In Canada, deaths from gynecological cancers have steadily decreased over the past three decades. As women are no longer heavily exposed to carcinogenic dyes in clothing and early detection programs have improved, detecting cervical and uterine cancers has slowly become less of a priority for gynecologists.
However, ovarian cancer continues to have mortality rates that are twice as high as any other reproductive cancer. In fact, according to Lucy Gilbert, director of the McGill University Health Centre (MUHC), Gynecologic Oncology Division, there are proportionally more women dying of ovarian cancer in Montreal than from cervical cancer in the whole of Canada.
Gilbert explained how a number of factors, such as advanced stage diagnosis, have stalled the reduction in ovarian cancer mortality statistics. In such cases, the outlook is bleak.
“These cancers spread, disseminate, and metastasize before the patient develops symptoms or can be detected by imaging,” Gilbert said. “With chemotherapy, we have been able to prolong life from 18 months to 3 years […] but they [still] die of the disease.
Even in cases where a patient displays symptoms, physicians often blame menopause, which can overshadow critical diagnosis periods for older women.
“Many women come along, and they have been bleeding for ages, they have pain, they have gone to [a] primary care physician, and they are told ‘oh, it’s the menopause,’” Gilbert said.
Gilbert also identified other gender-based obstacles in the fight against reproductive cancer mortality rates. She believes that implicit sexism within the walls of institutions has delayed scientific contributions to women’s health.
“[Many] older women do not have a lot of disposable income and power; therefore, because these cancers affect older women, they are neglected,” Gilbert said.
Gilbert is dedicated to improving the outcome for women with ovarian cancer through earlier detection.
“I started the DOvEE [Diagnosing Ovarian and Endometrial Cancers Early] project because I felt [that] by giving access, by improving awareness of symptoms, and reducing the number of roadblocks in seeking help […we] would be able to improve cure rates,” Gilbert said.
Gilbert’s program has opened five clinics in Quebec that provide free, immediate testing for women displaying symptoms. She quickly realized that focusing on women’s ovaries while testing was insufficient for making diagnoses in time.
“We were concentrating on giving [an] ultrasound of the ovaries,” Gilbert said. “But the vast majority of ovarian cancers are not actually ovarian cancers. They start in the fallopian tubes.”
The DOvEE program succeeded in diagnosing women in an earlier phase of stage three that was often still completely resectible, but Gilbert and her colleagues are hoping for an even earlier standard of detection.
In partnership with researchers at Johns Hopkins University, Gilbert recently evaluated the effectiveness of a technology called PapSEEK, which analyzes pap smear fluid for cancer-related genetic mutations. However, she has concerns about the technology’s availability.
“Unless [PapSEEK] is accessible and affordable to countries, and lends itself to automation and testing, you cannot have an impact on reducing mortality,” Gilbert said.
The technology must also align with the current diagnostic circumstances of ovarian cancer.
“We will not make an impact on this disease unless women over 50 are willing to go and have it done every two years, so it must be even more comfortable,” Gilbert said.
These concerns led the DOvEE project to grow into DOvEEgene, an ovarian cancer-detection technology developed at the MUHC that is in the pre-clinical trial phase. Gilbert hopes to secure funding for the clinical trial in the coming years.
While the DOvEE program and its offspring are making strides in mediating the gender gap in diagnostic oncology, Gilbert warned that continued neglect for women’s health could be detrimental to society—a notion familiar to women but seemingly novel to those funding medical research.
“Older women contribute a lot to the fabric of society,” Gilbert said. “They are critical for holding families together, and they support structure.”
The DOvEE Project is looking for students interested in raising awareness about ovarian cancer. If interested, please contact Gilbert at [email protected]