be a link.”

Helen adds, “If women have the symp­toms, get them checked out and be per­sis­tent – some­times it can be an up­hill bat­tle be­cause it can be hard to de­tect.”

It’s a sen­ti­ment echoed by Robert Marsh, chief ex­ec­u­tive of The Eve Ap­peal, who points out that while ovar­ian can­cer usu­ally strikes women over the age of 50, some are di­ag­nosed in their 30s and, for many, there’ll be no fam­ily his­tory. “If there’s any fam­ily his­tory, you need to be on height­ened aware­ness of both breast and ovar­ian can­cer, but if you don’t have it in your fam­ily it doesn’t mean you’re pre­dom­i­nantly in the clear ei­ther,” he says.

Marsh ad­mits that symp­toms can of­ten be dis­missed by doc­tors as some­thing far less se­ri­ous. “Doc­tors don’t see it on a reg­u­lar ba­sis and prob­a­bly don’t think symp­toms might be can­cer. We have a lot of anec­do­tal ev­i­dence from sur­vivors that they’ve re­ally had to bat­tle with their GP to get re­ferred.” He adds that most women aren’t di­ag­nosed un­til stage three or four (four is the last stage), when the prog­no­sis is not good, whereas 90 per cent of those di­ag­nosed at stage one sur­vive more than five years.

Al­though screen­ing would be the ob­vi­ous an­swer, Dr Branch of Amer­i­can Hos­pi­tal Dubai says there’s cur­rently no ef­fec­tive method avail­able. Mea­sure­ment of the tu­mour marker pro­tein Ca-125 via a blood test has been used as a way of de­tect­ing the dis­ease, but the re­sults can be very mis­lead­ing and, “there are nu­mer­ous be­nign con­di­tions that can in­crease the level of this marker in­clud­ing fibroids, en­dometrio­sis, pelvic in­flam­ma­tory dis­ease, even men­stru­a­tion,” says Dr Branch.

She says the key is to look out for “in­creased fre­quency, sever­ity and du­ra­tion of symp­toms [see box be­low]. Re­ports show that sev­eral months prior to di­ag­no­sis th­ese symp­toms were ex­pe­ri­enced 20-30 times per month as op­posed to the two to three times a month most women have”.

How­ever, there is hope on the hori­zon. Clin­i­cal tri­als are on­go­ing across the US and in the UK Pro­fes­sor Jacobs is lead­ing a re­search team funded by The Eve Ap­peal and Can­cer Re­search UK to try to find ways of iden­ti­fy­ing women at risk of ovar­ian can­cer, and of early de­tec­tion by screen­ing. “The hope is that screen­ing to pick it up ear­lier will re­sult in fewer women dy­ing from the can­cer,” he says.

The first trial will be com­pleted in 2015 and ev­i­dence so far sug­gests ovar­ian can­cer can be picked up in 85-90 per cent of af­fected women be­fore any symp­toms oc­cur, and po­ten­tially around two years be­fore signs start ap­pear­ing. If in­tro­duced, screen­ing would tar­get post-menopausal women, plus younger women who have a fam­ily his­tory of the dis­ease or a ge­netic pre­dis­po­si­tion.

For the time be­ing, aware­ness of the symp­toms and a readi­ness to raise them with your doc­tor is the best way for­ward. “It’s sad when any­one dies of ovar­ian can­cer, but hope­fully the death of Pierce Bros­nan’s daugh­ter will bring ovar­ian can­cer more at­ten­tion,” says Helen.

“Women need to be more aware of this dis­ease.”

Flu­o­res­cent stained ovar­ian car­ci­noma cells; be­low Pierce

Bros­nan with his daugh­ter Char­lotte, who died of ovar­ian

can­cer last month

Helen Kay (left) and sis­ter Lynn Muir (right) with their mother Ann Rob­bie be­fore she died of ovar­ian can­cer

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