Access : Awareness of ovarian cancer risk factors, beliefs and attitudes towards screening -baseline survey of 21,715 women participating in the UK Collaborative Trial of Ovarian Cancer Screening : British Journal of Cancer

Note: this study shows awareness levels in women who were wishing to enroll in a clinical trial program as opposed to the numerous surveys which have been done in the general population eg. the results would differ

Background:
Women's awareness of ovarian cancer (OC) risks, their attitudes towards and beliefs about screening, together with misunderstandings or gaps in knowledge, may influence screening uptake.

Methods:
In total, 21 715 post-menopausal women completed questionnaires before randomisation into the UK Collaborative Trial of Ovarian Cancer Screening.

Editorial: The Elusive Goal of Maintaining Population (Breast) Cancer Screening: It Is Time for a New Paradigm JNCI

"The promise of breast cancer screening has fallen short of its goals because of its imprecision, failure to screen those at highest risk, lack of compliance with screening continuance over recommended periods of time, and gaps in access to or quality of diagnostic follow-up and treatment (20). It is no longer enough to simply conduct more interventions to understand which work best in motivating individuals to undergo repeat cancer screening. New paradigms, guided by evidence from modeling, novel trials, and new scientific discovery, will be needed to realize the promise of eliminating the burden of cancer."

One to 2-Year Surveillance Intervals Reduce Risk of Colorectal Cancer in Families With Lynch Syndrome

Conclusions

With surveillance intervals of 1–2 years, members of families with Lynch syndrome have a lower risk of developing CRC than with surveillance intervals of 2–3 years. Because of the low risk of CRC in non-Lynch syndrome families, a less intensive surveillance protocol can be recommended.

NGC - Compare - NATIONAL GUIDELINE CLEARINGHOUSE™ (NGC) GUIDELINE SYNTHESIS SCREENING FOR OVARIAN CANCER

"This synthesis was prepared by ECRI Institute on October 2, 2007. It was reviewed by SIGN on October 10, 2007, UMHS on October 25, 2007, and ACR on November 2, 2007. The synthesis was updated in April 2010 to remove UMHS and USPSTF recommendations and to update ACR recommendations. The information was verified by ACR on June 2, 2010."

full free access: - Women's Health - Ovarian cancer biomarker screening: still too early to tell

"In 2004, the US Preventive Services Task Force (amongst other countries/guidelines) recommended against routine ovarian cancer screening [102]. None of the more recent findings overide this guideline. We must await the results of the two large-scale trials. Whether the results are positive or not, these trials will yield vital data to guide the next steps in biomarker research and subsequent guidelines for practice."

Abstract/full free access: Adherence to cancer screening guidelines across Canadian provinces: an observational study

Note:

1) study period - "We calculated age-cancer-specific screening rates for ages 40-60 using the Canadian Community Health Survey (2003 and 2005), a cross-sectional, nationally representative survey of health status, health care utilization and health determinants in the Canadian population."
2) includes: breast, mammography, PSA

Point: Justification for Lynch Syndrome Screening Among All Patients With Newly Diagnosed Colorectal Cancer — J Natl Compr Canc Network

Society of Gynecologic Oncologists Statement on Use of CA125 in Screening for Ovarian Cancer

press release:
June, 2010
Society of Gynecologic Oncologists Statement on Use of CA125 in Screening for Ovarian Cancer

Results of a multicenter screening trial using calculated algorithms based on age and trends in CA125 levels over time in women without familial risk of developing ovarian cancer have recently been reported at the annual meeting of the American Society of Clinical Oncology. Transvaginal ultrasound (TVUS) was not performed automatically but as indicated by the CA125 algorithm results. This study provides early evidence that incorporating a CA125 algorithm followed by TVUS may be a feasible strategy for screening low-risk women over 50 years of age. The results of this study have been featured in various professional and consumer media outlets, causing physicians and patients to seek guidance regarding the implications.

The Society of Gynecologic Oncologists commends the investigators of this study for contributing valuable data, and eagerly awaits the results of additional larger randomized controlled trials to confirm the usefulness of Risk of Ovarian Cancer Algorithm (ROCA) in screening women without familial risk of ovarian cancer. The positive predictive value noted in the study of 37.5% is superior to what has been reported from prior studies. However, as a screening strategy, that eventually could be applied to the general population, this figure is modest. There remains insufficient evidence to support routine CA125 +/- TVUS screening in low-risk women who are not part of a clinical trial. An additional limitation of this study was the lack of a control, observation-only arm, without which it is difficult to attribute any real benefit to the screening strategy. As with any prospective screening tool or treatment option, the impact of false positive and false negative screening results must be considered and balanced against the potential benefits of true positive and negative results. Finally, while the number of participants who needed more frequent CA125 monitoring, ultrasound, or referral to a specialist appeared small, a complete cost effectiveness analysis of this approach would be critical before adopting any universal screening program.

As specialists in women’s cancer care, gynecologic oncologists offer patients individualized treatment plans. Patients and their physicians are encouraged to discuss the pros and cons of CA125 and TVUS screening and the implications for subsequent treatment and quality of life.

abstract: A prospective U.S. ovarian cancer screening study using the risk of ovarian cancer algorithm (ROCA)

ASCO (Post-Meeting Edition)
Abstract
5003
Background: There are currently no effective screening tools for the early detection of ovarian cancer in women at average population risk. We evaluated a screening strategy that incorporates change of CA-125 over time and age of the participant to estimate risk of ovarian cancer, referring a small fraction (2%) of apparently healthy individuals annually to transvaginal sonography (TVS).
Methods: A single arm, prospective, multicenter screening study enrolled postmenopausal women age 50 to 74 with no significant family history of breast or ovarian cancer. Participants underwent a CA-125 blood test annually. Based on the Risk of Ovarian Cancer Algorithm (ROCA) result, women were triaged to the next annual CA-125 (low risk), repeat CA-125 in 3 months (intermediate risk), or TVS and referral to a gynecologic oncologist (high risk). Based on clinical findings and TVS, the gyn onc made the decision whether to proceed with surgery.
Results: 3238 women participated over an eight year period. The average annual rate of referral to 3 monthly CA125 was 6.8%, and the average annual rate of TVS and gyn onc referral was 0.9%. Cumulatively 85 women (2.6%) received TVS and referral to a gyn onc. Eight women subsequently underwent surgery based on the TVS and referral, with 3 invasive ovarian cancers, 2 borderline ovarian tumors and 3 benign ovarian tumors, providing a positive predictive value of 37.5% (95% CI 8.5%,75.5%).The combined specificity of ROCA followed by TVS for referral to surgery is 99.7% (95% CI 99.5%, 99.9%). The 3 invasive ovarian cancers were high-grade epithelial tumors that were all early stage (two stage 1C and stage IIB). All 3 women with invasive ovarian cancer had at least 3 years with low risk, annual CA-125 values prior to a rising CA-125.
Conclusions: In this prospective, single arm study, the ROCA followed by TVS demonstrated excellent specificity and PPV in a population of U.S. women at average risk for ovarian cancer. As expected, less than 1% of participants annually required a TVS. In addition, the invasive high-grade ovarian cancers that were detected were early stage. This study provides early evidence that ROCA followed by TVS is a feasible strategy for screening women over 50 years of age.

2010 Institute for Continuing Healthcare Education - Ovarian Cancer Screening and Management to Improve Patient Survival

OVERVIEW

Ovarian cancer is the leading cause of death from gynecologic malignancy and the fifth leading cause of cancer‐related death among women in the United States. The high mortality rate associated with ovarian cancer is due in part to the lack of effective screening strategies to detect the disease in early stages (I or II) when the cancer is confined to the ovary. Since symptoms associated with ovarian cancer are typically nonspecific, a clinical diagnosis is difficult to make until the disease has advanced. The Institute for Continuing Healthcare Education has identified a number of areas related to the screening, diagnosis, and treatment of ovarian cancer where education is vital in order to address the need for improvement in professional care.

PROGRAM DESCRIPTION

In this Webcast, the faculty members will present up-to-date, relevant information on screening guidelines, referral procedures, and therapies for ovarian cancer. As a learning reinforcement, individuals who complete this activity will be able to request a certified monograph with two case studies pertaining to the treatment strategies discussed within the Webcast.

INSTRUCTIONS FOR OBTAINING CME/CE CREDIT

There are no fees or prerequisites for participating in and receiving CME/CE credit for this online educational activity.

3rd article: CA-125 a screening tool for early detection of ovarian cancer | Biomarker News

2nd article: The Science and Technology Blog CA-125 change over time shows promise as screening tool for early detection of ovarian cancer

New early screening for ovarian cancer 'promising': study

WASHINGTON — A new screening approach to detect early stage ovarian cancer in post-menopausal women has proven promising, researchers said of results to a study released Thursday.

"More than 70 percent of ovarian cancers are diagnosed when they have already grown to an advanced stage, so identifying a reliable screening test for early-stage disease would be like finding the Holy Grail," said the study's lead author Karen Lu, of the University of Texas' Anderson Cancer Center.

"This study is one step forward in that direction. If confirmed in larger studies, this approach could be a useful and relatively inexpensive tool for detecting ovarian cancer in its early, more curable stages," she said.

The results were presented by the American Society of Clinical Oncology (ASCO) ahead of its annual conference, to be held June 4-8 in Chicago.

The new method uses a mathematical model to assess trends in CA-125 blood test results -- a protein known to rise during the cancer's development -- and a patient's age. The model is then "followed by transvaginal ultrasound and referral to a gynecologic oncologist, if necessary," researchers said.

For up to eight years, the study followed 3,238 post-menopausal women aged 50 to 74 who had no significant family history of breast or ovarian cancer, and the accuracy of using the mathematical model followed by ultrasound was 99.7 percent, indicating few false-positives using the approach, researchers said.

A larger study involving more than 200,000 women is currently underway in Britain, with results expected by 2015.

Gastroenterology and Endoscopy News - Inherited Colon and Rectal Cancer

"In Part 1 of this four-part series, we examine the clinical pathology and molecular biology of (Lynch Syndrome) hereditary nonpolyposis colorectal cancer (HNPCC). In Part 2, we will discuss screening and treatment, and the roles of the epidemiologist, the diagnostician and the surgeon."

An estimated 150,000 Americans may be carriers of the (Lynch Syndrome) HNPCC mutation(s) and have a 90% lifetime risk for developing some type of cancer. (MSH2/MSH6/MLH1/PMS2)

Editorial: A Step Forward for Two-Step Screening for Ovarian Cancer - Journal of Clinical Oncology

A Step Forward for Two-Step Screening for Ovarian Cancer
  Martee L. Hensley, Department of Medicine, Gynecologic Medical Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY

See accompanying article doi: 10.1200/JCO.19.2484

Breast Cancer Screening: How to Guide Black, White, and Asian Patients: Case Scenarios

• Case Scenarios 

• Background
• US Disparities in Breast Cancer: Statistics
• What Explains the Disparity in Breast Cancer Rates and Risks Between Black and White Women in the United States?
• Strategies to Minimize Disparities and Improve Care
• Summary
• Case Response

Three New Technologies for Beating Breast Cancer - Women's Health Online

* Intensity Modulated Radiation Therapy (IMRT)
* DyNeMo (analyzes networks of proteins in cancer cells)
* Automated Breast Volume Scanner (ABVS)

Reduced levels of hydroxylated, polyunsaturated ultra long-chain fatty acids in the serum of colorectal cancer patients: implications for early screening and detection

"There are currently no accurate serum markers for detecting early risk of colorectal cancer (CRC)."

Blog: What Reporters Missed at the NIH Colon CA Screening State-of-the-Science Conference By: Gary Schwitzer

(includes commentaries)
"....And it's difficult to understand why this didn't get news coverage. It sure sounded newsworthy to me."

CCAC_Research January 15, 2010 Section 10. ColoMarker

Note/Warning: very graphic images included in this newsletter

Section 10: ColoMarker Tests for Colon Cancer (Dec. 17/09)