Ongoing UK Markey Cancer Research program provides women free screening

By Carrie Stambaugh, For The Independent

ASHLAND, Ky. — To mark September as National Ovarian Cancer Awareness Month, local women are being encouraged to empower themselves by participating in a free research screening program.

The program, available at the Greenup Health Department, is already saving lives and researchers believe results could eventually save countless more.

Ovarian cancer is silent killer. It strikes about 21,000 American women annually and kills more than 14,500. There are no specific symptoms of ovarian cancer and no routine insurance-covered screening test to detect it. As a result, women are often not diagnosed until the disease has reached an advanced, much more deadly, stage.

For the last 27 years the University of Kentucky Markey Cancer Center has been conducting research aimed at changing that. Its Ovarian Screening Program provides free annual screenings to all women age 50 and older, or age 25 and older with a documented family history of the disease.

Screenings are provided statewide at seven locations including Lexington, Elizabethtown, Somerset, Prestonsburg, Maysville, Paducah and Greenup. All women are invited to participate, regardless of geographic location or income.

Initiated in 1987 by Dr. John R. van Nagell Jr., a professor of obstetrics and gynecology at UK, the study focuses on the use of transvaginal sonography (TVS) to detect ovarian cancers in early stages.

The results so far have been promising. To date 256,124 screenings have been performed on 43,092 Kentucky women, according to Dr. Edward J. Pavlik, director of research in gynecologic oncology at UK. The tests have resulted in the detection of hundreds of ovarian tumors and 89 malignancies.

“Two-thirds of women in our program have had their disease detected at stage one or stage two, whereas in the group of women who are referred to us without screening are referred to us with at least stage three (cancer). As a result the five year survival rate of women whose ovarian cancers were detected by screening is 80 percent — or double that of women who didn’t have screening and just had ovarian cancer detected when they did have symptoms,” explained Dr. van Nagell.

He said additional research is needed in order refine the screening process so that it can someday become standard practice. Researchers need to screen as many women as they can annually in order to further define those risks and best practices, said van Nagell.

“We have all kinds of questions that still need to be answered. We have to show absolutely that it is saving lives, but as we get the test more accurate and the risk populations more defined, then we know exactly who to screen,” said van Nagell.

For example, he said, researchers are learning that women who are at highest risk should probably be screened more often, up to every four months, while women with lower risk may only need to be screened every few years.

“We want to have the very best product before we come out and say this needs to be covered by insurance. Unless it is cost effective, clearly insurance companies are not going to pick it up,” he explained. A TVS screening now costs about $50, while the cost of treating an invasive ovarian cancer costs $300,000 on average, said van Nagell.

All women are at risk of developing ovarian cancer, but it most often occurs after age 50 in post-menopausal women. Ovarian cancers also have strong genetic links as well, which is why the study is extended to women age 25 and older with a family history of the disease.

“The lifetime risk of getting ovarian cancer is 1.2 percent in the general population, but if you have one primary relative that has had it, the lifetime risk goes up to 5 percent. If you have two relatives that have had ovarian cancer, it is 7 percent,” said van Nagell. “If you have BRCA -1 mutation it may be as high as 35 to 40 percent. A BRCA 2 mutation probably as high as 16 or 17 percent,” he added.

He encouraged all women to get the free screening and educate themselves about the disease. “We see so many people that come in with the symptoms of ovarian cancer and we treat them with the most advanced types of surgery and chemotherapy and despite all that the survival rate is very low,” said van Nagell.

“We are always happy when we can detect these cancers by screening, and the patients are alive and well. The treatment is cheaper and the prognosis is so much better,” he added.

The Greenup screening location inside the Greenup Health Department was opened in 2012, thanks to a $200,000 grant from the Appalachian Regional Commission, secured by Rep. Tanya Pullin (D-South Shore.) Pullin also secured an additional $10,000 for operations at the Greenup location in this year’s state budget to ensure the program continues to be available to women in eastern Kentucky, southeast Ohio and western West Virginia.

“I just felt women at home deserved to have it,” said Pullin, who herself is screened annually. “You really can’t detect it (ovarian cancer) without one of these tests. Unless (screening) is close and available women in our area don’t have it. It was only fair for women to have it in our area,” she said.

Pullin and Dr. van Nagell encouraged women to talk to their friends, family members and other women about being screened and encourage them to do it together.

“We want as many women screened as possible because we want to save as many lives as possible. If you don’t get screened you won’t get saved,” said Pullin.

To further bolster awareness of the program, a series of public service announcements and advertisements are scheduled to run locally through September. Pullin recently recorded a radio PSA and the UK Markey Center has been running print advertisements in The Independent and other publications.

By educating women about the disease and the screening program, officials hope to overcome persistent barriers that prevent women from being screened for ovarian cancer.

Women often falsely believe they are being screened for ovarian cancer as part of their annual gynecology exam. “It’s not that the medical community is misleading women in that they do have protection when they get an annual pap smear and exam, it just isn’t effective for ovarian cancer,” said Dr. van Nagell. In postmenopausal women the ovaries can often not be felt during a pelvic exam so tumors or other changes may go undetected. A TVS is the only way to capture an image of a woman’s ovaries, which can serve as a baseline to detect future changes.

Women are also hesitant to be screened because they don’t know what to expect, added Tina Payne, a nurse and administrative associate with the UK Markey Cancer Research Center. “They are afraid it is painful or more involved than it is,” she said.

“Most of our women come out of the exam room say it is easy, it is less uncomfortable than a pelvic exam or a pap smear,” she said. The test takes less than 5 minutes and most women are in and out of an appointment in less than 30 minutes.

During the TSV, a small wand, about the size of a regular tampon, is inserted into the vagina in order to capture an image of a woman’s ovaries. Unlike an annual pap smear, there is no speculum involved and no tissue sample is taken. All screenings are private and confidential.

Officials stressed the screening is not a replacement for annual gynecological exams but a supplement to it. Women should still visit their doctor for an annual pelvic exam and pap smear.

For more information about the Ovarian Cancer Screening program contact 1-800-766-8279. For appointments specifically at the Greenup location call 1-855-226-0174.