Pierce Brosnan's daughter is the third generation of women in her family to die from ovarian cancer, shining a light on the disease which often defies early diagnosis. Lisa Salmon reports.

 

Twenty-two years after his first wife Cassandra Harris died from ovarian cancer, film star Pierce Brosnan has lost his daughter Charlotte to the same disease.

The mother-of-two was just 41, two years younger than her mother, whose own mother also died of the disease.

Ovarian cancer is the fourth most common cause of cancer death in UK women. More than 6,500 are diagnosed every year and, currently, around 4,200 die.

The disease is known as the 'silent killer', because early symptoms can easily be missed, or passed off as something minor.

"The use of the 'silent killer' phrase is a succinct way of getting across the message that the problem with this cancer is that, when it's confined to the ovary in its early stages, it doesn't cause many symptoms, and those that it does cause, like bloating and feeling full, are hard to distinguish from symptoms that women get every day," says Professor Ian Jacobs, a professor of Women's Health and Cancer at the University of Manchester.

"The key is when symptoms persist and there's no obvious reason, to get them checked by a doctor."

Jacobs, who is also medical advisor to The Eve Appeal, a charity which funds research into gynaecological cancers, says that while more than 80% of women with breast cancer will be alive five years after diagnosis, only 30-40% of those diagnosed with ovarian cancer survive that long.

The disease is often seen as a hereditary curse, as two specific genes - BRCA1 and BRCA2 - are known to increase the risk of both ovarian and breast cancer.

Hollywood actress Angelina Jolie recently revealed she'd had a preventative double mastectomy, after finding out that she has one of the 'cancer' genes, which caused her mother's death from ovarian cancer and her aunt's death from breast cancer.

But, in the majority of cases, no genetic link is found.

For the most common form of ovarian cancer (epithelial), the BRCA1 or BRCA2 gene mutation is only actually found around 10-13% of the time. Most ovarian cancers develop for unknown reasons.

It's unclear whether Charlotte Brosnan had been tested for the gene mutations, and her mother and grandmother died before such testing was available.

However, BRCA1 or 2 aside, ovarian cancer can still strike repeatedly in families which aren't carriers.

Helen Kay's mother, Ann, and aunt Christine died within months of each other, in March 2010 and July 2009, from ovarian cancer, yet neither were BRCA1 or BRCA2 carriers.

Helen, 42, and her sister Lynn, 45, felt they could take no chances that an as-yet-undiscovered gene was lurking within them so last year Helen had her ovaries and fallopian tubes removed, and Lynn had a hysterectomy.

"We were told that although we weren't BRCA1 or 2 carriers, there could still be a genetic link and we might want to have surgery," explains Helen.

"We chose that option so we'll be around for our children - we saw how our mum and aunt died and we didn't want to go through what they went through."

The sisters each have two daughters, and Helen says that when the girls grow up, they'll have to decide if they want to undergo genetic testing - by then, other cancer genes may have been identified.

"It's a shadow that you just can't get away from, and we've still got this nagging doubt that there's something genetic somewhere," she says.

"It's too much of a coincidence for two sisters to be diagnosed with it and there not to be a link."

Helen adds: "If women have the symptoms, get them checked out and be persistent - sometimes it can be an uphill battle because it can be hard to detect.

"It's sad when anyone dies of ovarian cancer, but hopefully the death of Pierce Brosnan's daughter will bring ovarian cancer more attention. Women need to be more aware of this disease."

It's a plea echoed by Robert Marsh, chief executive of The Eve Appeal, who points out that while ovarian cancer usually strikes women over the age of 50, some are diagnosed in their 30s and, for many, there'll be no family history.

"If there's any family history, you need to be on heightened awareness of both breast and ovarian cancer, but if you don't have it in your family it doesn't mean you're predominantly in the clear either," he says.

Marsh admits that symptoms can often be dismissed by doctors as something far less serious.

"That's worrying," he says. "GPs don't see it on a regular basis and probably don't think symptoms might be cancer. We have a lot of anecdotal evidence from survivors that they've really had to battle with their GP to get referred."

He says most women aren't diagnosed until stage three or four (four is the last stage), when the prognosis is not good.

"The whole effort behind the research we fund is to try and move diagnosis much earlier to stage one or two, where the prognosis is very good - 90% of those diagnosed at stage one survive more than five years. The research is about predicting risk, and early detection."

Professor Jacobs leads a team of researchers funded by The Eve Appeal and Cancer Research UK to find ways of identifying women at risk of ovarian cancer, and of early detection by screening. There is currently no screening programme in the UK.

"Given the pattern - that most women are diagnosed with advanced stage disease and do very badly, but a few are diagnosed early and do well - the hope is that screening to pick it up earlier will result in much fewer women dying from the cancer," says Jacobs.

Part of the research, a trial involving a blood test and ultrasound screening on 200,000 UK women, will be completed in 2015.

Evidence so far suggests that ovarian cancer can be picked up in 85-90% of affected women before any symptoms occur, and potentially around two years before signs start appearing.

If introduced, screening would probably target post-menopausal women, plus younger women who have a strong family history of the disease, like Helen and Lynn, or who have a genetic predisposition.

Jacobs says that if the trial proves screening is effective, it could be considered as part of a national programme, alongside breast and cervical screening.

He says: "My feeling is that if the study shows a reduction in deaths of 30-50%, the cost-effectiveness would be reasonably favourable and we'd move into an era where ovarian cancer screening was introduced."


Early ovarian cancer symptoms

While it's most likely that these symptoms aren't ovarian cancer, if they are persistent or you're concerned, get them checked by your GP.

:: Persistent pelvic and abdominal pain.

:: Increased abdominal size/persistent bloating (not intermittent bloating).

:: Difficulty eating and feeling full quickly.

:: Urinary symptoms - needing to pass water more often than usual.

 

:: For more information about ovarian cancer, visit www.eveappeal.org.uk