Dr explains: Why Pap smears can’t detect ovarian cancer and which tests women should rely on instead

Ovarian cancer remains one of the deadliest gynaecological cancers, largely because it is detected late and lacks effective early screening tools. Despite advances in treatment, many women are still unaware of the early signs, myths and genetic risks associated with the disease.

Firstpost spoke with Dr. Himani Sharma, Clinical Head & Senior Consultant – Obstetrics & Gynecology at Cocoon Hospital (Jaipur) to understand the challenges of early detection, treatment options, preventive measures and the latest advances in ovarian cancer care.

Why is ovarian cancer often called the ‘silent killer’ and what early warning signs should women look out for?

Dr Himani: Ovarian cancer is termed the “silent killer” because its symptoms are vague and easily mistaken for digestive or urinary issues, leading to late detection. Early warning signs of the same include persistent bloating, pelvic pain, early satiety, frequent urination, unexplained weight loss and fatigue. If these symptoms occur on daily basis, then they should not be ignored. Unlike other cancers, ovarian cancer doesn’t have an effective early screening tool, making awareness of subtle changes crucial for timely diagnosis and improved survival outcomes.

How much does family history increase the risk of ovarian cancer, and what role do BRCA1/2 mutations play?

Dr Himani: Family history significantly increases ovarian cancer risk, especially if a mother, sister, or daughter has had the disease. Women with BRCA1 or BRCA2 mutations have a markedly higher lifetime risk, about 40–60% with BRCA1 and 10–20% with BRCA2, compared to 1–2% in the general population. These genes are normally involved in DNA repair and mutations cause genetic instability. Because of this, genetic counselling and testing are recommended for women with a strong family history. Prophylactic surgeries, enhanced surveillance, or targeted therapies like PARP inhibitors may be advised for mutation carriers.

What are the main treatment options for ovarian cancer, from surgery to chemotherapy, and how do doctors decide the right path?

Dr Himani: Treatment typically starts with surgery to remove the ovaries, uterus, fallopian tubes, and as much tumour as possible (debulking). This is often followed by chemotherapy, usually platinum-based drugs combined with taxemes. The choice depends on cancer stage, spread, patient health, and genetic profile. In some advanced cases, chemotherapy is given before surgery (neoadjuvant) to shrink tumours. Newer options include targeted therapies like PARP inhibitors, especially for BRCA-mutated cancers. Multidisciplinary teams, oncologists, surgeons, and genetic specialists, tailor treatment to maximise survival while maintaining quality of life.

How is ovarian cancer different from cervical cancer in terms of causes, detection and outcomes?

Ans Ovarian cancer arises from the ovaries and is largely linked to genetic and hormonal factors, while cervical cancer is primarily caused by persistent infection with high-risk human papillomavirus (HPV). Cervical cancer is preventable with HPV vaccination and detectable early through Pap smears and HPV testing. Ovarian cancer, however, lacks reliable screening and is usually detected late. Prognosis for cervical cancer is generally better due to effective screening and prevention programs, whereas ovarian cancer often has poorer outcomes due to late diagnosis. Thus, the two cancers differ significantly in cause, detection, and treatment approach.

Why don’t routine Pap smears detect ovarian cancer, and what tests should women rely on instead?

Dr Himani: Pap smears screen for cervical cancer by detecting abnormal cervical cells but do not reach the ovaries, hence they cannot detect ovarian cancer. Currently, no effective population-wide screening exists for ovarian cancer. For women at higher risk, doctors may recommend a combination of CA-125 blood tests and transvaginal ultrasound, though these are not definitive. Genetic testing for BRCA and other mutations can identify women at elevated risk. Awareness of persistent symptoms, alongside individualized screening in high-risk women, remains the best approach until more accurate early-detection methods are developed.

What are some of the biggest myths about ovarian cancer that you often encounter in patients?

Dr Himani: Common myths include: “Ovarian cancer always has clear early symptoms”—in reality, symptoms are subtle. Another misconception is that “Pap smears detect ovarian cancer,” which is false. Many believe only older women get it, but younger women, especially with BRCA mutations, are also at risk. Some think fertility treatments cause ovarian cancer, though evidence is inconclusive. Another myth is that removal of the uterus eliminates risk, but women can still develop primary peritoneal cancer. Dispelling these myths is essential to promote awareness, timely medical evaluation, and preventive measures in high-risk women.

How useful are biomarkers like CA-125 and imaging such as transvaginal ultrasound in detecting ovarian cancer?

Dr Himani: CA-125 is a blood biomarker often elevated in ovarian cancer, but it is not specific—levels can rise in conditions like endometriosis or infections. Therefore, it is more useful for monitoring treatment response and recurrence than early detection. Transvaginal ultrasound can detect ovarian masses and changes in ovarian size or structure, but it cannot reliably distinguish benign from malignant tumours. When used together in high-risk women, these tests can offer better surveillance but are not effective as general screening tools. Research is ongoing to identify more accurate biomarkers and imaging approaches.

What preventive or risk-reduction strategies are recommended for women, especially those at high genetic risk?

Dr Himani: For women with BRCA1/2 or strong family history, risk-reducing salpingo-oophorectomy (removal of ovaries and fallopian tubes) after childbearing is highly effective. Oral contraceptives, when used for several years, can lower ovarian cancer risk by up to 50%. Maintaining a healthy weight, limiting hormone replacement therapy, and breastfeeding may also provide protective effects. Regular genetic counselling and testing help identify women at higher risk who may benefit from preventive measures. While no universal screening exists, proactive lifestyle choices and preventive surgery in select groups significantly reduce ovarian cancer risk.

In India, what are the main challenges to early diagnosis and treatment of ovarian cancer?

Dr Himani: In India, delayed diagnosis is a major challenge due to lack of awareness, vague symptoms, and absence of effective screening tools. Many women seek medical care late, often attributing symptoms like bloating or abdominal pain to routine issues. Limited access to specialized oncology centers, financial constraints, and socio-cultural stigma further delay treatment. Rural–urban disparities also play a role, with advanced facilities concentrated in cities. Additionally, genetic testing and targeted therapies are often unaffordable or unavailable. These barriers collectively contribute to poor outcomes and highlight the need for awareness, access, and affordability.

What new advances like targeted therapies or immunotherapy offer hope for better ovarian cancer outcomes in the future?

Dr Himani: Recent advances include PARP inhibitors, which are especially effective in BRCA-mutated cancers by exploiting defective DNA repair. Anti-angiogenic drugs like bevacizumab starve tumours of blood supply, improving survival in some patients. Immunotherapies, though still under study, are showing promise in combination with other treatments. Researchers are also exploring personalised medicine approaches, where genetic profiling guides therapy selection. Liquid biopsies and novel biomarkers may enable earlier detection in the future. Together, these innovations are transforming ovarian cancer care, offering more effective, tailored, and less toxic treatments that improve survival and quality of life.