World Ovarian Cancer Day, which has the highest mortality rate in Portugal

Among all gynecological cancers, ovarian cancer “has the highest mortality rate in Portugal”, as confirmed by Lúcia Correia, gynecologist oncology at the Portuguese Institute of Oncology in Lisbon and member of the Portuguese Society of Gynecology.

A reality that, according to the specialist, “comes from the fact that the majority (70-80%) of cases are diagnosed in advanced stages (III and IV), with the disease disseminated outside the pelvis”. This is why, in connection with World Ovarian Cancer Day, the alert goes to the commitment to early diagnosis, since “rapid diagnosis and rapid referral to the cancer treatment center are fundamental factors in the success of treatment” , as explained by Mónica Pires, oncological gynecologist at IPO-Porto and member of the Portuguese Society of Gynecology.

GLOBOCAN 2022 figures for Portugal point to the existence of 682 new cases of ovarian cancer that year, one of the most lethal cancers in females.

One of the reasons for late diagnosis may have to do with the symptoms, which are “very non-specific and insidious”, as Lúcia Correia explains (4). Patients may report pelvic or abdominal pain, increased abdominal volume, a feeling of fullness, easy tiredness, gastrointestinal or urinary complaints, weight loss, vaginal bleeding, among others – all symptoms easily attributable to other causes. More rarely, patients may be asymptomatic and the diagnosis may be made following examinations or surgery for another reason.”

According to this specialist, “among all known risk factors, genetic mutations are responsible for 20-25% of ovarian cancer cases, with mutations in the BRCA 1 and 2 genes being the highest risk”. But, adds Mónica Pires, “having a BRCA mutation does not mean having cancer! There are multiple genetic, environmental and individual factors that influence the risk of developing cancer, meaning that many carriers do not develop the disease.

Women carrying a BRCA mutation can opt for risk reduction strategies, either through earlier and more intensive screening for breast cancer, or through risk-reducing surgeries such as prophylactic mastectomy or prophylactic salpingo-oophorectomy (removal of ovaries and tubes) after fulfilling its reproductive project. In women already diagnosed with cancer, particularly ovarian cancer, knowledge of the existence of a BRCA mutation allows the multidisciplinary team to adapt the treatment.“

In ovarian cancer, the main reason for the lack of an effective screening program is related to the biology and natural history of this disease. In light of current knowledge, the precursor lesions described are not detectable by different imaging methods or biochemical markers. When malignant transformation appears, its evolution and metastasis, particularly intra-abdominal, is early and little symptomatic, which is why the majority (>75%) of ovarian cancers are detected in advanced stages.

In Portugal, the lack of regular gynecological monitoring is also a reality, according to Mónica Pires. “Recourse to emergency care turns out to be an alternative, often justified by the rapid progression of the disease, which often results in abdominal distension or pain” *.

To improve early diagnosis, this specialist defends the need for “health literacy, prevention education and the importance of valuing certain signs or symptoms.*” Lúcia Correia agrees, reinforcing that “women who belong to high-risk groups, such as those carrying genetic mutations, must be monitored in specific units” *.

An alert also given by the know more ContA project, an initiative that has the support of Careca Power, Evita, Europacolon, MOG (Gynecological Oncological Movement), Portuguese Society of Human Genetics, Portuguese Society of Gynecology, Portuguese Society of Oncology, Portuguese Society of Senology and AstraZeneca.

About the “saBeR mais ContA” project:

Since 2019, the “SaBeR mais ContA” campaign initiative has aimed to educate the population, particularly cancer patients and their families, about the relationship between BRCA genetic mutations and some types of cancer, including ovarian cancer. It has a website for consultation and presence on social networks, where various content is regularly shared, including informative videos. In 2024, the campaign’s partners include Careca Power, Evita, Europacolon, MOG (Gynecological Oncological Movement), the Portuguese Society of Human Genetics, the Portuguese Society of Gynecology, the Portuguese Society of Oncology, the Portuguese Society of Senology and AstraZeneca.