Women Choose Surgery to Prevent Ovarian Cancer : * Health: Some whose family histories make them more likely to develop malignancies are having ovariectomies after their child-bearing years.

For Diane Wedner, it was like walking around with a ticking time bomb in her lower abdomen.

Wedner, 40, of Toluca Lake says she knew from the time she was a teen-ager that ovarian cancer was a virtual death sentence. She had a grandmother and an aunt who died of ovarian cancer, both at 45.

Then, in 1977, her mother developed worrisome signs--a swollen abdomen and flu-like fatigue--and an exploratory surgery showed she had advanced ovarian cancer that had spread to her uterus and abdominal wall. Four years later, after chemotherapy, radiation and two more surgeries, her mother died at 61.

“When my mother was on her deathbed,” says Wedner, “she begged me to have my ovaries removed after I had my children. If you live through this--a slow, long, tedious process of watching someone you love dying from this--the question of having your ovaries removed becomes when, not if.”

For the past five years, gynecological oncologists have been suggesting that women over 35 get their ovaries removed if at least two first-degree relatives--mothers or sisters--have had ovarian cancer. Although the medical evidence supporting such a recommendation is building, women who opt for an ovariectomy, as the procedure is called, need to take supplemental estrogen.

Depending on their medical insurance and on how their physicians describe their need for the procedure on insurance forms, they also may have to pay the surgery’s $6,000 to $10,000 cost out of their own pockets, physicians say. Not all insurers cover preventive surgeries.

Because ovarian cancer is tough to detect in its early stages, 76% of the cases are diagnosed late, when hope is slim for five-year survival. It is the most likely gynecological cancer to kill the women who get it.

In California, according to Robin Bergman, director of patient services for the American Cancer Society in Van Nuys, there will be 2,540 new cases of ovarian cancer in 1992--and 1,330 deaths. There were 20,700 new cases nationally last year.

Unlike breast cancer, there is no early-detection system for ovarian cancer. “Pelvic ultrasound is unproved and not as effective as mammography,” says Dr. Leo Lagasse, director of gynecological oncology at Cedars-Sinai Medical Center and a professor at UCLA. Lagasse says blood tests for elevated levels of CA 125, a cancer-cell byproduct, are falling out of favor because they produce a high percentage of false-negative test results.

The average woman has a 1-in-70 chance of developing ovarian cancer during her lifetime. But, according to Lagasse, a woman with a sister and a mother who have had ovarian cancer has a 50% chance of contracting the disease. And the next generation encounters its highest period of risk 10 years earlier than the previous generation. So a woman whose mother got ovarian cancer at 50 is at greatest risk beginning at age 40.

Women are faced with deciding whether to go for the surgery smack in the middle of their last-chance childbearing years. This can be part of what makes the decision a tough call for some.

“I was 35 when my mother died,” says Marilyn Wedner, 44, Diane’s sister and a massage therapist in Santa Monica. “I was feeling more pressure then from my biological clock than from cancer,” she says. She chose to have a child soon afterward--Sarah, now 8.

When Marilyn turned 40, her gynecologist started monitoring her more closely, including a pelvic exam and Pap smear every six months and an annual pelvic ultrasound. “I was holding off because I thought I might have another child,” she says.

But at 42, a pelvic ultrasound picked up irregularities in her ovaries, and, given her family history, the recommendation was for immediate surgery. She says Gilda Radner’s experience with ovarian cancer and death from it in May, 1989, were also an added incentive for her to choose to have her ovaries removed.

After surgery, Marilyn had a tough course. “The finality of knowing that it wasn’t a choice anymore--it was an emotional and a physical trauma. But now--two years later, I’m glad I did it,” she says. “Now I know my cause of death won’t be ovarian cancer.”

For Marilyn’s sister Diane, the choice to have the surgery and her experience afterward were easier. She got pregnant with her first child two months after her mother died. She had the ovariectomy immediately after the Cesarean-section delivery of her second child five years ago.

“I don’t even view it as elective surgery. I felt it was necessary. I haven’t regretted it one day. Now I feel I’ve really broken this cycle of cancer,” Diane says.

Karen Blanchard, 45, a Santa Monica-based obstetrician and gynecologist who performed the Wedners’ surgeries, has herself had an ovariectomy. Although she does not have a family history of ovarian cancer, she decided to have her ovaries removed during a hysterectomy for endometriosis, she says.

For the woman at high familial risk for ovarian cancer, preventive removal of the ovaries “is the only choice, and women need to know there is a way they can prevent the disease,” Blanchard says.

But Blanchard has encountered a great deal of resistance from third-party insurers that don’t want to pay for the surgery, despite the growing data to support the need for it, she says. “You have to do a lot of lying to insurance companies,” she says, “to ensure they will cover the procedure.”

Other physicians have found it easier to secure reimbursement by writing the insurers a detailed letter explaining the need for the surgery. Lagasse says he has never had a surgery refused. “I tell them that instead of the $350,000 they would have to pay if the patient gets cancer, they can pay a fraction of the cost,” he says.

That cost-benefit argument makes more sense now, he says, than it did five years ago because the surgery is far simpler. “It only takes an hour to an hour and a quarter. It’s a more precise and more complete removal of the ovaries we can do now--and that has turned the tide on the controversy,” he says.

For women who are members of health maintenance organizations, getting the OK for a preventive ovariectomy can be a longer process, but the surgery is sometimes done. According to Dr. Mark Binstock, staff physician in the department of obstetrics and gynecology at Kaiser Permanente in Woodland Hills, inquiring patients are screened by genetic counselors to determine their true risk.

Although fewer than five patients a year have had the preventive surgery at the Woodland Hills Kaiser, many undergo the ovariectomy while having a hysterectomy or other gynecological surgery for different reasons, Binstock says. Interest in the procedure is growing with more than 10 calls or consultations a month about the surgery in Binstock’s department alone.

What is still up in the air is whether a woman with just one relative--a mother, a sister, or a daughter--diagnosed as having ovarian cancer should choose ovariectomy. “In that category the patient needs to think about it a lot,” Lagasse says.

Understanding is rapidly increasing among physicians about the familial link of ovarian cancer, and more doctors are routinely asking their patients about their family histories and are prepared to counsel patients about their options, he says.

Yet for Laura Fisher, 41, of Westlake, attempts at getting conclusive advice from her physician failed. Fisher’s mother had surgery as a young woman for a rare, grapefruit-size tumor on her ovary, and although it wasn’t fatal, Fisher says she has lived with the fear she was going to get the same thing her whole life.

“My doctor couldn’t give me a straight answer on how lethal it was,” she says. When she developed other gynecological problems that required surgery after the birth of her son Kevin, now 5, Fisher opted for the ovariectomy.

Now on supplemental hormones to replace what her ovaries would have been producing, Fisher says she has had to adapt to some drastic changes as her body adjusts. “But I’d rather live with that than with the fear of ovarian cancer,” she says.

As for what’s in store for the next generation of women, Lagasse predicts that by the time Diane and Marilyn’s daughters reach a decision point, there will be a chemical blood test for the genetic marker responsible for ovarian cancer. “Then it won’t be a question of predicting risk but of identifying the problem,” he says.

Diane’s 9-year-old daughter, Leah, already has asked her if she too will have to have the surgery after she has children. Diane has told her it is possible.

But whenever Diane hears a news story on ovarian cancer, she says she sits back and smiles. “I know I’ve taken care of it,” she says.