Tag: Ovarian Cancer

Oral Contraceptives Tied to Lower Risk for Certain Cancers

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Oral Contraceptives Tied to Lower Risk for Certain Cancers

The drugs may increase the risk of breast cancer, but may lower the risk of ovarian and endometrial cancers.

Nicholas Bakalar

  • Jan. 5, 2021, 5:00 a.m. ET

Women who have used oral contraceptives may be at lower risk for ovarian and endometrial cancer.

Oral contraceptives are known to be associated with a higher risk for breast cancer, but a new study in Cancer Research suggests the increased risk is small and of short duration. At the same time, researchers found that the lowered risk of ovarian and endometrial cancer is substantial and long-lasting.

The analysis included health data through 2019 on 256,661 women born between 1939 and 1970 in Britain. More than 80 percent of the women had used oral contraceptives.

After adjustment for many other health and behavioral characteristics, the scientists found that compared with women who had not used them, women who had used oral contraceptives had a 32 percent reduced risk for endometrial cancer and a 28 percent reduced risk for ovarian cancer. Those reduced risks persisted for life.

“Ovarian cancer is deadly and hard to treat,” said the senior author, Asa Johansson, an assistant professor at Uppsala University in Sweden. “The mortality rate for breast cancer is lower. If you have a close relative who died from ovarian cancer, you might make one decision about oral contraceptives. If you have one who died from breast cancer, you might make another.”

In any case, she said, “I don’t think we can offer advice. People should be informed about the risks and benefits and make their own decisions.”

Keeping the Disruption of a Move in Perspective

Camilla Engman

At midnight, the ice cube dispenser on the refrigerator is not merely dripping. Water pours onto the floor. I drop down towels, empty the accumulated cubes from their plastic container and pop it back inside the freezer.

“Was that the right thing to do?” I ask my husband, who is trying to sleep. “For goodness sakes,” Don says, getting out of bed. We must leave for my monthly cancer blood test at 8 a.m. tomorrow.

Don pulls out the tray, puts it in the sink, and props up a little stick in the freezer, pushing up the ice maker’s metal wand in an attempt to stop the leak. Might work, might not… I’ll stay awake to see whether the deluge stops. When an unexpected disaster arises, I diminish its significance by comparing it to the worst of my cancer treatments a few years ago. I can do this because my current condition remains stable with an experimental drug.

Yet as I contemplate all the chairs and sofas and rugs that have to be donated to Goodwill, the mattresses and box springs to be given to the St. Vincent de Paul society, my late mother’s files and cabinets, Don’s late wife’s luggage and papers, his massive collection of 78 r.p.m. records, the yards of books on the shelves in the studies, our daughters’ stored memorabilia and their children’s baby equipment, the sheer volume of stuff seems daunting.

We are moving from a house of 4,000 square feet to an apartment less than half that size. One reason for our relocation: Don and I want to release our girls from the responsibility of dealing with the detritus accumulated over decades. We also have to leave because he cannot negotiate the stairs and both of us together cannot manage the upkeep.

Throughout the weeks and then the months when our beloved but aging house has to be repaired so we can sell it, workers arrive to shore up the porch, to fix the bowed ceiling supports in the garage, the cracks over the foyer doorway, a foundation that needs to be anchored to keep the structure from shifting, broken screen doors, mold in basement closets, chipped kitchen cabinets, and (oh!) a tree appears to be growing out of the chimney, and (yup!) an inspector found clogged drains — which suggest there might be trouble with the septic tank.

People tell me that moving ranks high up there on the stress index. But the commotion comes nowhere close to the terrifying havoc of cancer and its traditional treatments. Throughout the weeks and then the months of removals and renovations, the rhythms seem downright soothing, if measured against the ghastly tempos of surgeries, radiological interventions and chemotherapies.

The magnitude of cancer provides a scale against which everything else falls happily short. Cancer can be so bad that it imparts a sense of proportion. The poet Jane Kenyon once said that leukemia and a bone marrow transplant dispelled her fear of flying.

In the midst of all this chaos, I will postpone treating my recently diagnosed osteoporosis — I’m not clear yet about the efficacy of various remedies — but what about the cataract surgery? With or without glasses, I cannot see clearly and I have become the designated driver. Given the boxes mounting everywhere as well as the appointments of various people who are coming to take away the piano and the records and some paintings we won’t have room for, should I cancel? No way, I decide: a piece of cake, in contrast to cancer.

Ever shifting, the cancer terrain is treacherous to negotiate, its perilous landscape always unstable. There are roadmaps, but they often seem indecipherable. With surgeons, radiologists, and oncologists, I advance without a clear sense of how I will end up where and when.

As a cancer patient, I feel like an immigrant in a strange land. The customs of the country bewilder me. Dazed by unfamiliar sounds, sights, tastes, and touches, I had to learn a whole new language quite distinct from the idioms of every day discourse. I will never master it.

I speak of genetic mutations, chemicals and my anatomy in a grammar so simple that it resembles a 2-year-old’s. Terms must be adopted — debulking, PICC, port, PARP inhibitor — for processes I cannot really conceptualize. Frequently, physicians and nurses have to write down or spell out their prescriptions or directions. I mispronounce or stumble over words — anastomosis, extravasation, Gastrografin — that seem foreign.

So even this unsettling removal from a country house to an apartment strikes me as a change I can take in stride. After all, I know the address of my destination, the date of my prospective arrival, the route the truck will take and the neighbors speak my native tongue.

I’m staying up very late and can attest to the fact that the kitchen floor has remained dry. Don and I will travel to the hospital tomorrow and return. I will have cataract surgery and we will reside in a town whose byways may be easier to navigate with improved vision.

When you have cancer, you don’t just have cancer: You might have a broken refrigerator and cataracts and osteoporosis and loads of other issues. But you also have a unique perspective which, in a curious way, helps me keep on moving on.

Susan Gubar is the author of the new book “Reading and Writing Cancer: How Words Heal.”

Lawsuits Over Baby Powder Raise Questions About Cancer Risk

Tony Cenicola/The New York Times

Deane Berg thought she was going to die, and she wanted to know why. She was 49, way too young, she thought, to have advanced cancer in her ovaries.

As she scrolled through websites that listed possible causes of ovarian cancer, one jumped out at her: talcum powder. She did not have risk factors like infertility or endometriosis, but she had dusted baby powder between her legs every day for 30 years.

“I went into the bathroom, I grabbed my Johnson’s Baby Powder and threw it in the wastebasket,” recalled Ms. Berg, now 59, a physician assistant in Sioux Falls, S.D. “I said, ‘What else could it be?’”

Ms. Berg was the first of thousands of women with ovarian cancer to file a lawsuit against the consumer products giant Johnson & Johnson, claiming that Baby Powder caused their disease and pointing to a long trail of studies linking talc to the cancer. The research dates to 1971, when scientists in Wales discovered particles of talc embedded in ovarian and cervical tumors.

Deane Berg with her husband, Jim. She blamed Johnson’s Baby Powder for her ovarian cancer.

Deane Berg with her husband, Jim. She blamed Johnson’s Baby Powder for her ovarian cancer. David Eggen for The New York Times

Since then, numerous studies have linked genital talc use to ovarian cancer, including a report earlier this month that among African-American women, genital use of powder is linked with a 44 percent increased risk for invasive epithelial ovarian cancer.

Johnson & Johnson says its trademark Baby Powder is safe, and it plans to appeal two multimillion dollar jury awards, including $55 million in damages awarded to a cancer survivor earlier this month and a $72 million award in February.

The International Agency for Research on Cancer in 2006 classified talcum powder as a possible human carcinogen if used in the female genital area. But the agency, part of the World Health Organization, has also said pickled vegetables and coffee are possible carcinogens and that hot dogs cause cancer.

Johnson & Johnson says research implicating talcum powder is flawed and points to studies that absolve talc of any cancer risk.

“We have children ourselves,” said Tara Glasgow, the research and development lead for the company’s baby products franchise worldwide. “We would never sell a product we didn’t believe was safe.”

So did the juries get it right or wrong? Is it plausible that Johnson’s Baby Powder — that clean-smelling soft stuff that’s a medicine cabinet staple, packaged in milky-white containers and supposedly mild enough for babies’ bottom — can cause cancer?

It’s not an easy question to answer.

“There is no way we’re ever going to know for certain that any exposure is necessarily causal to a disease,” said Dr. Shelley Tworoger, an associate professor of medicine and epidemiology at Brigham and Women’s Hospital and Harvard. “We might be 99 percent sure,” in some cases, she said, “but there’s usually no way to guarantee that what you see is actually the truth.”

Cancer is hard to study because it develops over a long period of time and is influenced by many factors, including genes, behaviors and environmental exposures. The best we can do, Dr. Tworoger said, “is look at the preponderance of the evidence.”

Talc is a naturally occurring clay mineral composed of magnesium and silicon. Known for its softness, it is used in cosmetic products like blush because it absorbs moisture and prevents caking. It is also an additive in tablets, chewing gum and some rice. It’s often mined in proximity to asbestos, a known carcinogen, and manufacturers have to take steps to avoid contamination. Many women use the powder on their inner thighs to prevent chafing, while others sprinkle it on their perineum, sanitary pads or underwear to stay “fresh” and dry. A 1980s ad campaign for a once-popular powder promised with a catchy jingle that “a sprinkle a day helps keep odor away.”

There has never been an experiment to see what happens when you deliberately expose women to talcum powder — for practical and ethical reasons, there never will be — so scientists must rely on observational studies that can link an exposure to a disease but cannot determine a cause-and-effect relationship.

In 1982, a Harvard professor, Dr. Daniel W. Cramer, and his colleagues compared 215 women with ovarian cancer and 215 healthy women who served as a control group. Compared with nonusers, women who used talcum powder were at nearly twice the risk for having ovarian cancer, and those who used it regularly on their genitals and sanitary pads were at more than three times the relative risk.

At least 10 subsequent studies echoed the results, with varying degrees of increased risk. But a small number of studies did not find a heightened risk for talc users.

When researchers pooled the results of similar studies involving nearly 20,000 women, they found powder use was associated with a 24 percent increased risk for ovarian cancer, an uncommon disease but one that is often fatal. If the finding is true, it means that for every five or six talcum powder users who develop ovarian cancer, one may be a result of talcum powder use, Dr. Steven A. Narod, an expert in cancer genetics from Toronto, said.

But critics say such studies can get it wrong, because they quiz women about their risk factors after a cancer diagnosis, and people, by nature, have selective memories.

“A patient is looking for reasons, and wondering, Why did this happen to me?” said Dr. Larry Copeland, a gynecologic oncologist from Ohio State University Wexner Medical Center and paid expert for Johnson & Johnson. If a researcher asks a patient about talc use, he said, “The answer is going to be ‘Aha, yeah — maybe that was it.’”

Dr. Copeland points to a large government-funded study, the Women’s Health Initiative. Researchers asked 61,576 women at the beginning of the study whether they had ever used perineal powder (although they did not specify talcum powder) and tracked their health over time. After 12 years, the study investigators found no relationship between powder use and cancer.

But that paper has critics, too. Dr. Narod said that the Women’s Health Initiative cohort was not large enough and did not track women long enough to find differences in ovarian cancer. The findings, he said, do not invalidate the earlier observational research that showed a link between talc and cancer.

Why talc use might lead to cancer is not clear. Studies have shown that talc crystals can move up the urinary tract into the peritoneal cavity, where the ovaries are. Indeed, a pathology report on Ms. Berg’s tumor found talc particles embedded in the tissue.

There is also a plausible mechanism, Dr. Tworoger said, because talc particles can set off inflammation, and inflammation is believed to play an important role in the development of ovarian cancer

Since the research began showing a link between talc and cancer in the 1990s, federal officials have not acted to remove the powders or add warning labels. The nonprofit Cancer Prevention Coalition petitioned the Food and Drug Administration in 1994 and again in 2008 for talc warning labels. In a 2014 denial letter, the agency said there was “no conclusive evidence” to establish causality, though it is plausible that talc “may elicit a foreign-body-type reaction and inflammatory response that, in some exposed women, may progress to epithelial cancers.”

Nevertheless, Johnson & Johnson made plans to “grow the franchise” by targeting African-American and Hispanic customers, according to internal company documents obtained by the plaintiff’s lawyer, Allen Smith. “Negative publicity from the health community on talc (inhalation, dust, negative doctor endorsement, cancer linkage) continues,” a 1992 memo said.

Although Johnson & Johnson’s talc supplier added warning labels in 2006, J&J did not add similar warnings to its products, according to litigation documents. Baby powder does carry a warning to keep it out of the reach of children and many pediatricians discourage its use on babies, who can become ill or die after breathing in the particles. Inhalation studies in female rats demonstrated carcinogenicity, according to the National Toxicology Program. Condom and surgical glove makers have stopped dusting their products with talc.

“Talcum powder is an interesting case, because it’s not something that’s necessary,” said Dr. Anne McTiernan, an epidemiologist with the Fred Hutchinson Cancer Research Center in Seattle. “If there’s any doubt, why should anyone use it?”

As for Ms. Berg — the Sioux Falls woman with advanced ovarian cancer — she won her lawsuit against Johnson & Johnson, but the jury did not award damages. She hopes other talc lawsuits will raise awareness.

“I knew nothing about this before,” she said. “I figured baby powder is for babies, it must be safe.”

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Ovary Removal Tied to Colon Cancer Risk

Removal of the ovaries — a procedure known as oophorectomy — may increase the risk for colorectal cancer, a new study concludes.

In some cases, such as cancer, the ovaries must be removed. They are commonly also removed electively during surgery for hysterectomy to avoid the risk of ovarian cancer.

The study, in the British Journal of Surgery, included 195,973 women in a Swedish health registry who had undergone oophorectomy either prophylactically or for benign conditions between 1965 and 2011. After an average follow-up of 18 years, 3,150 had been diagnosed with colorectal cancer. That rate — 1.6 percent — is about 30 percent higher than the rate in the general population.

The scientists found that the rate of colorectal cancer was lower in younger women and highest in the first four years after oophorectomy.

Oophorectomy has other risks too, said the study’s lead author, Dr. Josefin Segelman, a surgeon at the Karolinska Institute in Stockholm. Androgen levels drop after the operation, and this is tied to osteoporosis, decreased sexual desire and other problems.

Still, she said, “If you find abnormal ovaries at the time of surgery, they should be removed. But prophylactic oophorectomy should not be performed where there is no clear risk of ovarian cancer.”

A Bittersweet Passover: Cancer, Remission and Change

Camila Engman

Despite good news about my cancer treatment, it has been a hard winter, so I am looking forward to Passover. By retelling the story of the Jewish people’s escape from slavery in Egypt, the Haggadah — the text recited at the annual Seder — celebrates deliverance and springtime renewal. How would its rituals and prayers resonate for me this year, when cancer concerns were unexpectedly supplanted by other tribulations?

Alesha, the research nurse of my clinical trial, informed me in February that she and my oncologist were requesting an amendment of the Phase 1 study rules on my behalf. Since August 2012, I have driven up to Indianapolis every month for tests that have charted my vital signs and the CA-125 blood marker of ovarian cancer. The signs remained good, the marker stayed low, and each month Alesha passed over another bag of the experimental pills. Soon the leash tying me to the hospital will loosen. Maybe I will get two or even three months of pills all at once.

My jubilation was tempered by the difficult circumstances with which I currently contend. Over the past year, my husband, Don, has suffered a series of debilitating accidents, surgeries and infections. Just when I was priding myself on caring for Don as devotedly as he had cared for me, I slipped and fractured my pelvis. Once energetic seniors, Don and I now hobble around on canes, a geriatric duo. Grounded, we realize that we must move out of a country house we love but cannot maintain.

As I turn over the pages of the Haggadah in preparation for the last of some 22 Passovers we have commemorated here, I find myself startled by its images of the inextricable collocation of joy and sorrow. On the Seder plate, parsley, celery and scallions represent nature’s regeneration; however, they are dipped into salt water, signifying the tears of oppression. We read that the lettuce on the plate starts out sweet, but it becomes bitter if left in the ground too long, just as people do in bondage.

The Hillel sandwich best exemplifies the discord of elation and distress. It consists of matzo eaten with charoset (often a mixture of apples, honey, cinnamon and wine) and maror (horseradish). The horseradish, if strong enough, can elicit yowls from guests simultaneously savoring the honeyed fruit which, oddly, represents the mortar used in making bricks for the pharaohs.

Dissonance resounds throughout the Seder story. The sustaining matzo we are enjoined to offer all who are hungry and needy is the bread of affliction, baked hastily by migrants fleeing for their lives. Although the story says that the Angel of Death passed over the houses of Jews, the first-born babies of the Egyptians died. Liberation from slavery occurred centuries ago, yet the Haggadah states that in every generation, all participants should regard themselves as if they have personally come out of slavery. We are each and every one of us strangers in a strange land, but the Jews arrived at their promised destination.

The state of cancer survivorship has everything to do with this weird sort of discordance, or so it seems to me. Life-saving protocols produce injurious side effects, impairments or mutilations. The relief of remission is shadowed by fear of recurrence. While I profit from a targeted drug, two members of my support group report the failure of their chemotherapies. Those in the group who exult at being cancer-free mourn the three participants whose lives have been cut short by the disease.

According to the essayist David Rakoff, living with cancer may also blur “the borders between the micro and the macro,” leading people to conflate private with public woes: “The world seems lethally friable.” As the political becomes personal, the incivility and violence of presidential contests in this country scare me. Then there are the bombings overseas. That politicians recurrently refer to terrorist cells as cancers rightly suggests that cancer terrorizes its hosts, but the victims of terrorism have no recourse to treatments.

This year, the narrative of the Seder will remind me that we all remain in captivity while millions of refugees suffer in exile and populations across the globe struggle with anti-Semitism, racism and sexual slavery. To symbolize the need for a renewal of faith in forces that can right these grievous wrongs, after the meal we will open the door for the stranger and sing a hymn to the prophet Elijah, who heralds harmony and redemption.

Considering cancer research, I rejoice that the clinical trial in which I participate means a little bit of redemption for women who test positive for the BRCA1 or BRCA2 mutations. Drugs called PARP inhibitors, like the one I take, will extend the progression-free survival — the length of time during and after treatment of a disease that does not worsen — of women whose ovarian cancer was caused by these genetic mutations. But I grieve over the majority of ovarian cancer patients besieged by a miserable prognosis.

For me, living longer means getting old — which, my mother always told me, is not for sissies. As I welcome Elijah this April, I will be hoping that Don and I garner the strength to open another door next year — not in our spacious country home, rich in the memories of Seders past, but in the promised land of a one-story, in-town apartment we can manage to negotiate. It is a bittersweet prospect for which Passover will prepare us.

Susan Gubar is the author of “Reading and Writing Cancer: How Words Heal,” which will be published May 17.

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