High-risk women may need more frequent ovarian cancer screening

Cancer Research UK

Screening women at high risk of ovarian cancer once a year may not be effective enough to spot the disease in its earlier stages, and more frequent screening may be needed for this group of women, according to new research published in the Journal of Clinical Oncology.

The UK Familial Ovarian Cancer Screening Study (UKFOCSS) looked at the results of annual screening in over 3,500 women aged 35+ between 2002 and 2008. During this period, 26 women developed ovarian or fallopian tube cancers.

The research, funded by Cancer Research UK and The Eve Appeal, aimed to see how good a yearly screening programme (involving ultrasound and blood tests) would be at picking up ovarian and fallopian tube cancers in women who were thought to be at high risk of the disease*.

The study found that annual ovarian screening did pick up the majority of cancers, but by the time cancers had been diagnosed, most of them had already started to spread. Women who had been screened within the previous year were less likely to be diagnosed with the most advanced stages of ovarian cancer, compared to women who had not been screened for over a year.  But screening did not increase the proportion of women diagnosed with stage I cancers, leaving the question of whether even more frequent screening would be necessary to increase the number of cancers detected earlier.

The authors from UCL’s Institute for Women’s Health suggest that screening high-risk women more frequently, coupled with swift surgery where necessary, might improve the chances of finding these cancers at an earlier stage. They are now assessing the results of the second phase of the study, which will show the impact of screening high-risk women every four months, and the findings are to be presented next year.

Dr Adam Rosenthal, senior lecturer and consultant gynaecological oncologist at Barts Cancer Institute and lead author of the study, said: “These results support a possible role for screening women at high risk of ovarian cancer, but only if they have decided not to have surgery to remove their ovaries and fallopian tubes.

“The study shows that screening is picking up most cases of ovarian cancer before they reach the most advanced stages. But, by the time they are detected, the majority have still spread and the outlook for these patients is likely to be poorer than for women whose cancers have not spread. At this time, annual screening cannot be considered to be such a safe bet as risk-reducing surgery and it’s important that high-risk women know the options and outlooks available to them.”

Professor Ian Jacobs, principal investigator of UKFOCSS said “I am delighted that the results of this first phase are now published and that the findings are encouraging. We await further information from this trial and from the large study of screening in women without a family history, the UK Collaborative trial of Ovarian Cancer Screening, UKCTOCS, to establish whether or not screening with a blood test or ultrasound saves lives.”

Jessica Harris, health information manager at Cancer Research UK, said: “Until we have the results from two other key studies into ovarian cancer screening, it’s too soon to know whether any type of screening could be effective for high-risk women. So women with a strong family history of ovarian or other cancers should talk to their doctors about the options and whether they could be referred for genetic testing.

“Cancer Research UK has been at the heart of research that has helped make women diagnosed with ovarian cancer now twice as likely to survive compared to back in the 1970s. When ovarian cancer is diagnosed at an early stage, treatment is more likely to be successful and many more women survive. So if you experience tummy pain, bloating or a lasting sense of feeling full that won’t go away, then you should visit your doctor.”

Robert Marsh, CEO of The Eve Appeal, said: “It’s encouraging to receive meaningful and helpful information for high-risk women from the first phase of this trial. While we await the results of phase II of this, and the larger UKCTOCS trial for women without a history of ovarian cancer, our message to all women is to be aware of the signs and symptoms of ovarian cancer and to visit your GP if you have any concerns at all.”

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References

Rosenthal, A., Fraser, L., Manchanda, R., Badman, P., Philpott, S., Mozersky, J., Hadwin, R., Cafferty, F., Benjamin, E., Singh, N., Evans, D., Eccles, D., Skates, S., Mackay, J., Menon, U., & Jacobs, I. (2012). Results of Annual Screening in Phase I of the United Kingdom Familial Ovarian Cancer Screening Study Highlight the Need for Strict Adherence to Screening Schedule Journal of Clinical Oncology DOI: 10.1200/JCO.2011.39.7638

Notes to Editor

*The authors defined high-risk women as those with a strong family history of cancer or with a genetic alteration known to increase the risk of getting ovarian or fallopian tube cancers.