Final results of 4-monthly screening in the UK Familial Ovarian Cancer Screening Study (UKFOCSS Phase 2).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 5507-5507 ◽  
Author(s):  
Adam N Rosenthal ◽  
Lindsay Fraser ◽  
Susan Philpott ◽  
Ranjit Manchanda ◽  
Philip Badman ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Early Stage ◽  
Transvaginal Ultrasound ◽  
Phase 1 ◽  
Menopausal Status ◽  
Cancer Registries ◽  
Ovarian Cancer Screening ◽  
Fallopian Tube Cancer ◽  
Early Stage Disease ◽  
Optimal Debulking

5507^ Background: Annual transvaginal ultrasound (TVS) and serum CA125 screening for women at high-risk of Ovarian/Fallopian tube cancer (OC/FTC) in Phase 1 of UKFOCSS lacked sensitivity for early stage disease but downstaged disease volume and may have improved optimal debulking rates. More frequent screening might provide greater benefits. Here we report the final results of 4-monthly screening in one of the largest such trials worldwide. Methods: Between 14/06/2007 and 29/03/2012, 4,531 women at an estimated ≥10% lifetime risk of OC/FTC were recruited and screened by 42 UK centres for 14,263 women screen years. Screening comprised 4-monthly CA125 tests analysed by a risk of ovarian cancer algorithm, adjusted for menopausal status. TVS was annual in those with normal algorithm results, but was triggered sooner if results were non-normal. Women with suspicious scan and/or algorithm results were referred for consideration of surgical intervention. Participants were followed prospectively by centres, questionnaire and national cancer registries. Data was censored 365 days after final screen, withdrawal or death. Clinical trial information: 32794457.

Ovarian cancer: screening and future directions

2019 ◽  
Vol 29 (1) ◽  
pp. 195-200 ◽  
Author(s):  
Keshav Kumar Gupta ◽  
Vinay Kumar Gupta ◽  
Robert Wendel Naumann
Keyword(s):  
Ovarian Cancer ◽  
Fallopian Tube ◽  
Screening Program ◽  
Early Stage ◽  
Imaging Techniques ◽  
Transvaginal Ultrasound ◽  
Menopausal Status ◽  
Screening Tools ◽  
Predictive Values ◽  
The Uk

Ovarian cancer carries a lifetime risk of approximately 2% for women and is the leading cause of death from any gynecologic malignancy. Currently, no screening program for ovarian cancer exists for the general population in the UK. This review focuses on the evidence surrounding the efficacy of current markers and discusses future improvements in screening for this disease. One-off cancer antigen 125 (CA125) measurements for detecting ovarian cancer have been well researched. However, studies have highlighted low positive predictive values (5%) and high false positive rates leading to patient anxiety and unnecessary invasive follow-up. Commonly, in the UK, CA125 is combined with transvaginal ultrasound, but there is little evidence that this approach can decrease mortality from ovarian cancer. Recently the Risk of Ovarian Cancer Algorithm, involving a combination of serial CA125 measurements and age, has been shown to detect more early stage cancers. Nevertheless, these measures are not robust in decreasing mortality from ovarian cancer and are costly to implement. Newer markers, such as human epididymis protein 4, have shown greater specificity. Its combination with CA125 and menopausal status in the Risk of Ovarian Malignancy Algorithm can predict the risk of malignancy but provides no additional benefit as a screening tool. Advanced techniques are emerging, including ultrasound molecular imaging techniques using microbubbles targeted to kinase domain receptors, and fallopian tube cytology. To reduce mortality from ovarian cancer, detection of pre-invasive lesions is imperative as ovarian cancer may develop in the fallopian tube and spread to the peritoneal cavity before being detected systemically. It seems that screening tools for ovarian cancer are currently not worthwhile for implementation into a national program. An emphasis on reducing false positives rates, associated anxiety and subsequent overdiagnosis is needed.

scholarly journals Screening for ovarian cancer: Evidences

2017 ◽  
Vol 1 (1) ◽  
pp. 1-7
Author(s):  
Binuma Shrestha ◽  
Bijaya Chandra Acharya
Keyword(s):  
Ovarian Cancer ◽  
Early Stage ◽  
Abdominal Cavity ◽  
Average Risk ◽  
Preventive Healthcare ◽  
Ovarian Cancer Screening ◽  
Early Stage Disease ◽  
Risk Result ◽  
Stage Disease ◽  
Increased Risk

Cancer of the ovary is a leading cause of death among women. Early stage disease are not evident for the incumbent nature of disease in the abdominal cavity. When ovarian cancer is detected and treated while it is still confined to the ovary (stage I), the 5-year survival rate is approximately 90%, but 33% when the disease is diagnosed at stage III or IV. So screening had role in down staging the disease and improve survival. Evidence still does not support screening in average risk women but annual gynecologic examination with pelvic examination is recommended for preventive healthcare. Screening in women with increased risk and inherited risk result in a decrease in the number of deaths in women. For women with mutations in BRCA2, ovarian cancer screening should be initiated between ages 35 and 40.

scholarly journals Screening methods of ovarian cancer in adults

2005 ◽  
Vol 133 (1-2) ◽  
pp. 72-75 ◽  
Author(s):  
Vera Milenkovic ◽  
Radmila Sparic ◽  
Jasmina Atanackovic
Keyword(s):  
Ovarian Cancer ◽  
High Mortality ◽  
Early Stage ◽  
Uterine Cancer ◽  
Direct Result ◽  
High Risk Population ◽  
Screening Methods ◽  
Ovarian Cancer Screening ◽  
Early Stage Disease ◽  
Stage Disease

Ovarian cancer is associated with high mortality rate which has improved a little despite therapeutic advances. It causes more deaths than combined cervical and uterine cancer. High mortality is believed to be a direct result of already advanced stage at the time of diagnosis. Survival is excellent in case of early stage disease but poor in late stage disease, regardless of histology. The goal of screening for ovarian cancer is restricted to detection of asymptomatic early stage disease, as precursor lesions of ovarian cancer have not been identified. At present, there is no reliable method of ovarian cancer screening which has been shown to reduce mortality from ovarian cancer. Therefore, routine screening of women in general population can not be currently advised. Screening should be limited to high-risk population and subjects participating in research projects as long as the results of current studies are available.

scholarly journals Sonomorphology and colour flow Doppler studies in differentiating between benign and malignant ovarian masses

2017 ◽  
Vol 6 (2) ◽  
pp. 626
Author(s):  
Shyamala Jothy M. ◽  
Anju Padmasekar
Keyword(s):  
Ovarian Cancer ◽  
Scoring System ◽  
Early Stage ◽  
Menopausal Status ◽  
Ca 125 ◽  
Screening Methods ◽  
Surgical Removal ◽  
Color Flow ◽  
Early Stage Disease ◽  
Ovarian Masses

Background: Ovarian cancer is the most frequent cause of death from Gynaecological malignancies in the world. Most patients with epithelial ovarian cancer are asymptomatic in early stage disease and usually present with stage III or IV disease. There are various screening methods for detection of ovarian cancer like bimanual pelvic examination, ultrasound examination (TVS and TAS) with or without color Doppler flow imaging and measurement of various circulating proteins like CA 125. The Purpose of a study is to determine optimal cut off point for a morphological scoring system and color flow directed Doppler values to differentiate benign and malignant ovarian masses.Methods: This study was done at Department of obstetrics and Gynaecology, Government Rajah Mirasudhar Teaching Hospital attached to Government Thanjavur Medical College, Thanjavur, Tamilnadu, India during the period of June – 2011 to October – 2012. This study consisted of 73 patients, 3 patients were not operated as they were not fit for surgery for medical reasons. Hence 70 patients were included in the study. A note was made of their main symptoms at admission, Parity, menopausal status, family history of carcinoma. Patients admitted with diagnosis of ovarian masses and clearly ovarian by sonomorphology and surgery were only included in this study. Morphological Score, RI and PI were calculated. All patients underwent exploratory laparotomy with surgical removal of the tumor. The final diagnosis obtained based on HPE were classified as either benign or malignant. The score of each mass and the Doppler values were assessed individually and in combination with regard to its relationship to final diagnosis.Results: In summary the resistance to flow measurement obtained by Doppler had a higher sensitivity and specificity compared to the morphological scoring system in differentiating benign and malignant ovarian masses. The combination of morphological score and Doppler Measurements improved the specificity positive predictive value for differentiating benign and malignant ovarian masses. Conclusions: The combination of ultrasound and Doppler values is better in differentiating benign from malignant ovarian masses. The cut off point for ultrasound guided morphological scoring system was 4 and Doppler velocimetry for differentiating benign and malignant ovarian masses was a RI of 0.55 and PI of 0.8.

scholarly journals BARD1 Autoantibody Blood Test for Early Detection of Ovarian Cancer

Genes ◽  
2021 ◽  
Vol 12 (7) ◽  
pp. 969
Author(s):  
Maxim Pilyugin ◽  
Magda Ratasjka ◽  
Maciej Stukan ◽  
Nicole Concin ◽  
Robert Zeillinger ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Early Detection ◽  
Blood Test ◽  
Menopausal Status ◽  
Clinical Samples ◽  
Average Risk ◽  
Healthy Controls ◽  
Cancer Antigen 125 ◽  
Cancer Syndrome ◽  
Ovarian Cancer Screening

Background: Ovarian cancer (OC) is the most lethal gynaecological cancer. It is often diagnosed at an advanced stage with poor chances for successful treatment. An accurate blood test for the early detection of OC could reduce the mortality of this disease. Methods: Autoantibody reactivity to 20 epitopes of BARD1 and concentration of cancer antigen 125 (CA125) were assessed in 480 serum samples of OC patients and healthy controls. Autoantibody reactivity and CA125 were also tested for 261 plasma samples of OC with or without mutations in BRCA1/2, BARD1, or other predisposing genes, and healthy controls. Lasso statistic regression was applied to measurements to develop an algorithm for discrimination between OC and controls. Findings and interpretation: Measurement of autoantibody binding to a number of BARD1 epitopes combined with CA125 could distinguish OC from healthy controls with high accuracy. This BARD1-CA125 test was more accurate than measurements of BARD1 autoantibody or CA125 alone for all OC stages and menopausal status. A BARD1-CA125-based test is expected to work equally well for average-risk women and high-risk women with hereditary breast and ovarian cancer syndrome (HBOC). Although these results are promising, further data on well-characterised clinical samples shall be used to confirm the potential of the BARD1-CA125 test for ovarian cancer screening.

scholarly journals CA125 test result, test-to-diagnosis interval, and stage in ovarian cancer at diagnosis: a retrospective cohort study using electronic health records

2021 ◽  
pp. BJGP.2020.0859
Author(s):  
Garth Funston ◽  
Luke TA Mounce ◽  
Sarah Price ◽  
Brian Rous ◽  
Emma J Crosbie ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Primary Care ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Early Stage ◽  
Cancer Antigen 125 ◽  
Early Stage Disease ◽  
Cancer Registry Data ◽  
Test Result

BackgroundIn the UK, the cancer antigen 125 (CA125) test is recommended as a first-line investigation in women with symptoms of possible ovarian cancer.AimTo compare time between initial primary care CA125 test and diagnosis, tumour morphology, and stage in women with normal (<35 U/ml) and abnormal (≥35 U/ml) CA125 levels prior to ovarian cancer diagnosis.Design and settingRetrospective cohort study using English primary care and cancer registry data.MethodAssociations between CA125 test results and test-to-diagnosis interval, stage, and ovarian cancer morphology were examined.ResultsIn total, 456 women were diagnosed with ovarian cancer in the 12 months after having a CA125 test. Of these, 351 (77%) had an abnormal, and 105 (23%) had a normal, CA125 test result. The median test-to-diagnosis interval was 35 days (interquartile range [IQR] 21–53) for those with abnormal CA125 levels, and 64 days (IQR 42–127) for normal CA125 levels. Tumour morphology differed by CA125 result: indolent borderline tumours were less common in those with abnormal CA125 levels (n = 47, 13%) than those with normal CA125 levels (n = 51, 49%) (P<0.001). Staging data were available for 304 women with abnormal, and 77 with normal, CA125 levels. Of those with abnormal CA125 levels, 35% (n = 106) were diagnosed at an early stage, compared to 86% (n = 66) of women with normal levels. The odds of being diagnosed with early-stage disease were higher in women with normal as opposed to abnormal CA125 levels (odds ratio 12.2, 95% confidence interval = 5.8 to 25.1, P<0.001).ConclusionDespite longer intervals between testing and diagnosis, women with normal, compared with abnormal, CA125 levels more frequently had indolent tumours and were more commonly diagnosed at an early stage in the course of the disease. Although testing approaches that have greater sensitivity might expedite diagnosis for some women, it is not known if this would translate to earlier-stage diagnosis.

scholarly journals BRAF Mutation is associated with early stage disease and improved outcome in patients with low-grade serous ovarian cancer

Cancer ◽  
2012 ◽  
Vol 119 (3) ◽  
pp. 548-554 ◽  
Author(s):  
Rachel N. Grisham ◽  
Gopa Iyer ◽  
Karuna Garg ◽  
Deborah DeLair ◽  
David M. Hyman ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Braf Mutation ◽  
Early Stage ◽  
Low Grade ◽  
Serous Ovarian Cancer ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Improved Outcome

scholarly journals Osteopontin, Macrophage Migration Inhibitory Factor and Anti-Interleukin-8 Autoantibodies Complement CA125 for Detection of Early Stage Ovarian Cancer

Cancers ◽  
2019 ◽  
Vol 11 (5) ◽  
pp. 596 ◽  
Author(s):  
Jing Guo ◽  
Wei-Lei Yang ◽  
Daewoo Pak ◽  
Joseph Celestino ◽  
Karen H. Lu ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cancer Patients ◽  
Late Stage ◽  
Early Stage ◽  
Characteristic Curve ◽  
Stage I ◽  
Inhibitory Factor ◽  
Early Stage Disease ◽  
Biomarker Panel ◽  
Early Stage Ovarian Cancer

Early detection of ovarian cancer promises to reduce mortality. While serum CA125 can detect more than 60% of patients with early stage (I–II) disease, greater sensitivity might be observed with a panel of biomarkers. Ten protein antigens and 12 autoantibody biomarkers were measured in sera from 76 patients with early stage (I–II), 44 patients with late stage (III–IV) ovarian cancer and 200 healthy participants in the normal risk ovarian cancer screening study. A four-biomarker panel (CA125, osteopontin (OPN), macrophage inhibitory factor (MIF), and anti-IL-8 autoantibodies) detected 82% of early stage cancers compared to 65% with CA125 alone. In early stage subjects the area under the receiver operating characteristic curve (AUC) for the panel (0.985) was significantly greater (p < 0.001) than the AUC for CA125 alone (0.885). Assaying an independent validation set of sera from 71 early stage ovarian cancer patients, 45 late stage patients and 131 healthy women, AUC in early stage disease was improved from 0.947 with CA125 alone to 0.974 with the four-biomarker panel (p = 0.015). Consequently, OPN, MIF and IL-8 autoantibodies can be used in combination with CA125 to distinguish ovarian cancer patients from healthy controls with high sensitivity. Osteopontin appears to be a robust biomarker that deserves further evaluation in combination with CA125.

Prognostic utility of circulating transforming growth factor beta 1 in breast cancer patients

2012 ◽  
Vol 27 (1) ◽  
pp. 53-59 ◽  
Author(s):  
Heena Dave ◽  
Manoj Shah ◽  
Sunil Trivedi ◽  
Shilin Shukla
Keyword(s):  
Breast Cancer ◽  
Growth Factor ◽  
Cancer Patients ◽  
Transforming Growth Factor ◽  
Early Stage ◽  
Menopausal Status ◽  
Breast Cancer Patients ◽  
Early Stage Disease ◽  
Unique Challenge ◽  
Tgf Β1

Transforming growth factor betas (TGF-βs) are multifunctional cytokines with a biphasic role in breast tumorigenesis, acting as tumor suppressors at early stages while stimulating tumor progression at later stages (TGF-β switch). Among the 3 human isoforms, TGF-β1 is known to be overexpressed in several tumor types including breast tumors. TGF-β signaling and “crosstalk” in the tumor microenvironment presents a unique challenge and an opportunity to develop novel therapies. We assessed circulating TGF-β1 levels by ELISA in blood samples from 117 previously untreated breast cancer patients in this prospective study to explore the TGF-β switch at the forefront. The levels were correlated with clinicopathological prognosticators like age, menopausal status, nodal status, histological type, histological grade, necrosis, stromal involvement, and survival. Higher mean preoperative serum TGF-β1 was observed in early-stage patients than controls (p=0.05) as revealed by receiver operating characteristic (ROC) analysis. Elevation of TGF-β1 was evident in patients with advanced-stage breast cancer compared with those having early-stage disease (p=0.0001). Prognosticators of an aggressive phenotype were associated with higher TGF-β1 levels, and higher levels thus announced the likelihood of relapse, marking the role of TGF-β1 as a tumor promoter and evidencing the existence of a TGF-β switch. Moreover, higher levels of TGF-β1 shortened the overall survival in breast cancer patients (p=0.010). The results indicate that circulating TGF-β1 may be used as a predictive and prognostic marker in breast carcinoma.

A prospective multi-center ovarian cancer screening study in women at increased risk

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5510-5510 ◽  
Author(s):  
S. J. Skates ◽  
C. W. Drescher ◽  
C. Isaacs ◽  
J. M. Schildkraut ◽  
D. K. Armstrong ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cancer Screening ◽  
Cancer Genetics ◽  
Early Stage ◽  
Screening Strategy ◽  
Ovarian Cancer Screening ◽  
High Compliance ◽  
Increased Risk ◽  
Screening Study ◽  
Incident Cases

5510 Background: No proven ovarian cancer (OC) screening strategy exists for women who are at increased risk for the disease. A risk of ovarian cancer algorithm (ROCA) using serial CA125 values has previously shown greater positive predictive value (PPV) and sensitivity than a single CA125 in screening women at general population risk. We hypothesized that using ROCA would yield a reasonable PPV for ovarian cancer screening in a cohort at increased risk. Methods: Between 7/2001 and 9/2006, 25 sites (14 Cancer Genetics Network, 3 ovarian SPOREs, 1 EDRN, 7 others) prospectively enrolled patients. Inclusion criteria included: among self, 1° or 2° relatives in same lineage either (i) BRCA1/2 mutation, or (ii) two of OC or early onset (age = 50) breast cancer (BC), or (iii) Ashkenazi ethnicity and 1 of OC or BC. A previous diagnosis of OC excluded subjects. Subjects underwent CA125 every 3 months and the risk of having ovarian cancer based on the CA125 profile was recalculated after each test. ROCA referred subjects with risk > 1% to ultrasound (US), and risk > 10% additionally to a gynecologic oncologist. Objectives included PPV for study indicated surgery, sensitivity, and compliance. Sample size was chosen to observe 8 OC endpoints with a power of 80% to rule out PPV = 10% if the true PPV = 20%. Results: 2,343 high risk women enrolled, with 6,284 women years of screening and 19,549 CA125s obtained. There were 628 (10%/yr) referrals to US with 414 US performed. 38 women underwent study indicated surgeries. 9 OCs were identified during screening, 3 were prevalent (1 early, 2 late stage), and 6 were incident (5/6 = 83% early, 1 late). 3 of the 6 incident cases were found on prophylatic oophorectomy in early stage. ROCA detected 2 in early stage of remaining 3 incident cases, and 3 of 3 prevalent cases. The PPV was 5/38 = 13% (95% CI 4.4%, 28%) and sensitivity was 5/6 = 83%, CI (36%, 99%). There was high compliance with CA125 testing throughout study, with 84%, 85%, 85%, 82% subjects returning within 1 month of schedule for first 4 tests. Conclusions: Frequent CA125 testing using ROCA results in an acceptable PPV and high compliance in a cohort of women at increased risk for OC. A definitive screening study (= 30 incident cases) using ROCA with serial CA125 and possibly additional markers is required to define sensitivity for early stage OC. [Table: see text]

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