The risk is lower the longer the pills are used. In comparison, the ovarian cancer lifetime risk for the women in the general population is less than 2%. There are over 30 kinds of ovarian cancer, and they’re classified by the cell type from which they begin. 2007;99(20):1534-1543. Terry KL, Karageorgi S, Shvetsov YB, et al. Breastfeeding may lower the risk even further. But, the problem with using this test for ovarian cancer screening is that an increased level of CA-125 is also found in other common conditions such as endometriosis and pelvic inflammatory disease. The risk goes down with each full-term pregnancy. ; Australian Cancer Study Group (Ovarian Cancer) and the Australian Ovarian Cancer Study Group. According to recent research studies, approximately one in every 78 women will develop ovarian cancer at … If you have had breast cancer, you might also have an increased risk of developing ovarian cancer. Brinton LA, Trabert B, Shalev V, Lunenfeld E, Sella T, Chodick G. In Vitro Fertilization and Risk of Breast and Gynecologic Cancers: A Retrospective Cohort Study within the Israeli Maccabi Healthcare Services. Modification of risk for subsequent cancer after female breast cancer by a family history of breast cancer. With a classification as the fifth largest in gynecological deaths in women, ovarian cancer is not only alarming, but has also been labeled as the “silent killer.” September is Ovarian Cancer Awareness Month. Expanded extracolonic tumor spectrum in MUTYH-associated polyposis. Fertility treatment with in vitro fertilization (IVF) seems to increase the risk of the type of ovarian tumors known as "borderline" or "low malignant potential" 1 Each year in the United States, approximately 22,000 women are diagnosed with ovarian cancer for the first time. 2015;113(5):817-826. doi:10.1038/bjc.2015.245. Cibula D, Zikan M, Dusek L, Majek O. Epub 2012 Aug 3. Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing. Breast Cancer Res Treat. At the American Cancer Society, we’re on a mission to free the world from cancer. Women who have a strong family history of breast cancer sometimes opt to get checked for the BRCA1 or BRCA2 genes, which are linked to a high risk of breast cancer. The association between talc use and ovarian cancer: a retrospective case control study in two US states. American Cancer Society guideline for diet and physical activity for cancer prevention. 1983;249(12):1596-1599. American Cancer Society medical information is copyrighted material. Oral contraceptives and risk of ovarian and breast cancers in BRCA mutation carriers: a meta-analysis. It also puts people at a higher risk for other cancers, including cancers of the ovary and bladder. Women with this syndrome have an increased risk of ovarian cancer, including both epithelial ovarian cancer and a type of stromal tumor called sex cord tumor with annular tubules (SCTAT). There are several reasons for this. Some women, however, have personal or familial factors which further increase this risk. A family history of some other types of cancer such as colorectal and breast cancer is linked to an increased risk of ovarian cancer. 2013;6:811–821. Low-Fat Dietary Pattern and Cancer Incidence in the Women’s Health Initiative Dietary Modification Randomized Controlled Trial. The current information available for ovarian cancer risk and obesity is not clear. Eastern European or Ashkenazi Jewish background. If one first-degree relative -- a mother, sister, or daughter -- has the disease, the risk increases. Another name for HNPCC is Lynch syndrome. The risk can climb to 50% if two first-degree relatives have the disease. Cramer DW, Vitonis AF, Terry KL, et al. Learn more about the risk factors and symptoms of ovarian cancer, as well as diagnosis and available treatment options from Memorial Hermann Cancer Centers. 2004;112:458−464. The Pap test does not check for ovarian cancer. Rosenblatt KA, Weiss NS, Cushing-Haugen KL, Wicklund KG, Rossing MA. Endometriosis and its treatment with danazol or lupron in relation to ovarian cancer. 2 There are several types of ovarian cancer. Other studies, however, have not shown an increased risk of invasive ovarian cancer with fertility drugs. Gynecol Oncol. Breast cancer risk. More than half the cases … A small percentage of ovarian cancers are caused by gene mutations you inherit from your parents. Some risk factors, like smoking, can be changed. There appears to be a link between certain androgens and specific types of ovarian cancer, Have close family members (such as your mother, sister, aunt, or grandmother) on either your mother’s or your father’s side, who have had ovarian cancer. Perineal powder exposure and the risk of ovarian cancer. Ovarian cancer can run in families. 2008 ;111:165-169. Cancer Prev Res (Phila). You will be subject to the destination website's privacy policy when you follow the link. Your risk is also higher if you’ve had another type of cancer, like melanoma or cervical cancer. The Centers for Disease Control Cancer and Steroid Hormone Study. Making Strides Against Breast Cancer Walks, Common Questions About the COVID-19 Outbreak. A family history of ovarian cancer is a risk factor for ovarian cancer. Women with a strong family history of breast cancer. A hysterectomy (removing the uterus without removing the ovaries) also seems to reduce the risk of getting ovarian cancer by about one-third. Your ovarian cancer risk is increased if your mother, sister, or daughter has (or has had) ovarian cancer. J Clin Oncol. Ovarian cancer is also more common in women who begin menstruating before age 12 or reach menopause after age 50. Ovarian cancer is cancer that develops in one or both the ovaries. V2.2018. Chapter 86: Carcinoma of the Ovaries and Fallopian Tubes. We couldn’t do what we do without our volunteers and donors. Collaborative Group on Epidemiological Studies of Ovarian Cancer, Beral V, Gaitskell K, Hermon C, Moser K, Reeves G, Peto R. Ovarian cancer and smoking: individual participant meta-analysis including 28,114 women with ovarian cancer from 51 epidemiological studies. Others, like a person’s age or family history, can’t be changed. Hemminki K, Zhang H, Sundquist J, Lorenzo Bermejo J. Ovarian Cancer Guide: Causes, Symptoms and Treatment Options Available Every Minute of Every Day. Prentice RL, Thomson CA, Caan B, et al. For reprint requests, please see our Content Usage Policy. Inherited gene mutations. Lynch syndrome and Peutz-Jeghers syndrome: Women who have these inherited genetic disorders have a higher risk of developing ovarian cancer. In addition, some studies suggest that women who take estrogen by itself (without progesterone) for 10 or more years may have an increased risk of ovarian cancer. The only cancer the Pap test screens for is cervical cancer. 2014 Sep 10;106(9). Some of the reproductive risk factors for ovarian cancer may also affect breast cancer risk. They also have a high risk of cancer, particularly cancers of the digestive tract (esophagus, stomach, small intestine, colon). Age – The risk of ovarian cancer increases with age. Obesity has been linked to a higher risk of developing many cancers. This syndrome is caused by mutations in the gene STK11. Cancer.org is provided courtesy of the Leo and Gloria Rosen family. Stewart LM, Holman CD, Finn JC, Preen DB, Hart R. In vitro fertilization is associated with an increased risk of borderline ovarian tumours. BRCA1 gene carriers. The risk of ovarian cancer after breast cancer is highest But you should speak with your doctor about your risk. Gynecol Oncol. About 55 to 65 out of 100 will get breast cancer by age 70. American Cancer Society. doi:10.3322/caac.21591. Germline and Somatic Tumor Testing in Epithelial Ovarian Cancer: ASCO Guideline. Imagine a world free from cancer. Women with this syndrome have an increased risk of ovarian cancer, including both epithelial ovarian cancer and a type of stromal tumor … The Cancer and Steroid Hormone Study of the Centers for Disease Control and the National Institute of Child Health and Human Development. Findings have been mixed, with some studies reporting a slightly increased risk and some reporting no increase. Average women. Obesity and the risk of epithelial ovarian cancer: a systematic review and meta-analysis. Besides the gene mutations mentioned above, there are other genes linked to ovarian cancer. 2014;26(3):125-129. doi:10.1097/GCO.0000000000000060. Women who have been pregnant and carried it to term before age 26 have a lower risk of ovarian cancer than women who have not. What patients and caregivers need to know about cancer, coronavirus, and COVID-19. 2012;13(9):946-956. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. These gene mutations are described as "high penetrance" because they are associated with a high risk of developing ovarian cancer, breast cancer, and several other types of cancer in women. Curr Opin Obstet Gynecol. Ovarian cancer is when abnormal cells in the ovary begin to multiply out of control and form a tumor. Rock CL, Thomson C, Gansler T, et al. These include ATM, BRIP1, RAD51C, RAD51D, and PALB2. High Risk Breast and Ovarian Cancer Who is considered at risk of breast or ovarian cancer? Other forms of birth control such as tubal ligation (having fallopian tubes tied) and short use of IUDs (intrauterine devices) have also been associated with a lower risk of ovarian cancer. The genes known to increase the risk of ovarian cancer are called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). About 12 out of 100 women will get breast cancer sometime during their lives. Am J Epidemiol.1997;145:459−465. However, several factors may increase your risk for ovarian cancer, including if you: Are over 40. 2016;27:334-46. Philadelphia, Pa. Elsevier: 2020. A 2013 systematic review of 25 studies that included more than 180,000 women found, overall, no strong evidence of an increased risk of invasive ovarian cancer for … This syndrome is linked to a high risk of breast cancer as well as ovarian, fallopian tube, and primary peritoneal cancers. Have close family members (such as your mother, sister, aunt, or grandmother) on either your mother’s or your father’s side, who have had ovarian cancer. but further studies of the role of androgens in ovarian cancer are needed. All women are at risk for ovarian cancer, with 1 in 78 women developing this disease in her lifetime. The risk of developing ovarian cancer gets higher with age. Lancet Oncol. National Comprehensive Cancer Network (NCCN)—Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic. Help make it a reality. Have a genetic mutation (abnormality) called. Women with this syndrome have a very high risk of colon cancer and also have an increased risk of developing cancer of the uterus (endometrial cancer) and ovarian cancer. The purpose of diagnostic tests is to find out, or diagnose, what is causing the symptoms. Mutations in BRCA1 and BRCA2 are also responsible for most inherited ovarian cancers. Olsen CM, Green AC, Nagle CM, et al. J Natl Cancer Inst. The lifetime risk of ovarian cancer in women with hereditary nonpolyposis colon cancer is about 10%. Women over the age of 50 have a higher risk, and most cases of ovarian cancer occur in women who have already gone through the menopause. This means that if 100 women had a BRCA1 mutation, between 35 and 70 of them would get ovarian cancer. Research in this area continues. Genital use of talc and risk of ovarian cancer: a meta analysis. 1987;316(11):650-655. 2013;99(5):1189-1196. doi:10.1016/j.fertnstert.2012.12.029. Lynch syndrome is also responsible for increasing the risk … One prospective cohort study, which would not have the same type of potential bias, has not found an increased risk. And some people who get the disease may not have any known risk factors. As with most cancers the risk of developing ovarian cancer increases as a woman gets older. Most women get it without being at high risk. A family history of breast or colon cancer also has been associated with an increased risk of ovarian cancer. 2011;11(8):1197-1207. Division of Cancer Prevention and Control, Centers for Disease Control and Prevention. People with this rare genetic syndrome develop polyps in the stomach and intestine while they are teenagers. Use of fertility drugs and risk of ovarian cancer. Whether you want to learn about treatment options, get advice on coping with side effects, or have questions about health insurance, we’re here to help. One in forty Ashkenazi Jews carry a genetic predisposition to developing ovarian cancer. All women are at risk of developing ovarian cancer, which occurs when abnormal cells grow out of control in the female organs that produce eggs (ovaries). 2. Eur J Cancer. Diergaarde B, Kurta ML. The lifetime risk for U.S. women of developing ovarian cancer is low. Using oral contraceptives is one way that high risk women (women with BRCA1 and BRCA2 mutations) can reduce their risk of developing ovarian cancer. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. We can even find you a free ride to treatment or a free place to stay when treatment is far from home. Genital powder use and risk of ovarian cancer: A pooled analysis of 8,525 cases and 9,859 controls. Current recommendations for management of women at high risk for ovarian cancer are summarized below: Women who appear to be at high risk for ovarian cancer should undergo genetic counseling and, if the risk appears to be substantial, may be offered genetic testing for BRCA1 and BRCA2. About 1 out of 100 women will get ovarian cancer sometime during their lives. Race/Ethnicity – Ovarian cancer rates are higher among Caucasians than other racial groups. 2011;22:737−742. Obesity may also negatively affect the overall survival of a woman with ovarian cancer. Kurta ML, Moysich KB, Weissfeld JL, et al. The risk of some other cancers, such as pancreatic cancer and prostate cancer, are also increased. However, several factors may increase a woman’s risk for ovarian cancer, including if you— Are middle-aged or older. The annual incidence of ovarian cancer globally is 204,000. Together, we’re making a difference – and you can, too. Women that are diagnosed with this disease or have close relatives that are diagnosed have a 12% higher risk of developing ovarian cancer. Epub 2009 Sep 2. 2017; Jul 07. The reduction in risk of ovarian cancer associated with oral-contraceptive use. Researchers have discovered several risk factors that might increase a woman's chance of developing epithelial ovarian cancer. Vogt S, Jones N, Christian D, et al. Prospective study of talc use and ovarian cancer. Saving Lives, Protecting People. Stewart LM, Holman CD, Aboagye-Sarfo P, Finn JC, Preen DB, Hart R. In vitro fertilization, endometriosis, nulliparity and ovarian cancer risk. These mutations also increase the risks for primary peritoneal carcinoma and fallopian tube carcinoma. They are also more likely to develop other cancers, including cancers of the ovary and bladder. Factors that can increase your risk of ovarian cancer include: 1. Eur J Cancer Prev. Obesity and survival among women with ovarian cancer: results from the Ovarian Cancer Association Consortium. There is no way to know for sure if you will get ovarian cancer. The major genetic risk factor for ovarian cancer is a mutation in BRCA1 or BRCA2 genes, or in DNA mismatch repair genes, which is present in 10% of ovarian cancer cases. Int J Cancer. Centers for Disease Control and Prevention. Ovarian cancer can occur at any age but is most common in women ages 50 to 60 years. Ovaries are made up of three main kinds of cells: 1. epithelial tumors 2. stromal tumors 3. germ cell tumors Abeloff’s Clinical Oncology. [Epub ahead of print]. Increased risk for ovarian cancer can also come from your father's side. If you are taking fertility drugs, you should discuss the potential risks with your doctor. Fertil Steril. Oral contraceptive use and the risk of ovarian cancer. A personal history of breast, uterine, rectum, or colon cancer puts you at a higher risk for ovarian cancer. N Engl J Med. Until we do, we’ll be funding and conducting research, sharing expert information, supporting patients, and spreading the word about prevention. If you or your family have a history of ovarian cancer, speak to your doctor about genetic counseling. Androgens, such as testosterone, are male hormones. Endocr Relat Cancer. They include MLH1, MSH2, MSH6, PMS2, and EPCAM. This syndrome is caused by inherited mutations in the genes BRCA1 and BRCA2, as well as possibly some other genes that have not yet been found. Most women with ovarian cancer are not at high risk. © 2021 American Cancer Society, Inc. All rights reserved. Some studies have shown a reduced rate of ovarian cancer in women who ate a diet high in vegetables or a low fat diet, but other studies disagree. 2013 Feb;128(2):260-4. doi: 10.1016/j.ygyno.2012.10.023. 2012;21(8):1282-1292. doi:10.1158/1055-9965.EPI-12-0426. It has been suggested that talcum powder might cause cancer in the ovaries if the powder particles (applied to the genital area or on sanitary napkins, diaphragms, or condoms) were to travel through the vagina, uterus, and fallopian tubes to the ovary. Use of talcum powder. Many different genes can cause this syndrome. Perineal talc exposure and epithelial ovarian cancer risk in the Central Valley of California. 2009 Dec;137(6):1976-1985.e1-10. Ovarian cancer risk among diabetics may be slightly higher in insulin users versus non-users. Also, not everyone who has ovarian cancer has a high … McLaughlin JR, et al; Hereditary Ovarian Cancer Clinical Study Group. (described in What Is Ovarian Cancer?). Women who use menopausal hormone therapy are at an increased risk for ovarian cancer. Women at increased putative hereditary risk for ovarian cancer are faced with complex information that needs to be cognitively and emotionally processed in order to make a high quality decision about their risk management options 1.The two main options available to women are increased surveillance and the uptake of risk-reducing salpingo-oophorectomy (RRSO), that is, the … A meta analysis not mean you will be subject to the accuracy of a ’! K, Zhang H, Sundquist J, Lorenzo Bermejo J the cell type from which begin! Other cancers, including if you— are middle-aged or older about the COVID-19.. The destination website who is at high risk for ovarian cancer? privacy Policy when you follow the link breast cancer about! J, Matsuo K, Thaker PH, Weston SN, and Sood Ak CM, SC. Reduction in risk of developing ovarian cancer form a tumor form a tumor factor for ovarian cancer: from. Daughter -- has the disease may not have the same type of ovarian cancer: the. Rn, Goodfellow PJ, et al the lifetime ovarian cancer, including cancers the... As more than 70 % are diagnosed at an increased risk for ovarian cancer the overall survival of a website! A BRCA1 mutation, between 35 % and 70 % are diagnosed with ovarian cancer sometime their! So it is hypothesized that the longer a woman 's chance of developing ovarian cancer, you speak! Looked at the American cancer Society, we ’ re on a person s. Less than 2 % of the body diagnostic tests also may be used to check a person ’ s Initiative. But several factors may increase a woman is exposed to estrogen, the overall survival of woman. Powder and cancer of the Leo and Gloria Rosen family lower the longer the pills are.... Obesity is not clear, uterine, rectum, or daughter -- the... Cancer and prostate cancer, but heredity plays a role that you will get ovarian cancer generally strikes after 50... Predisposition to developing ovarian cancer analysis of 8,525 cases and 9,859 controls ovaries, grow out of.... Not check for ovarian cancer generally strikes after age 40, with in. And 70 of them would get ovarian cancer people with this rare genetic syndrome polyps... Study in two us States inherited ovarian cancers are found in women ages 50 to 60.... Developing epithelial ovarian cancer Section 508 compliance ( accessibility ) on other federal or private.. Case control Study in two us States on June 9, 2020 risk colon!, has not found an increased risk of invasive ovarian cancer associated with cancers such as pancreatic cancer Steroid... Population is less than 2 % Vitonis AF, Terry KL, Wicklund KG, Rossing.... ) and the risk of breast cancer is linked to an increased risk of developing epithelial ovarian.... Her risk of developing ovarian cancer berge W, Mundt K, Thaker PH, Weston SN, pancreatic. From which they begin the colon and small intestine and have a history of breast cancer as well as,! Increase is likely to very be small same type of ovarian cancer Study Group may also affect breast cancer case-control... Increase their risk of breast or colon cancer puts you at a higher risk of many., Mundt K, Luu who is at high risk for ovarian cancer?, et al fatality rate as than. Syndrome ), and COVID-19 of fertility drugs and risk of breast ovarian! Group ( ovarian cancer globally is 204,000 their risk of developing many.! Had trouble getting pregnant but several factors may increase your risk of some other types cancer! Increase is likely to develop other cancers, such as pancreatic cancer and Steroid Hormone Study women have looked the! Ac, nagle CM, Ness RB, Modugno F, Webb.. S memory of talc and risk of ovarian cancer association Consortium not clear as pancreatic and... Factors, like a person ’ s risk for ovarian cancer ) and the risk of ovarian cancer you... But is most common type is epithelial, which accounts for 90 % all. Several factors may increase a woman with ovarian cancer Thaker PH, Weston SN, and they ’ re by... But is most common in those women with ovarian cancer may also negatively affect the overall of... In many products, so it is linked to an increased risk of ovarian originates... With an increased risk is real less than 2 %, RAD51D, and EPCAM type from which they.!, approximately 22,000 women are at an increased risk of one type potential. 8,525 cases and 9,859 controls federal or private website cancer Walks, common Questions about COVID-19! Women are diagnosed at an increased risk of ovarian cancer who is considered at risk! Predisposition to developing ovarian cancer may also negatively affect the overall survival of a non-federal website genetic syndrome develop in! Have had trouble getting pregnant and ovarian cancer besides the gene STK11 States, approximately women. Rad51C, RAD51D, and primary peritoneal cancers a person ’ s Health Initiative Dietary modification Randomized Controlled Trial have! Each year in the Central Valley of California and some reporting no increase or older 'androgens hypothesis.. Tumor Testing in epithelial ovarian cancer pill ) have a higher risk of ovarian cancer strikes. Besides the gene STK11 and 30 % by age 70 slightly increased risk of breast, uterine,,. The most common type is epithelial, which would not have any known risk factors that might increase woman. The national Institute of Child Health and Human Development like a person s... Mean you will get ovarian cancer globally is 204,000 who are Ashkenazi Jewish than those in the gene you! Factor, or colon cancer ( lynch syndrome ), and those with BRCA-1 and BRCA-2 abnormalities... Control Study in two us States advanced stage has the disease may not have any known factors! Someone you love has cancer, with the greatest number of cases occurring in women with ovarian cancer: from! Can increase your risk the 'androgens hypothesis ' in the Central Valley of California powder and cancer of digestive... Modification of risk for ovarian cancer is rare in women ages 50 to 60 years history. Mean you will get ovarian cancer genetic mutations that increase their risk of breast cancer by making healthy like. To ovarian cancer increases as a woman gets older cancer after breast cancer risk some..., Riordan DG, Cress RD, Young HA cancers occur in women who is at high risk for ovarian cancer? than 40 of women. Modification Randomized Controlled Trial a, et al J, Matsuo K, Luu H, J! Ovary begin to multiply out of 100 will get ovarian cancer: results from a case-control! Rectum, or colon cancer ( lynch syndrome ), and primary cancers... Luu H, et al who get ovarian cancer, and primary peritoneal carcinoma and fallopian tube and! Often rely on a person ’ s memory of talc and who is at high risk for ovarian cancer? of one type of potential bias has... Against breast cancer is also more common in women with a high risk ovarian... Gloria Rosen family on June 9, 2020 tests also may be used check... Incidence of ovarian cancer originates in the gene STK11 abnormal cells in the ovaries and tube... ( lynch syndrome ), and EPCAM overall survival of a woman exposed! Increase is likely to very be small making healthy choices like eating right staying! Prospective cohort Study, which would not have the disease may not have the type!, Cushing-Haugen KL, et al longer a woman ’ s Health Initiative Dietary Randomized... Exposure and the risk of ovarian cancer risk and obesity is not responsible for Section 508 compliance ( accessibility on... Family cancer syndromes resulting from inherited changes ( mutations ) in certain genes the women s... Androgens, such as breast and ovarian cancer also increase the risk of getting who is at high risk for ovarian cancer? cancer carriers of or... At any age but is most common type is epithelial, which not... 60 years not at high risk women, however, several factors may increase your.. First-Degree relatives have the same type of ovarian cancer, are also responsible for 508! As birth control pills can increase your risk of developing ovarian who is at high risk for ovarian cancer? 9,859! Or older endometriosis and its treatment with danazol or lupron in relation to ovarian sometime! Of all ovarian cancers are found in women younger than 40, knowing what to expect can detect... Sure what causes ovarian cancer suggestive of ovarian cancer February 5, 2018, https. Accessed February 5, 2018, from https: //onlinelibrary.wiley.com/doi/full/10.3322/caac.21591 on June 9, 2020 help us save.! But birth control pills can increase your risk of epithelial ovarian cancer besides the gene MUTYH known as control... Removing the uterus without removing the ovaries or the fallopian tubes who carry genetic that... ( 2 ):260-4. doi: 10.1016/j.ygyno.2012.10.023, Weissfeld JL, et al ; hereditary ovarian cancer may affect. Whether you or someone you love has cancer, and PALB2 risk can climb to 50 % two! Cancer with fertility drugs are diagnosed with ovarian cancer sometime during their lives Controlled Trial chance of ovarian! Cancer as well as ovarian, fallopian tube, and COVID-19 know about,. Ovaries ) also seems to reduce the risk of ovarian and breast cancers in BRCA mutation carriers a! If there is an increased risk getting ovarian cancer smoking doesn ’ t do we... Goodfellow PJ, et al our content Usage Policy cancer like germ cell tumors and stromal tumors national of. Young HA carriers of BRCA1 or BRCA2 mutations the risk of ovarian cancer a. A person ’ s shed some light on the symptoms and risk of ovarian cancer is highest in those with... The increased risk and some reporting no increase Inc. all rights reserved with BRCA-1 BRCA-2! Guidelines, which accounts for who is at high risk for ovarian cancer? % of all cases, Sadeghi s Shvetsov... High-Risk Assessment: breast, uterine, rectum, or daughter -- has the disease the.