Last year, Seattle’s Rivkin Center and Washington state’s Andy Hill Cancer Research Endowment (CARE) Fund joined forces to earmark $1 million in funding for ovarian cancer research.
This week, they began to dole those funds out.
Fred Hutch Cancer Center and UW Medicine researchers Holly Harris, MPH, ScD, and Elizabeth Swisher, MD, each received $200,000 from the organizations — nearly half of the dedicated $1 million fund — for new work to identify risk factors and promote better prevention for these often-intractable cancers.
According to the National Cancer Institute, ovarian cancer is the eighth most common type of cancer in U.S. women, but the fifth leading cause of cancer death. Symptoms can be subtle, often leading to late diagnoses after the cancer has spread beyond the ovary (or fallopian tube) to the lymph nodes or other organs.
Treatment options have improved over the years, but less than half of the women diagnosed with metastatic ovarian cancer will survive beyond five years.
Both Swisher and Harris are trying to improve those statistics through their research.
There is still no screening test for ovarian cancer as there are for breast, prostate, colorectal and other cancers, though researchers have worked for decades to develop one.
Genetic testing, however, can be a useful tool for those concerned about inheriting this cancer. For those diagnosed with ovarian cancer, genetic testing can also help select the most effective therapies, in addition to helping people better understand their — and their family’s — risk.
As a gynecologic oncologist, Swisher has been treating ovarian cancer patients and conducting research on their behalf for 25 years. Her newly-funded project will focus on identifying and overcoming barriers to completing genetic testing in order to help people better understand their inherited risk for the disease — and potentially prevent it.
Not all ovarian cancers are driven by inherited or germline genetic mutations but mutations in two important DNA repair genes — BRCA1 and BRCA2 — have been identified in 13%-15% of those diagnosed with ovarian cancer. Mutations in these genes are also associated with fallopian tube cancer, primary peritoneal cancer, male breast cancer, prostate cancer, pancreatic cancer and early-onset breast cancer.
Genetic testing can identify the presence of mutations in these and other cancer susceptibility genes. Unfortunately, several large studies have shown that some people get partway through the genetic testing process, then, for whatever reason, they don’t complete it.
Swisher will dig in and discover the reasons behind these incomplete tests by interviewing people from a previous trial and analyzing their responses.
“By uncovering and addressing barriers to genetic testing, we aim to expand access to lifesaving genetic information and edge closer to preventing hereditary ovarian cancer,” she said. “Our improved understanding of genetic testing barriers will then be used to design supportive strategies to broaden access to cancer genetic testing and ultimately eliminate hereditary ovarian cancer.”
Testing positive for a germline mutation does not mean a cancer diagnosis is inevitable, she noted. Rather, it can give people a leg up on cancer prevention.
Some people with these mutations opt for preventive surgeries; Angelina Jolie, for instance, had a double mastectomy as well as an oophorectomy to remove her breasts and ovaries in order to successfully sidestep these cancers. Others take estrogen-blocking drugs, like tamoxifen, or do more frequent cancer screenings. Patient advocacy organizations like Facing Our Risk (also known as FORCE), offer resources to help people hash out their choices.
“Our best chance for decreasing mortality for ovarian cancer is prevention,” Swisher said in a related video. “Genetic testing allows us to document a small subset of women that have a very high risk of ovarian cancer. And those cancers can be entirely prevented if we identify their risk. Every woman that dies of hereditary ovarian cancer is a life unnecessarily lost. Making this testing more accessible is an opportunity to save lives.”
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Harris, a Fred Hutch epidemiologist, has been studying endometriosis for over a decade, trying to identify its various causes as well as working to find ways to reduce the pain and suffering caused by the disease.
The condition, which affects about 200 million women worldwide, has been linked to ovarian cancer, but until now, no prospective studies have been conducted that identify which people with endometriosis are more likely to go on to develop the cancer.
Harris will do just that with her Rivkin Center/Andy Hill CARE Fund grant, launching the first large-scale analysis of people with endometriosis to pinpoint characteristics most crucial for ovarian cancer development.
A common condition that usually affects women in their 20s and 30s, endometriosis starts when tissue similar to the tissue that lines the uterus, starts growing outside of that area, attaching itself to the ovaries, fallopian tubes, bowel, bladder or other parts of the body.
Over time, the extra tissue builds up and creates cysts, scar tissue and adhesions that can lead to chronic pain, excessive bleeding, pain with sexual intercourse, pain with urination or elimination, and, for up to half of people with the condition, infertility.
And then there’s the ovarian cancer risk.
“We know endometriosis increases ovarian cancer risk, but we do not know how to identify which individuals with endometriosis will develop ovarian cancer,” Harris said. “For this project, we plan to combine data from 10 previous endometriosis studies, including some that have followed patients for up to 35 years.”
Harris aims to identify a subset of high-risk individuals based on risk factors — think medication use, prior surgeries, personal factors and other health factors — who would benefit from closer monitoring or more aggressive endometriosis treatment to prevent an occurrence of ovarian cancer.
Ovarian cancer and endometriosis are both underfunded, and thus understudied, health conditions, Harris noted.
“There is much we don’t know about what causes endometriosis lesions to progress to ovarian cancer,” she said. “We’re thrilled to have received this funding.”
Rivkin Center CEO Molly O’Connor was quick to congratulate the two scientists.
“Through our partnership with the CARE Fund, we are making an unprecedented investment in ovarian cancer research in Washington state to help get the answers we need to save more lives,” she said. “We’re incredibly fortunate to have such committed leaders in ovarian cancer research right here in our state.”
Fred Hutch surgical oncologist David R. Byrd, MD, who chairs the Andy Hill CARE Fund board, said the gift was a historic investment.
"Both the Rivkin Center and Andy Hill CARE Fund have a strong record of promoting cancer research,” he said. “With the collaboration of these two organizations to invest in cancer research in Washington state, we are making history. We look forward to the results, which will improve the health of family members, friends, neighbors and communities.”
Since 1999, the Rivkin Center has invested $16.4 million in ovarian cancer research worldwide, helping to launch new research and new researchers. At an average return of $17.30 for every dollar the Rivkin Center invests, these early funds have helped researchers secure another nearly $280 million in funding to continue their work.
The Rivkin Center/Andy Hill CARE Fund will announce another $600,000 in grants in 2025.
Diane Mapes is a staff writer at Fred Hutchinson Cancer Center. She has written extensively about health issues for NBC News, TODAY, CNN, MSN, Seattle Magazine and other publications. A breast cancer survivor, she blogs at doublewhammied.com and tweets @double_whammied. Email her at dmapes@fredhutch.org. Just diagnosed and need information and resources? Visit our Patient Care page.
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