Ovarian Cancer Screening in Asymptomatic Women - USPSTF

In 2012, I wrote a blog post titled I Agree with the USPSTF  regarding the latest recommendation on screening asymptomatic women for ovarian cancer.

On February 13, 2018 the USPSTK released an updated recommendation.

The USPSTF recommends against screening for ovarian cancer in asymptomatic women.
This recommendation applies to asymptomatic women who are not known to have a high-risk hereditary cancer syndrome.
Grade: D 
(The USPSTF recommends against the service. There is moderate to high certainty the service has no net benefits or the harms outweigh the benefits.)

You can read the full recommendation here.

In the February 25th issue of the ASCO Post. Michael J. Barry, MD said "“Evidence shows that current screening methods do not prevent women from dying of ovarian cancer and that screening can lead to unnecessary surgery in women without cancer.”

Remember if you have a history of breast or ovarian cancer in your family these recommendations do NOT apply to you.

It is sad that in the past six years there is still no effective screening test for ovarian cancer that is both specific and sensitive to the disease. We still have a lot of work to do to help find a test that will find ovarian cancer at an early stage.

Dee
Every Day is a Blessing!

A Month of Teal- Is there a Screening Test for Ovarian Cancer ?

NO !
There is no screening test for ovarian cancer.

You may have heard about the CA-125 blood test. This test is not specific enough to be used on the general population to detect ovarian cancer.

You can learn more about CA-125 by reading this newly updated brochure, CA-125 Levels: Your Guide  by the Foundation for Women's Cancer.

The PAP test does not screen for ovarian cancer - it screens for cervical cancer.

Dee
Every Day is a Blessing!

Interview with Dr Goli Samimi ~ Ovarian Cancer Researcher

About two weeks ago I read an article on the news.com.au site entitled "Ovarian Test is Close:Researchers". The research of Dr Goli Samimi a researcher in Australia was mentioned in the article and I was interested in learning more about the DNA blood test she was developing. I searched online and found her page on the Garvan Institute of Medical Research site which is located in Australia. So after a bit of thought and a nudge by a friend I decided to e-mail Dr. Samimi and ask her if she would answer a few questions about her research for this blog. She responded to me and said she would be happy to discuss her line of research. 

I am happy to share with you Dr Samimi's responses to my interview questions. 

1.  You are currently associated with the Garvan Institute of Medical Research in Australia. What is your medical background and how did your interest in ovarian cancer research begin?

I’m not a medical doctor—I received my PhD from the University of California, San Diego in 2004. My thesis involved studying why ovarian cancer cells become resistant to chemotherapy. I then did my post-doctoral fellowship at the National Cancer Institute, NIH in Bethesda, MD. My post-doc research involved studying ovarian tumors to find new therapeutic targets.

2.  In the recent online article “Ovarian Cancer Test is Closer: Researchers” it mentioned identifying specific biological changes in DNA of women with ovarian cancer. Does your research use blood samples, tumor samples or cell lines?

Our research uses blood samples to identify DNA changes, because the hope is to develop a non-invasive test (such as a blood test) that can be used to determine which women may have early stage cancer. Once we have identified some of these changes, we will check to see if they are also present in the corresponding tumor.

3.  Please describe in layman’s terms the methods you are using to conduct your research.

We collect blood from patients or healthy volunteers. We then separate the plasma and use a commercial kit to isolate the DNA that is present in the blood. We then use another commercial kit to enrich the DNA for regions that are methylated—this is a biochemical alteration in the DNA that happens during the development of cancer. We then subject the DNA to sequencing to compare which regions are methylated in cancer versus healthy subjects. Once we get a list, we need to confirm these regions in a larger sample before it could be applied to the public. We are looking at 5-10 years down the line.

4.  What DNA changes are you looking for? Insertions, deletions, mutations?

DNA methylation is considered an epigenetic alteration, which means a change in the structure of DNA, rather than the actual sequence.

5.  How does your line of research differ from others developing early detection tests?

We are the first who are applying whole-genome sequencing to methylated DNA from blood. Most are focusing on proteins (like CA-125) or specific DNA sequences.

6.  Do you see this test being used in the general population, with women at risk for ovarian cancer or those exhibiting symptoms of the disease?

Because of the relative rarity of ovarian cancer, it’s difficult to apply these kinds of tests to the general population as you would need essentially 100% accuracy for it to be helpful. So we intend to apply this test to women at risk, so women with a family history of breast or ovarian cancer.

7.  When will your test be ready for clinical trial? What issues do you see in developing this method for widespread use?

Because the analysis of whole genomes takes some time, and the results have to be validated in larger samples before being applied in a trial, we are aiming for 5-10 years down the road.

8.  Will the cost of this test be in line with other detection tests, such as the CA-125?

Good question, I actually don’t know the answer to this. I guess it would depend on who markets it and how many women it can be applied to.

9.  What do you see in the future for women diagnosed with ovarian cancer?

We know that women who are diagnosed early have a very high survival rate (80% 5-year survival). They usually undergo surgery and may not even need chemotherapy treatment. So if we can improve early detection, we can improve the survival rate and quality of life of women diagnosed with ovarian cancer.

10. Is there anything else you would want women to know about your test for ovarian cancer?  

We still have some time before our test or others will be developed or applied, so in the meantime listen to your body and make sure to have regular check-ups.

Thank you Dr Samimi for taking time to answer these questions and all your efforts to find a early detection test for ovarian cancer. 


Dee
Every Day is a Blessing!  

OC Awareness #11- Task Force Recommendation

Just yesterday the US Preventative Services Task Force released its recommendation regarding ovarian cancer screening in the general population.

The recommendation is for adult women and does not apply to women who are at risk for the disease ( genetic mutation) or women already diagnosed with the disease.

"The Task force recommends against screening women for the disease. "

This recommendation was made because screening using CA-125 and ultrasound did not have any benefit (reduce mortality)  and if fact those tests could lead to harm (unnecessary surgery) .

The task forced used three large trials( including the Prostate, Lung and  Ovarian Cancer Screening Study) to reach their conclusion . A discussion of the test can be found on the USPSTF website here and the consumer fact sheet ( pdf)  can be found on their website.


Here is a good article to read for a very complete explanation of the studies behind the recommendation.
http://annals.org/article.aspx?articleid=1357339


Dee
Every Day is a Blessing!

Research News : OC screening and Secondary Cytoreductive Surgery

Two interesting articles appeared recently in the Oncologist and Cancer Prevention Research .

Impact of Screening Test Performance and Cost on Mortality Reduction and Cost-effectiveness of Multimodal Ovarian Cancer Screening

This study looking at mortality reduction, years of life saved and cost -effectiveness for women who underwent an annual CA-125 and on a rising result underwent a subsequent transvaginal ultrasound . Results showed a  moderate decrease in mortality (13%). The tests were found to meet cost effective guidelines.

The Role of Secondary Cytoreductive Surgery in Patients with Recurrent Epithelial Ovarian, Tubal, and Peritoneal Cancers: A Comparative Effectiveness Analysis

This comparative study showed reported the cytoreductive surgery used to treat  recurrent Ovarian cancer may increase overall survival.

Dee
Every Day is a Blessing!

Doctors Don't Follow OC Guidelines

The has been a buzz on the internet about a study published in the Annals of Internal Medicine titled " Vignette-Based Study of Ovarian Cancer Screening: Do U.S. Physicians Report Adhering to Evidence-Based Recommendations?". In the study , 1800 family physicians,internists and gynecologists answered a 12 page survey regarding women's annual exams and their offers or orders for a transvaginal ultrasound (TVU) or CA-125 blood test .

The conclusion of the study was

"One in 3 physicians believed that ovarian cancer screening was effective, despite evidence to the contrary. Substantial proportions of physicians reported routinely offering or ordering ovarian cancer screening, thereby exposing women to the documented risks of these tests"

The report also stated that 33% of the doctors offered TVU and the CA-125 to low risk women. Everyone should know that physicians answered questions based on patient scenarios. The doctors were not answering questions about their actual patients.

Although I am happy that physicians are aware of ovarian cancer there appears to be a need to better educate physicians that screening of asymptomatic women is not recommended by any professional medical organization or government agency . Maybe one of the ovarian cancer organizations ( OCNA or NOCC or even FORCE) might develop some continuing education training for physicians regarding ovarian cancer symptoms, risk factors, the CA-125 test, a review of the studies regarding screening and the different way they should interact with both low risk and high risk women.

(Source: Baldwin LM, et al "Vignette-based study of ovarian cancer screening: Do US physicians report adhering to evidence-based recommendations?" Ann Intern Med. 2012;156:182-194.)

If you would like to read further commentary on this study please see:

Wall Street Journal

http://blogs.wsj.com/health/2012/02/06/many-doctors-dont-follow-ovarian-cancer-screening-guidelines/

Huffington Post

http://www.huffingtonpost.com/2012/02/06/ovarian-cancer-screening-_n_1258156.html

Dee

Every Day is a Blessing