media: Fast-track testing helps to find ovarian cancer early (relates to Dove Report/see comment 'pelvic cancer')

Blogger's Note:

this media report relates directly to the Dove Report published (and commentary) in the Lancet Oncology Jan 17th;

search this blog and/or direct link  to the Lancet: http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2811%2970405-3/fulltext

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" (Dr) Gilbert is also campaigning to change the name of ovarian cancer to "pelvic cancer."
Research over the last decade has shown that most cases of ovarian cancer don't actually begin in the ovaries at all, but in the fallopian tubes. Pre-cancerous cells grow in the tubes and then shed over the surface of the ovaries, where they cause tumours.
By the time the cancer is found in the ovaries, it's already advanced. She says the focus should be on finding the cancer in its earliest stage in the tubes.
"We, for so many years, [kept] looking at the wrong place," she told reporters Thursday.
"Put bluntly, we had the name wrong, the staging wrong, and the diagnostic testing wrong. It is no wonder we have lost so many lives to this disease.""

Assessment of symptomatic women for early diagnosis of ovarian cancer: results from the prospective DOvE pilot project : The Lancet Oncology

"....Seven (78%) of the HGSC in the DOvE group originated outside the ovaries and five were associated with only slightly raised CA-125 concentrations and minimal or no ovarian abnormalities on TVUS."

 

Interpretation

The proportion of HGSC that originated outside the ovaries in this study suggests that early diagnosis programmes should aim to identify low-volume disease rather than early-stage disease, and that diagnostic approaches should be modified accordingly. Although testing symptomatic women may result in earlier diagnosis of invasive ovarian cancer, large-scale implementation of this approach is premature.

Commentary to article Gilbert (Dove Project) - Early detection of ovarian cancer in symptomatic women : The Lancet Oncology

The Lancet Oncology, Early Online Publication, 17 January 2012

doi:10.1016/S1470-2045(11)70405-3

Early detection of ovarian cancer in symptomatic women

JR van Nagell a

"Since Goff and co-workers1 first reported that many women with ovarian cancer have symptoms of abdominal bloating, early satiety, pelvic pain, and urinary urgency, frequency, or both, questions have arisen as to whether assessment of these symptoms could lead to earlier detection of this cancer. The Diagnosing Ovarian Cancer Early (DOvE) pilot project reported in The Lancet Oncology by Gilbert and co-workers2 seeks to answer this question. Clinical examination, measurement of CA-125 concentrations in serum, and transvaginal ultrasonography (TVUS) were used in 1455 women older than 50 years who had symptoms associated with ovarian cancer. 11 ovarian cancers were detected, which yielded a prevalence of one per 132 women (0·76%), or about ten times that observed in screening studies in the USA, UK, and Japan.3—5."

"Whether assessment of symptomatic women with multiple methods will lead to detection at earlier stages or increase survival needs to be tested in larger numbers of cases. That the assessment algorithm used in the DOvE project identified most patients with symptomatic ovarian cancer when their disease was still resectable, however, is encouraging. Optimum cytoreduction is associated with a notable survival advantage in patients with ovarian cancer, and was achieved in eight (73%) of 11 women in the study group versus 33 (44%) of 75 women in a control group of patients with ovarian cancer who had been referred to a local gynaecological oncology clinic (p=0·075). The degree of cytoreduction, however, also depends on factors other than tumour burden, including the location of disease and experience of the surgeon. To continue this project beyond the pilot phase, it will be important to document disease substage and note tumour volume before debulking (in study and control cases) to establish whether assessment-driven interventions affect tumour burden. Although the DOvE algorithm successfully identified 11 cases of ovarian cancer, 1444 (99.2%) symptomatic women did not have ovarian cancer. In the next phase of this study, the positive and negative predictive values of each symptom must be critically assessed to identify the profile of highest risk. Additionally, the duration of symptoms before ovarian cancer detection should be recorded for the study and control populations. In this way, it should be possible to investigate whether a public education campaign alters the time from symptom onset to detection of disease in patients with ovarian cancer."
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Assessment of symptomatic women for early diagnosis of ovarian cancer: results from the prospective DOvE pilot project

Prof Lucy Gilbert MD et al

Ovarian cancer: early detection saves lives | McGill University (Montreal) Health Centre - the Dove Project

For more information about DOVE: http://muhc.ca/royalvic/article/dove-project