While advancing research and treatment options for women diagnosed or at risk of the disease is a critical priority, exploring and informing women about disease prevention is also important to us. In a recent blog post, Elisabeth Baugh, CEO, shared some perspective about prevention and ovarian cancer. In this Q&A, we meet and hear more from Alicia Tone, Scientific Advisor with Ovarian Cancer Canada, about prevention.

Tell us about yourself? What drew you to this field of work and study?

I have a scientific research background and have been in the ovarian cancer field for 16 years. I’ve been interested in science since I was a child and in women’s health since I was a teenager. I started to become interested in cancer when my grandfather passed away from colon cancer at the beginning of university. I pursued a PhD at the University of Toronto in Ontario, Canada, my post-doctorate in British Columbia, and have worked as a Scientific Associate in the Division of Gynecologic Oncology at Princess Margaret Cancer Centre in Toronto, Ontario for the past 7 years. I was drawn to ovarian cancer as a subject area because at the time there was so little known about its biology and therefore a lot of space for scientific discovery.

How long have you been working with Ovarian Cancer Canada?

I have been collaborating with Elisabeth Baugh, CEO, for 10 years on our bi-annual national ovarian cancer conference, where I help run an educational day for research and clinical trainees who are new to the field. Ovarian Cancer Canada is also a supporting partner on the Prevent Ovarian Cancer Program that I manage at Princess Margaret Cancer Centre. I officially started working with Ovarian Cancer Canada as a Scientific Advisor this past May, and I remain excited to be a part of this team.

What has been your key focus in the role thus far?
My current focus has included reviewing the state of science and practice across Canada when it comes to ovarian cancer prevention. This includes summarizing the most relevant scientific studies on factors affecting ovarian cancer risk and risk-reducing/preventative options, as well as talking to genetic counsellors and gynecologic surgeons who care for women who are or who may be at risk for ovarian cancer.

Ultimately, this data will help Ovarian Cancer Canada communicate with women who may be at risk and identify gaps that should be addressed to make sure they can access genetic testing and risk-reducing options across the country.

What do you really mean by prevention? What are some examples of this?

Prevention essentially means taking an action or intervention to not develop ovarian cancer in the first place. The most relevant example is performing risk-reducing gynecologic surgery (involving removal of the ovaries and fallopian tubes) in a woman with an inherited mutation in the BRCA1 or BRCA2 genes. There are also additional, non-surgical, ways that any woman (regardless of genetic risk/family history) can reduce her risk of developing ovarian cancer, such as taking oral contraceptive pills.

Those are serious decisions and actions to take. How can a woman determine if it’s the right course of action for her?

If a woman is concerned that she may be at risk for ovarian cancer based on a history of ovarian or breast cancer on either side of her family, the best thing to do is to speak with a genetic counsellor.
A genetic counsellor will speak with the woman about her estimated lifetime risk of developing ovarian cancer based on her family history, and whether genetic testing for the BRCA1, BRCA2 or other ovarian cancer risk genes is appropriate for herself and/or other family members.

If a mutation is found that increases ovarian cancer risk, the genetic counsellor will go through recommendations for risk-reduction/prevention and, if appropriate based on the woman’s age and reproductive desires, refer her to a gynecologic surgeon for consideration of prophylactic surgery.

Are there stats to support preventative surgery as a reliable or guaranteed way to reduce the risk of ovarian cancer?

There is strong evidence and support for this intervention, yes*. Several studies have reported a reduction in ovarian cancer risk of between 80-98% for BRCA1/2 mutation carriers undergoing prophylactic surgery. The extent of protection depends on a combination of the age when surgery is performed and the specific gene mutation.
Importantly, even if a woman is found to have an early cancer at the time of prophylactic surgery, her 5-year survival is greater than 90%. The most effective non-surgical way of reducing risk is use of the oral contraceptive pill, with a 20% decrease in risk for each 5 years of use.

Prevention or risk-reduction is the most effective way of impacting ovarian cancer outcomes, as screening is not effective at detecting the disease at an early stage.

What has inspired and motivated you most in this line of work?

What has inspired me most is the possibility of making a real impact on women’s lives, beyond scientific publications. I started studying the early events of ovarian cancer during my PhD and have witnessed first-hand the evolution of our collective understanding of the role of genetic mutations and other reproductive factors in determining risk for ovarian cancer. I feel like I am finally in the position to use everything I have learned to help ensure that women across the country can access this information to protect themselves and their family members from developing this devastating disease.

What has surprised you?

I have been encouraged and surprised by the willingness of genetic counsellors and surgeons across the country to share information, and the infrastructure that many have set up to best serve those who may be at risk. I am encouraged that everyone is deeply invested in making sure we provide women the opportunity to assess and manage their risk if this is what they choose.

What do you most want people to understand about prevention and ovarian cancer?

For this I am going to steal a quote from a presentation by Mary-Claire King at the BRCA Symposium in Montreal in 2018. “Every breast or ovarian cancer patient with a BRCA1 or BRCA2 mutation detected after diagnosis is a missed opportunity to prevent a cancer. No woman with a mutation in BRCA1 or BRCA2 should die of breast or ovarian cancer.” Clearly this is (at least currently) an aspirational quote, but it really resonated with me and I come back to it frequently to continue to motivate my work.

*See: Impact of Oophorectomy on Cancer Incidence and Mortality in Women With a BRCA1 or BRCA2 Mutation. Published by the Journal of Clinical Oncology®, An American Society of Clinical Oncology Journal, May 2014.