1) The Times They Are a Changin'

2) 10 Differences Between Men and Women
    that Make a Difference in Women's Health

3) What are the known risk factors for breast cancer?

4) Mifepristone: The New Face of Abortion

5) Ovarian Cancer 

For many women of the baby boomer generation (people born from 1946-1964) "the change" is happening—menopause. Menopause is one of the major transitions in a woman's life, as was menstruation, a first sexual experience, and the birth of a child. While often experienced as a time of renewed freedom and a completely natural life cycle stage, the transition to menopause does not usually pass unnoticed. The changes that happen during perimenopause (the period of transition leading to menopause) can be quite dramatic for many women. Perimenopause, the gradual period leading up to menopause, produces a change in a woman's hormone levels, that affect her physically, mentally, and emotionally. The typical symptoms of
menopause are:
achy joints

• exercise regularly to relieve hot flashes and night sweats;
• take calcium supplements to reduce the loss of bone mass and help prevent osteoporosis;
• reduce your intake of tea, alcohol, coffee, and spicy foods to relieve hot flashes;
• use stress reduction techniques (meditation, yoga, breathing exercises) as tension may trigger hot flashes;
• drink eight glasses of water daily;
• try over-the-counter vaginal lubricants to relieve vaginal dryness with intercourse (such as Astroglide^®, Slippery Stuff^®, or KY Jelly^®, which are all condom compatible); try Replens^® for relief of day-to-day dryness;
• ask a practitioner about using herbal extracts, capsules and infusions, especially those rich in phytosterols—plant estrogens and progesterones (such as flax seed oil, black cohosh, and Dong Quai); and
• try acupuncture treatments to manage stress.

     Not all of these supplements, products, and helpful hints will alleviate every woman's perimenopausal symptoms. Some will, and so each woman must examine her options and choose the methods that work best for her lifestyle. Most importantly, see your doctor to determine what methods for easing perimenopauseal symptoms (including the natural alternatives described above) are best for you. As well, your doctor may recommend HRT even if you don't have symptoms. HRT is used as prevention for health risks such as low bone density, heart disease risk and others.

     Many women forget that they can still get pregnant late in life. While it is uncommon, women should check with their doctors about their pregnancy risk and use contraception if needed.
By Jason Osher

PPFA Web Site © 1999, Planned Parenthood^® Federation of America, Inc.

10 Differences Between Men and Women
that Make a Difference in Women's Health

1. After consuming the same amount of alcohol, women have a higher blood alcohol content than men, even when you allow for size differences.
    
2. Women who smoke are 20 to 70 percent more likely to develop lung cancer than men who smoke the same amount of cigarettes.
    
3. Women tend to wake up from anesthesia more quickly than men—an average of 7 minutes for women and 11 minutes for men.
    
4. Some pain medications, known as kappa-opiates, are far more effective in relieving pain in women than in men.
    
5. Women are more likely than men to suffer a second heart attack within one year of their first heart attack.
    
6. The same drug can cause different reactions and different side effects in women and men—even common drugs like antihistamines and antibiotics.
    
7. Just as women have stronger immune systems to protect them from disease, women are more likely to get autoimmune diseases (diseases where the body attacks its own tissues) such as rheumatoid arthritis, lupus, scleroderma and multiple sclerosis.
    
8. During unprotected intercourse with an infected partner, women are 2 times more likely than men to contract a sexually transmitted disease and 10 times more likely to contract HIV.
    
9. Depression is 2-3 times more common in women than in men, in part because women's brains make less of the hormone serotonin.
    
10. After menopause women lose more bone than men, which is why 80 percent of people with osteoporosis are women.
     

www.womens-health.org

What are the known risk factors for breast cancer?

Age - The risk of breast cancer increases as a woman gets older. About 85 percent of breast cancers occur in women aged 50 and older.

The risk is especially high for women older than age 60. Breast cancer is uncommon in women younger than 35.

Family History - The risk of getting breast cancer increases for a woman whose mother, sister, daughter, or two or more close relatives, such as cousins, have had the disease.

Personal History - Women who have had breast cancer may develop it again. Women with a history of breast disease (not cancer but a condition that may predispose them to cancer) and women having so much dense breast tissue on a previous mammogram that a clear reading is difficult are also at increased risk.

Laboratory evidence that a woman is carrying a specific genetic mutation or change will also increase her susceptibility to breast cancer.

Other Risk Factors - Other risk factors include having a first child after age 30, or never having children. Current research is investigating the roles of obesity, hormone replacement therapy, diet, and alcohol use.
 

NBCAM

Mifepristone: The New Face of Abortion

For a decade around the world, several million women have used a pill to end pregnancy in its earliest weeks. Now mifepristone has crossed US borders. Also known as RU-486 or the "French abortion pill," the drug should be ready for widespread use in the US by 2000. Like all abortion methods, mifepristone has been the subject of controversy, in part because it promises to make abortion even safer, more effective and more accessible.

How does it work?
     Mifepristone blocks the effects of progesterone, causing the uterus to shed its lining. This dislodges the fertilized egg or embryo. A second drug, misoprostol, is given two days after mifepristone. Misoprostol has the same effect as a specific prostaglandin produced in the body. The drug combination of mifepristone and misoprostol is more than 95% effective in terminating a pregnancy within the first 7 weeks.

Use in other countries
     Mifepristone became available for medical abortion in France during the 1980s. In 1988 Roussel-Uclaf, the pharmaceutical company that developed the drug and named it RU-486, reacted to the protests of abortion opponents and removed the drug from the market. The French government forced Roussel to return the drug to the market, deeming it the "moral property of women." Since then, roughly 300,000 women in Europe, and possibly more than 3 million in China have used it.

Implications for abortion in the US
     Since it can terminate pregnancy so early — even before a woman misses her period — medical abortion is more politically acceptable in the United States. A 1998 New York Times/CBS poll showed that almost two thirds of American adults believe women should have the legal right to have abortions performed during the first three months of pregnancy. ¹

     Medical abortion also offers women more privacy, away from anti-choice violence. Mifepristone can be dispensed in the anonymity of a doctor's office, clinic, or hospital, away from the jibes of right-to-life picketers.

     The drug also promises to make abortion more accessible. In 1996, 86% of all U.S. counties lacked an abortion provider. A 1998 Kaiser Family Foundation poll, however, showed that 45% of family practitioners were "very" or "somewhat" willing to prescribe mifepristone. Fifty-four percent of nurse practitioners and physician's assistants were also "very" or "somewhat" willing to prescribe it.

Hurdles for U.S. approval
     With support from President Bill Clinton, feminist organizations jumped high hurdles to bring mifepristone to this country. Within the first year of preliminary approval from the U.S. Food and Drug Administration, additional setbacks delayed the drug's market appearance. Remaining threats to mifepristone even after it is approved by the FDA include: legislative restrictions on who can provide it, and limiting its use to doctors' offices. (Clinical evidence shows that the second drug in the regimen, misoprostol, is effective when women administer it at home and that most women prefer to use it this way. The preferred scenario is for clinicians to dispense mifepristone in their offices and for women to take misoprostol at home two days later.) The possibility also exists that the FDA will not be able to protect the anonymity of the drug's distributors and that abortion opponents will focus terrorist attacks or boycotts against them.

Other Potential Uses
     Mifepristone's potential goes beyond early abortion. It has proven 99% effective as an emergency contraceptive. It can also be used as a monthly birth control pill, as well as a treatment for breast and prostate cancer, meningioma, Cushing's syndrome, and other conditions.

By Susan Motamed
September 1999
PPFA Web Site © 1999, Planned Parenthood^® Federation of America, Inc.
 

Ovarian Cancer

She crowned herself "the Queen of Neurosis," but this time, it was not simply an overactive imagination that made her fear for her health. It was symptoms of the ovarian cancer that eventually claimed her life.

     Gilda Radner, one of the original Not Ready for Prime Time Players of television's "Saturday Night Live," claimed in her book " It's Always Something", that she could get neurotic over any health problem. "I hated to be sick and I had an imagination that could turn a stomach ache into the plague."

     So, she wrote, when a complete physical examination in January 1986 failed to explain the overwhelming fatigue and general malaise she was feeling, she agreed with the doctor that her symptoms might just be from depression; she had, after all, been going through a rough period in both her personal and professional life. It was not until October--10 months and several symptoms, diagnoses, and failed therapies later--that cancer of the ovaries was confirmed.

     Delay in diagnosing ovarian cancer is not unusual. Early detection is difficult because disease confined to the ovary seldom produces symptoms. When symptoms do surface, they are often vague and easily mistaken for other, often minor, ailments.

     Radner's cancer was not discovered until it had spread to her bowel and liver. She suffered from fatigue, low-grade fever, pelvic cramping, abdominal bloating, gas, and aches and pains in her upper thighs and legs. Loss of appetite and a feeling of fullness, indigestion, nausea, weight loss, and, less often, vaginal bleeding and low back pain are other symptoms.

     As the tumor grows, it may press on the bowel and bladder, causing constipation and frequent urination. Malignant cells can break away from the tumor and spread directly to other organs in the abdomen, such as the stomach, colon and diaphragm (muscle separating the chest cavity from the abdomen), causing a fluid buildup that results in swelling and discomfort. The cells can also enter the bloodstream or lymph system and spread to other parts of the body.

     Radner wrote that her complaints had been variously attributed to Epstein-Barr virus infection, depression, stress, and anxiety. She had undergone blood tests, a barium enema, and ultrasound (pelvic sonogram). According to Radner, the sonogram, done in the summer of 1986, showed "congestion" and the "ovaries weren't exactly in the place they were supposed to be, but that wasn't serious." There was no sign of tumor or bowel obstruction.

Aspirin to Acupuncture

     Attempting to combat her ills through both mainstream and holistic medicine, Radner tried remedies that ran the gamut from aspirin, anti-inflammatories and antidepressants to health foods, vitamins, acupuncture, and colonics (unconventional type enemas).

     "Suddenly, I began to wonder how to please so many people," she wrote. "Do I take the magnesium citrate? What about the coffee enema? Do I do both? Do I do the abdominal massage or the colonic? Do I tell the doctors about each other?"

     Then, late in October, an abnormal liver function test prompted more exams. A CAT scan and analysis of fluid from the abdomen confirmed ovarian cancer.

     Diagnosed at age 40, Radner was younger than most women with the disease. The chance of developing ovarian cancer increases with age; most cases are found in women who have gone through natural menopause, with the average age at diagnosis being 61. As was true with Radner, however, women with a family history of the disease generally are diagnosed at a younger age.

     Each year in the United States, ovarian cancer is diagnosed in about 26,000 women and claims more than 14,000 lives. It is most common in women living in Europe and North America; Asian women have a relatively low incidence. Although Chinese and Japanese women living in the United States have higher rates of ovarian cancer than their counterparts in Asia, the disease is still less common among this group than among the native white population in the United States. Rates among black women in all parts of the world are low.

     Certain factors are associated with an increased risk of getting ovarian cancer. Although the lifetime risk for most women is 1 in 70, it doubles for women who have never been pregnant. Also at increased risk are women who have had breast, intestinal, or rectal cancer. Under investigation as possible risk factors are: high-fat diet, early onset and late cessation of menstruation, being of Eastern European Jewish descent, and use of talcum powder in the genital area.

     Women with close relatives who have had ovarian cancer are also at greater risk, reaching perhaps a 50 percent chance if they have at least two first-degree relatives (mother, sister or daughter) with the disease. This compares with a 1.4 percent chance in women without a family history. Women who have a first-degree relative and one or more second-degree relatives (aunt, grandmother) who had ovarian cancer have a somewhat lesser risk than those with two first-degree relatives, but are still considered to be at high risk. Radner wrote that her mother had breast cancer and a cousin had both breast and ovarian cancer. Later, it was learned that other of her relatives had ovarian cancer as well.

     About 5 to 7 percent of all ovarian cancer is thought to be inherited. In 1994, scientists identified a gene, which they named BRCA1, that related to the development of inherited breast cancer. Changes or abnormalities in this gene are now also considered responsible for about 80 percent of inherited ovarian cancer. The abnormal gene can be inherited from either parent.

     The Gilda Radner Familial Ovarian Cancer Registry, established in 1981 at Roswell Park Cancer Institute in Buffalo, N.Y., and named for Gilda Radner after her death in 1989, included 2,946 cases of ovarian cancer in 1,346 families as of January 1997.

Reduced Risk

     Factors associated with a reduced risk of ovarian cancer include: giving birth to more than one child, breast-feeding, tubal ligation (female sterilization), and use of birth control pills.

     Evidence suggests that hormones may influence development of the disease. The risk of ovarian cancer is reduced in women who have had multiple pregnancies and in those who used birth control pills. The Cancer and Steroid Hormone Study by the national Centers for Disease Control and Prevention and the National Institute of Child Health and Human Services found that use of oral contraceptives for even a few months reduced the risk of ovarian cancer by 40 percent in women 20 to 54 years old.

     The study, published in the March 12, 1987, New England Journal of Medicine, also found that the longer a woman used birth control pills, the lower her risk of ovarian cancer, and that the protective effect persisted long after stopping the pill. Based on these data, since 1989, the labeling for oral contraceptives has included decreased incidence of ovarian cancer among the noncontraceptive health benefits of the pill.

     On the reverse side of the coin, in January 1993, FDA requested that drug firms revise fertility drug labels to include ovarian cancer as a potential adverse drug reaction. The action was in response to a report in the November 1992 issue of the American Journal of Epidemiology suggesting a possible relationship between use of fertility-enhancing drugs and ovarian cancer. The analysis was based on data from 12 studies comparing women with ovarian cancer to those without the disease. Only three of the studies, however, contained data on the use of fertility drugs and risk of ovarian cancer. (A 1987 article in the same journal reported no association between the drugs and ovarian cancer.)

     FDA urged caution in interpreting the findings of the 1992 report because the analysis only included small numbers of women and because the article gave no information about the fertility drugs prescribed, reasons for the infertility, or tumor size or stage of disease at diagnosis.

Search for a Screening Test

     According to the registry, if ovarian cancer is diagnosed while still confined to the ovaries, the chance for cure is 85 to 90 percent. According to the American Cancer Society, only 23 percent of all cases are diagnosed at this early stage. Among women whose cancer has spread beyond the ovary by the time it's diagnosed, only 20 to 25 percent survive five years. However, unlike cervical or breast cancer (which may be detected early by a Pap test or mammogram, respectively), ovarian cancer has no approved screening test, though some are under investigation.

     "The traditional routine pelvic examination is largely ineffective for early detection," says Julie Beitz, M.D., a medical oncologist in FDA's division of oncology and pulmonary drug products. "Often you can't feel a normal-sized ovary. And even if you can, it's hard to tell if it's enlarged because ovaries vary in size from person to person and day to day. Ovarian cancers start very small, and by the time they're large enough to feel, the cancer is most likely already advanced." The problem with ovarian cancer, she says, is that "you have to detect very small changes, and these are hard to detect on a pelvic exam because it's a very indirect examination."

     Researchers are working on developing an accurate test for the BRCA1 gene. The American Society of Human Genetics has recommended that testing for BRCA1 be limited to research in which subjects are members of families at high risk for either ovarian or breast cancer.

     Researchers continue looking for tumor markers--substances that may appear in abnormal amounts in the blood or urine--that may prove useful in developing a screening test.

     One such marker is CA 125, a substance in the blood that is elevated in patients with advanced ovarian tumors. Doctors now measure CA 125 levels in patients treated for advanced disease to determine if the tumor has shrunk or if disease has recurred. Its value in monitoring treatment prompted scientists to study its potential for early detection. Its use for screening, however, is investigational.

     Transvaginal ultrasound is also being studied as a screening tool. With ultrasound, high-frequency sound waves are projected into the body, and the echoes produced are converted by computer into a picture. Unlike abdominal ultrasound, in which the sound wave-emitting device is placed on the outside of the belly, transvaginal ultrasound uses a probe placed in the vagina that can reach within millimeters of the ovaries, producing more detailed images.

     "There is uncertainty as to the value of these tools as screening tests and their ultimate impact on mortality," says John Gohagan, Ph.D., chief of the National Cancer Institute's Early Detection Branch in the Division of Cancer Prevention and Control. NCI is conducting a clinical trial including 74,000 women aged 60 to 74 to clarify the issue. The trial is designed to assess the value of CA 125 and transvaginal ultrasound for early detection of ovarian cancer and to measure their impact on mortality.

     Women in the trial are randomly assigned to either a screening group or a control group of 37,000 women each. The screening group will have periodic pelvic examinations along with CA 125 and transvaginal ultrasound tests. The control group will have routine medical care.

Diagnostic Procedures

     If a woman or her doctor suspects ovarian cancer, diagnosis begins with a medical history of the patient, review of her symptoms, and complete physical examination, including a pelvic exam, in which the physician feels the vagina, ovaries, fallopian tubes, bladder, and rectum to check for any growths. A Pap test may also be done because, even though it cannot reliably detect ovarian cancer, it may detect cancer cells that have migrated to the uterine cervix from the ovaries.

     Blood and urine tests may also be done, as well other procedures, depending on the woman's symptoms and results of her physical exam. These procedures include:

• abdominal or transvaginal ultrasound--helps distinguish fluid-filled cysts from a solid tumor
• CAT scan--produces x-ray images of cross-sections of body tissues
• lower GI series (barium enema)--visualizes the bowel on x-ray to detect abnormal areas that may be caused by ovarian cancer
• intravenous pyelogram (IVP)--produces x-ray pictures of the kidneys, bladder and ureters (tubes carrying urine from the kidneys to the bladder). Often, ovarian cysts or tumors can cause pressure on these organs, which may show up on an IVP.

     The only sure way to diagnose ovarian cancer, however, is through microscopic examination by a pathologist of abnormal-looking fluid or tissue. While fluid can sometimes be obtained by needle aspiration or other techniques, more commonly a laparatomy or laparoscopy is done. Laparotomy is an exploratory operation in which the surgeon examines the abdomen thoroughly and removes fluid or tissue for examination. In laparascopy, a flexible, lighted tube is passed through a small incision in the abdomen, allowing the surgeon to examine the area and extract tissue for a biopsy.

     If cancer is suspected, the surgeon usually removes the entire affected ovary to avoid cutting through the outer layer, which might cause the tumor to spread.

     The tissue is sent to the pathologist for immediate evaluation, and if cancer is confirmed, the surgeon nearly always removes the second ovary, the uterus, and the fallopian tubes. Samples are taken of nearby lymph nodes, the diaphragm, the omentum (a fold of membranous lining in the abdominal cavity), and fluid from the abdomen to see whether the cancer has spread. If no fluid is found, several "washings" are taken: A saline solution is put into the abdomen and then removed to be examined for cancer cells. If there are suspicious lesions, tissue samples are also taken from the liver, small intestine, and large intestine.

Early Treatment Crucial

     Trusting her instincts may have saved Jessica Marsh's life. Due in part to her own vigilance and persistence, Marsh (not her real name), a secretary in Rockville, Md., was diagnosed before her cancer had spread beyond the ovary, affording her a brighter prognosis.

     For three months in the fall of 1985, Marsh, then 36 years old, had noticed pains in her right side around the time of her menstrual periods. Although the pains were brief and not severe, she decided to have her doctor check it out. A week or so before her appointment, however, a very sharp pain prompted her to call the doctor again. Her gynecologist was out of town, but the doctor on call had her come in.

     "He told me that my stomach was distended, gave me a pelvic exam, and then congratulated me, telling me I was three months pregnant," Marsh recalls. "I told him I wasn't pregnant, that I already had two children and knew what it was like to be pregnant, and this was not a pregnancy."

     At Marsh's insistence, the physician arranged for her to have a pelvic sonogram that day at a local hospital.

     "I had the sonogram and the next thing I knew, the doctor who had examined me at the office came in, repeated the sonogram, and told me there was a mass and he wanted to do some more tests. The next morning, I had surgery to remove my ovaries, uterus, and fallopian tubes."

     Although Marsh's experience may not be typical, it illustrates again the difficulty in correctly diagnosing the disease early. Yet, early detection and treatment can mean the difference between life and death.

Treatment Options

     Ovarian cancer is always treated surgically, removing as much tumor as is feasible. Chemotherapy (drug treatment) or radiation therapy, or both, may also be given, depending on the extent of disease. Ovarian tumors usually grow outward, with an irregular, cauliflower-like shape. When the cancer spreads, parts of the tumor break off and attach to nearby organs. Cells may then spread to lymph nodes and distant organs.

     Cancer limited to the ovaries may be successfully treated with surgery alone, removing the ovaries, fallopian tubes, omentum (a fold of tissue attached to organs in the abdominal cavity), and uterus. Some patients may also receive chemotherapy or radiation therapy to kill any cancer cells remaining after surgery.

     Disease that has spread beyond the ovaries almost always requires chemotherapy or radiation therapy in addition to surgery. Radiation therapy may be given by placing a radioactive solution into the pelvis and abdomen through a thin tube, coating the organs and total abdominal contents. Less commonly, external radiation using high-energy x-rays directed to the pelvis and abdomen may be prescribed.

    The type of drugs used in chemotherapy depends not only on the extent of disease, but also on the type of cancer. About 85 to 90 percent of ovarian cancers arise from epithelial cells, which form the outer layer of the ovary. The rest derive from other cell types that make up the organ.

     FDA has approved several drugs to treat ovarian cancer. Two of the most commonly used are Platinol (cisplatin) and Taxol (paclitaxel). Taxol was approved in April 1998 as a first-line treatment for advanced ovarian cancer. It has been used since December 1992 to treat advanced ovarian cancer that has not responded to other therapies or has progressed after treatment and is being evaluated for first-line treatment. National Cancer Institute and FDA scientists cooperated in studies to evaluate the safety and effectiveness of Taxol. FDA's research role in drug development is a fairly new concept, designed to help speed the approval process for drugs for life-threatening diseases.

     "It's a commitment by the agency to do more than just wait for packages of data to come in [from the drug's sponsor] and review them for approval," says Jerry M. Collins, Ph.D., director of the division of clinical pharmacology research in the Center for Drug Evaluation and Research. "We can't do this for every new drug in every therapeutic area," he says, "but for AIDS and cancer, we have done similar research before."

     Since Taxol is given in combination with several other drugs, there was major concern about the potential for serious drug interaction. However, according to Collins, this research demonstrated that "paclitaxel actually had a lower risk of metabolic interactions than most other drugs."

     Other chemotherapeutic agents used to treat ovarian cancer include Cytoxan and Neosar (cyclophosphamide), Paraplatin and Adriamycin (doxorubicin), and Hexalen (altretamine). A recent addition is Hycamtin (topotecon, approved in 1996 to treat ovarian cancer that recurs after other chemotherapeutic agents have failed. Hycamtin is the first of a new class of drugs called topoisomerase I inhibitors. They kill cancer cells by inhibiting an enzyme essential to the replication of human DNA.

Side Effects

     Surgery, the first-line treatment for ovarian cancer, requires several days' hospitalization and a recuperative period of from four to six weeks. Removing the ovaries, which are the main source of the female hormones estrogen and progesterone, causes immediate menopause, and the symptomatic hot flashes are more severe than when menopause occurs more gradually, as it usually does naturally.

     Radiation therapy can cause mild skin reactions, such as redness and drying in treated areas, urinary discomfort, diarrhea, and vaginal dryness. (Menopause can also cause vaginal dryness.) A small percent of patients may develop bowel obstruction, sometimes requiring surgical correction.

     Other possible side effects of radiation therapy, commonly experienced with chemotherapy as well, include loss of energy and appetite, nausea, and vomiting.

     Chemotherapy may also cause mouth sores, hair loss, and reduced platelet and blood cell counts that can lead to infections, anemia or bleeding. The drugs used to treat ovarian cancer may also have neurologic effects, causing hearing loss, ringing in the ears, nerve damage, and numbness or tingling in the face, fingers and toes. There may also be kidney damage.

     Most side effects are temporary, and sometimes dietary changes or medicines can ease the symptoms. There are several drugs approved for countering nausea and vomiting often associated with chemotherapy. They include Zofran (ondansetron hydrochloride), Reglan (metocloparamide), and Marinol (dronabinol).

    Transfusions can correct red blood cell and platelet deficiencies. Hematopoietic growth factors such as G-CSF, approved in 1991, stimulate production of infection-fighting white blood cells. GM-CSF, which also received FDA approval in 1991 to increase white blood cell counts after bone marrow transplantation, is now being studied for its effectiveness in stimulating white cells after cancer chemotherapy. Among other drugs now under study for their ability to increase white cell counts, and perhaps platelets as well, are stem cell factor and PIXY 321. PIXY 321 is a genetically engineered product consisting of GM-CSF and another hematopoietic growth factor, interleukin-3.

    When therapy is completed, the woman continues to have regular checkups that include pelvic examinations and laboratory tests to measure blood levels of tumor markers such as CA 125. The doctor may recommend a laparotomy or laparoscopy after completion of chemotherapy to inspect the abdomen and pelvis and take multiple tissue biopsies. This "second-look surgery" helps evaluate the effectiveness of chemotherapy and determine whether treatment should be continued or stopped. Often a laparotomy or laparoscopy has been done previously to diagnose ovarian cancer.

Attempts at Prevention

    The Gilda Radner Familial Ovarian Cancer Registry advises women with two or more first- or second-degree relatives who have had the disease to have their ovaries removed via video laparoscopy as a precautionary measure by age 35, if they have completed their families. The registry also advises that there is a small increased risk (1.8 percent) of developing primary papillary cancer of the peritoneum for women who have had this prophylactic surgery. The registry also recommends that women with a family history of ovarian cancer receive genetic counseling, beginning in their early 20s, and have pelvic and abdominal examination, CA 125 testing, and transvaginal ultrasound every six months beginning in their early 30s.

    Jessica Marsh, seven years after her diagnosis, is today free of cancer and feeling fine. "I've become a much more positive person since my cancer," she says. "Life is too short to worry about little things. If life deals me lemons, I'll make lemonade."

Marian Segal is a former member of FDA's public affairs staff.www.fda.gov