Advances in Ovarian Cancer Screening

Ovarian cancer is notoriously difficult to diagnose, especially within the early and more treatable stages. More than 70% of women are diagnosed when the cancer has already progressed to advanced stages of ovarian cancer.  This is because the symptoms most often present as more benign conditions, and symptoms rarely ever develop in the early stages. Common symptoms include abdominal bloating, discomfort in the pelvic area, changes in bowel habits, and frequent urination. 

 

In a recent study, a new screening method for epithelial ovarian cancer (EOC), the most common of ovarian cancer, was developed, and is able to detect EOC one to two years earlier than the standard screening process currently implemented by detecting abnormal changes in the level of four biomarker proteins to help diagnose epithelial ovarian cancer. This is a very exciting breakthrough, as most cases of ovarian cancer are diagnosed in later stages when five-year survival rates drop significantly. When caught in stage I, the five-year survival rate of ovarian cancer is 92.4%, but this drops to 29.2% when diagnosed at late stages. 

 


Not only are the symptoms late presenting and misleading, but ovarian cancer itself is a very rare disease: women have a 1.3% risk of developing ovarian cancer by the age of 80.  Compare this with the 13% lifetime risk of the average woman developing breast cancer.

The goal of the recent study published by the British Journal of Cancer was to increase rates of detection at the primary care level, as well as decrease mortality rates by finding screening strategies that will catch epithelial ovarian cancer at earlier, more likely to be treatable, stages. The hope is to use this process to screen women annually.

 

The current screening process for ovarian cancer is rigorous. Women at high risk for ovarian cancer based on family history go through multiple tests annually. One is considered high risk for ovarian cancer if they have two or more blood relatives diagnosed with breast or ovarian cancer, if they have one blood relative with breast or ovarian cancer and one relative of Ashkenazi Jewish origins (as they have higher carrier rate of mutation in BRCA1 or BRCA gene), or if they themselves carry a mutated BRCA1 or BRCA2 gene. These genes are considered breast/ovarian cancer susceptibility genes, and those with mutated BRCA1 or BRCA2 genes are at a much higher risk for developing breast or ovarian cancer. 

 

These women are tested with annual pelvic exams, blood tests for Cancer Antigen-125 (CA-125), and transvaginal ultrasound. The blood testing is done to detect any sudden uptick in CA-125 from their baseline. However, the downside to this screening method is that many other conditions can result in an elevated CA-125 or abnormal pelvic ultrasound.

However, the newly published research outlined that there is still need for more effective screening strategies to not only identify ovarian cancer cases at earlier stages but to also decrease mortality rates, which previous screening strategies have not been successful at. 

The developed screening process is more sensitive to detecting epithelial ovarian cancer because it screens for abnormalities in the amounts of four different independent biomarkers that individually contribute to a higher risk for epithelial ovarian cancer. This means that although someone may have lower dysregulation of CA-125 (one of the four biomarkers), their risk assessment would still take into account three other biomarkers, which may be dysregulated enough to warrant concern and possible diagnosis. 

 

Dr. Rachel Shaw, Research Information Manager at the Cancer Research UK commented, “Around half of ovarian cancer cases are picked up at a late stage, when treatment is less likely to be successful, so developing simple tests like these that could help detect the disease sooner is essential.”

This study is still in its early stages, and more investigation into the process and algorithms developed is needed. It is yet to be studied on larger populations of women, but researchers remain hopeful. 

 

Dr. Bobby Graham, one of the researchers of the study commented that “The results of this study are encouraging, however, we now want to focus on testing it in a wider sample set so that we can use the data to advocate for an ovarian cancer screening program.”

 


El Camino Women’s Medical Group offers the latest Minimally Invasive Solutions for gynecologic problems.   Drs. Amy TengErika Balassiano, and Pooja Gupta, all members of AAGL (American Association of Gynecologic Laparoscopy) are highly trained and experienced in the field of Minimally Invasive Gynecologic Surgery.   Dr. Erika Balassiano has also completed a Minimally Invasive Gynecologic Surgery Fellowship, under the supervision of world-renowned Dr. Camran Nezhat.

 

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