paywalled: Causes of death of mutation carriers in Finnish Lynch syndrome families.

Fam Cancer. 2012 Jun 9. [Epub ahead of print]

Abstract

Lynch syndrome (LS) is an autosomal dominant cancer syndrome including increased life-long risk for colorectal (CRC) and endometrial (EC) cancer, but also for cancers of other types. The risk for CRC is up to 70-80 % and for EC up to 50-60 %. Due to screening and early diagnosing the mortality related to CRC and EC seems to be low. In spite of many studies on surveillance of mutation carriers, there is no comprehensive evaluation on causes of death in LS families. The disease history and cause of death of all the deceased, tested mutation carriers and their mutation negative relatives in the Finnish LS families (N = 179) was examined utilizing hospital records and relevant national registries. Out of 1069 mutation carriers 151 had succumbed; 97 (64 %) from cancer. Out of 1146 mutation-negative family 44 members had died; 11 (25 %) of them from cancer. In 12 (7.7 %) of the deceased mutation carriers no cancer had been diagnosed. The mean age of death from cancer was 63.2 years vs. 68.8 years from non-cancer causes. Only 7.9 % of the patients with CRC had died from CRC and 5 % of those with EC, respectively. 61 % of the cancer deaths were related to extra-colonic, extra-endometrial cancers. The cumulative overall and cancer specific death rates were significantly increased in Mut+ compared to Mut- family members. Even surveillance yields decrease in the life-long risk and mortality of the most common cancers CRC and EC in LS, almost all mutation carriers will contract with cancer, and two thirds of the deceased have died from cancer. This should be taken in account in genetic counseling. Mutation carriers should be encouraged to seek help for abnormal symptoms.

Ovarian cancer patient surveillance after curative-intent initial treatment

full free access: Journal of Oncology — Review Article: Potential Markers for Detection & Monitoring of Ovarian Cancer Feb 8, 2011

  Note:  pdf file


Conclusions and Emerging Trends in Biomarkers for Ovarian Cancer

"The ultimate aim of effective screening techniques is to bring about a reduction in mortality form ovarian cancer. As early detection continues to be vital in ovarian cancer patients, biomarkers may hold the key to unlocking effective screening strategies for the general population. It is also important to identify screening techniques with low false positive rates and high positive predictive value so that the number of negative surgical interventions can be minimized. Since our currently available single markers are not highly sensitive or specific, a combination of markers may be utilized as a profile for risk assessment. The current problem with screening panels is that the improvement in sensitivity usually correlates with a decrease in specificity, making the target positive predictive value hard to obtain. The multimodal screening profiles of the genetic markers could be utilized in the future for risk assessment, early diagnosis, prognosis and response to therapeutic treatment. Recent literature reports state that the screening is only recommended for the high risk population identified as those with a family history of the disease, women with BRCA1 and BRCA2 mutations, or with hereditary non polyposis colorectal cancer. Recent literature reports also emphasize that the different subtypes of ovarian cancer may have different genetic biomarker expression profiles. Current randomized controlled screening trials are directed towards finding the best molecular and genetic markers for the specific histology of the ovarian tumor with the most impact on reduction in morbidity and mortality. The tumor markers identified in these trials may also lead to novel targets for antitumor therapy."

(no abstract) How Surgeon Age Affects Surveillance After Curative-Intent Primary Treatment for Ovarian Carcinoma

How Surgeon Age Affects Surveillance After Curative-Intent Primary Treatment for Ovarian Carcinoma

A.Y. Patel1, F. Gao2, D.G. Mutch2, R.K. Gibb2, K.S. Virgo3, F.E. Johnson1

18.2

No abstract is available. To read the body of this article, please view the Full Text online.

1 Saint Louis University, Saint Louis, MO

2 Washington University, Saint Louis, MO

3 American Cancer Society, Atlanta, GA

PII: S0022-4804(10)01509-X

doi:10.1016/j.jss.2010.11.585

High detection rate of adenomas in familial colorectal cancer - Gut

Conclusion
The yield of colonoscopic surveillance in familial CRC is substantially higher than the yield of screening reported for the general population."

(full free access) Foreword: Today’s discoveries to tomorrow’s care: cancer biomarkers revisited

1) link:  Themed content: Using biomarkers to individualize and monitor cancer therapy - Foreword

2) link: Epigenomics and ovarian carcinoma

Leonel Maldonado, Mohammad Obaidul Hoque

Biomarkers in Medicine, August 2010, Vol. 4, No. 4, Pages 543-570.

(Summary)

 

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Making comparative effectiveness work in cancer care - Cancer Network

Note: discusses cost eg. BRCA's - surgery vs surveillance

SGO White Paper Ovarian Education Campaign [INTRODUCTORY PARAGRAPH-Herzog/Coleman] Project I-Background, Screening & Surveillance

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.

abstract: How to follow-up patients with epithelial ovarian cancer : Current Opinion in Oncology

How to follow-up patients with epithelial ovarian cancer
Miller, Rowan E; Rustin, Gordon JS

Abstract

Purpose of review: Despite optimal primary treatment most patients with advanced epithelial ovarian cancer will relapse. This review discusses the controversy regarding surveillance and the timing of treatment for recurrent disease.

Recent findings: Routine physical examination has a limited role in the detection of recurrent ovarian cancer. PET/computed tomography (CT) has been shown to be useful in detecting small volume disease not apparent on traditional imaging in patients with suspected recurrence based on symptoms and/or rising CA125. The results of PET/CT can alter treatment plans and have particular use in guiding site-directed therapy. The benefits of early detection and systemic treatment of recurrence are now in doubt following the presentation of the MRC/EORTC CA125 surveillance trial. The impact on survival of secondary cytoreductive surgery requires more investigation.

Summary: Uncertainties remain in the surveillance and timing of treatment for relapsed disease. Patients should be informed of these uncertainties and become involved in decisions regarding their follow-up.

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.

Characteristics and prognosis of coexisting adnexa malignancy with endometrial cancer: a single institution review of 51 cases

CONCLUSION:
Our results showed that OS and PFS of synchronous primary ovarian cancer in patients with endometrial cancer is better than those with ovarian metastasis patients. Pre- and intra-operative, intensive and careful assessment, and strict and continuous postoperative surveillance should pay attention to the endometrial cancer patients who preserved ovary for having possibility of coexisting occult ovarian lesions.

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

Background & Aims
Two percent to 4% of all cases of colorectal cancer (CRC) are associated with Lynch syndrome. Dominant clustering of CRC (non-Lynch syndrome) accounts for 1%–3% of the cases. Because carcinogenesis is accelerated in Lynch syndrome, an intensive colonoscopic surveillance program has been recommended since 1995. The aim of the study was to evaluate the effectiveness of this program.

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.

1-2-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.

Patient Surveillance After Ovarian Cancer Treatment Is Variable: Presented at SSO (article)

"New data indicate that there is marked variability in the intensity of patient surveillance after curative-intent treatment for ovarian cancer. The results were released here on March 6 at the 2010 Society of Surgical Oncology Annual Cancer Symposium (SSO)....The authors said that their study is the first to describe the self-reported practice of experienced clinicians who treat ovarian cancer patients.."

abstract: An effect from anticipation also in hereditary nonpolyposis colorectal cancer families without identified mutations.(Lynch Syndrome)

Note: this would apply to the many with no known mutations in the many genetic syndromes (eg. BRCA, Peutz-Jeghers Syndrome...)

"This observation suggests that anticipation may apply also to families without identified mutations and serves as a reminder to initiate surveillance programmes at young age also in HNPCC families with undefined genetic causes."