One woman’s story of how ‘silent killer’ ovarian cancer evades check-ups and diagnosis
●Ovarian cancer is the sixth most common cancer among women in Hong Kong.
●Actress Laura Clark-Hansen, who died two years ago from the disease, wrote a book and put on shows to educate women about ovarian cancer
They call ovarian cancer the silent killer because, as Hong Kong’s Dr Selina Pang observes, “typically it presents with no symptoms until late stage, most diagnoses aren’t made until Stage 3, or even later”.
Laura Clark-Hansen, though, prefers the name “the disease that whispers”.
She worked, even as she battled the illness herself, to teach women how to listen and what to listen for.
An actress, Clark-Hansen delivered performances to educate women about this cancer – one which Pang says it is the sixth most common cancer among females in Hong Kong and accounted for 3.8 per cent of all new female cancer cases in 2015.
Clark-Hansen’s performances included an engaging delivery of her “Beat” lessons in spotting symptoms of the condition: B for bloating, E for eating and gastrointestinal issues – gas, feeling full quickly, A for abdominal pain and T for tinkle, tinkle, tinkle, she says.
Or, as Pang says, urinary urgency or frequency.
But Clark-Hansen also called the illness the “chameleon cancer” because many of the symptoms are common to other maladies.
In her book, Please Send Hats, in a chapter entitled My Ovaries are Trying To Tell Me Something, she wrote: “My cancer hid in plain sight for a year looking like acid reflux, or an overactive bladder, or perimenopause – irregular periods. That’s because the subtle warning signs of ovarian cancer are the same as the ones associated with these more common conditions.”
If we are taught the illness is silent, we won’t hear it or look for it. If, however, we note any deviation from normal – our normal – and tell our doctor, there is a much greater chance the disease will be picked up much earlier. And early detection means a much more positive outcome.
Retrospectively, Clark-Hansen understood that what she thought was perimenopause was actually dysfunctional uterine bleeding and “a sign of a gynaecologic cancer”. She put her thickening waistline down to advancing menopause, too, unaware that weight gain and unexplained weight loss are symptoms associated with ovarian cancer, as is swelling of the abdomen, and bloating which leads to gas.
“Oh dear God,” she writes, “the gas” had her “burping, and farting”. It never occurred to her that this was dangerously abnormal, so she did not mention that to her doctor, not least because “let’s face it, these aren’t topics for polite conversation”.
Furthermore, there are no definitive tests for ovarian cancer. While a Pap smear helps to reveal changes in the cervix which may signal early malignancies, there is no such test to identify ovarian cancer – indeed, many women believe their smear is sufficient to identify anything that would give cause for alarm.
The CA 125 blood test, which measures the amount of the protein CA 125 (cancer antigen 125) in your blood, renders a high score if ovarian cancer is present, but it can be elevated for a number of reasons and isn’t accurate enough to use for screening because many non-cancerous – even normal – conditions, such as menstruation, can increase the CA 125 level, as can harmless fibroids.
When Clark-Hansen’s doctor suspected ovarian cancer, she ordered a CA 125 test. The result was elevated but not drastically so; “mine was 58”, she wrote “normal is zero to 35. Many women with ovarian cancer have numbers that reach well into the hundreds and even the thousands, but some have numbers that are almost normal”.
Not especially concerned, and putting her result down to fibroids, Clark-Hansen’s doctor pressed for a transvaginal ultrasound which, as Pang observes, is the definitive test: if it’s there, it will be seen no matter how quietly it’s been whispering.
And, indeed, in Clark-Hansen’s case, there it was.
The American Cancer Society estimates that in 2018, 22,240 women will receive a diagnosis of ovarian cancer and of those, more than 60 per cent – 14,070 – will die from the condition. Ovarian cancer ranks fifth in cancer deaths among women, accounting for more deaths than any other cancer of the female reproductive system.
A woman’s risk of getting ovarian cancer during her lifetime is about 1 in 78. Her lifetime chance of dying from ovarian cancer is about 1 in 108.
But what puts women at risk? Half of all women diagnosed with the condition are 63 and older. It’s more common in European than African-American women. Family history can play a part, says Pang, “inheritance of deleterious genetic mutations such as BRCA1/2 gene mutations”.
Ovarian cancer, says Pang, “is an important public health issue because it has a poor prognosis and [high] mortality rate, with the overall five-year survival rate [of patients] 44 to 46 per cent, mainly due to late detection of the disease. The absolute prognosis depends on cell type and stage of disease at detection”.
Clark-Hansen’s illness stole her life in the end. Her husband, Paul, told me: “Laura passed away in 2016. She was diagnosed with ovarian cancer in 2005, underwent chemo and showed no evidence of the disease for eight years. The cancer recurred in her liver in 2013 and we fought it off for three years with an entire year of remission in 2015. She began writing Please Send Hats in 2010.”
Clark-Hansen was part of a programme called Survivors Teaching Students Saving Women’s Lives. It involves, explains Paul, “ovarian cancer patients relating their stories to third-year medical students so that they will be on the lookout for those symptoms when they become doctors”.
It wasn’t enough for Clark-Hansen to teach women to listen to their bodies. She wanted to urge doctors to listen to women, too. Please Send Hats is a powerful story, a memoir, a message, beautifully and poignantly delivered with grace and humour.
Send this book to the women in your life, and read it yourself. It could save a life – maybe even your own.