Note: this journal requires subscription ($$$)
Abstract
Ovarian cancer is a heterogeneous,
rapidly progressive, highly lethal disease of low prevalence. The
etiology remains poorly understood. Numerous risk factors have been
identified, the most prominent involving an inherited predisposition in
10% of cases. Women with germline mutations associated with Hereditary
Breast/Ovarian Cancer and Lynch syndromes have dramatically elevated
risks (up to 46% and 12%, respectively). Risk-reducing
salpingo-oophorectomy is the best method to prevent ovarian cancer in
these high-risk women. Significant risk reduction is also seen in the
general population who use oral contraceptives. Since up to 89% patients
with early-stage disease have symptoms prior to diagnosis, increased
awareness of the medical community may facilitate further workup in
patients who otherwise would have had a delay. Despite enormous effort,
there is no proof that routine screening for ovarian cancer in either
the high-risk or general populations with serum markers, sonograms, or
pelvic examinations decreases mortality. Further evaluation is needed to
determine whether any novel biomarkers, or panels of markers, have
clinical utility in early detection. Prospective clinical trials have to
be designed and completed prior to offering of any of these new
diagnostic tests. CA125 is currently the only biomarker recommended for
monitoring of therapy as well as detection of recurrence. This
commentary provides an overview on the background, screening and
surveillance of ovarian cancer.
