Background
We evaluated a two stage ovarian cancer screening strategy that incorporates change of CA 125 over time and age to estimate risk of ovarian cancer. Women with high risk scores were referred for transvaginal ultrasound (TVS).
Methods
A single-arm, prospective study of post-menopausal women was conducted. Participants underwent an annual CA 125 blood test. Based on the Risk of Ovarian Cancer Algorithm (ROCA) result, women were triaged to next annual CA 125 (low risk), repeat CA 125 in three months (intermediate risk), or TVS and referral to a gynecologic oncologist (high risk).
Results
4051 women participated over 11 years. The average annual rate of referral to a CA125 in three months was 5.8%, and the average annual referral rate to TVS and review by a gynecologic oncologist was 0.9%. Ten women underwent surgery based on TVS, with four invasive ovarian cancers (one Stage 1A, two Stage 1C and one Stage IIB), two ovarian tumors of low malignant potential (both Stage 1A), one endometrial cancer (Stage 1), and three benign ovarian tumors, providing a positive predictive value of 40% (95% CI 12.2%, 73.8%) for detecting invasive ovarian cancer. The specificity was 99.9% (95% CI 99.7%, 100%). All four women with invasive ovarian cancer were enrolled in the study for at least three years with low risk, annual CA 125 values prior to a rising CA 125.
Conclusions
ROCA followed by TVS demonstrated excellent specificity and PPV in a population of U.S. women at average risk for ovarian cancer.
Today, more than ever before, millions of people are seeking an approach to medicine and health care that is more comprehensive, more holistic and integrative, and more compassionate and sensitive to their needs as a whole person. This is particularly true for those dealing with cancer. Changing patient demographics, heightened consumer demand for complementary and alternative medicine (CAM) products and services, advances in medical science and technology, expanding access to the Internet and health information, and other factors have contributed to a wave of transformation that is unprecedented in its impact on the entire health care system. These trends have fueled the emerging fields of integrative medicine and oncology, which are growing rapidly. As these fields continue to evolve, they will move beyond the present integrative model to a broader vision of whole-person, multidimensional care that will more fully and coherently address and embrace all dimensions of the human experience. This article describes 6 major driving forces behind the wave of transformation presently under way in medicine and health care. It provides a brief, historical overview of integrative medicine and oncology and summarizes the present status of these emerging fields. It discusses the future of integrative medicine and oncology, including a multidimensional approach to care, and highlights 5 key elements that underlie this approach. Finally, it describes The Seven Levels of Healing-a model of multidimensional care-and concludes with a discussion of 3 important challenges and opportunities for medicine and health care that lie on the horizon.
Optimal cancer care balances the need for scientific knowledge, statistical analysis, and rational thought with the need for wisdom, kindness, compassion, and love. Finding and maintaining this balance is one of the most important challenges inherent in creating optimal healing environments (OHEs) for cancer care. This new medical paradigm, which promotes awareness, healing, and transformation at the deepest levels of the body, mind, heart, and spirit for patients and their families, must make an equal commitment to developing the health, well-being, awareness, and communication skills of medical and other staff members. This paper articulates the insights, challenges and lessons gleaned from the author's experience in creating and directing an OHE with a scientifically based, sensitive, and compassionate approach to healing for patients with cancer and their loved ones.
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