Screening for Ovarian Cancer: A Pilot Randomised Controlled Trial

Jacobs, Ian; Skates, Steven J.; MacDonald, Nicola; Menon, Usha; Rosenthal, Alan D.; Davies, Anthony; Woolas, Robert; Jeyarajah, Arjun; Sibley, Karen; Lowe, David; Oram, David

doi:10.1097/00006254-199911000-00017

Cited by 59 publications

(73 citation statements)

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“…Although MUC16 (CA 125) is the best-known tumor marker for serous cancers [34,49], multiple clinical trials have shown it is a poor biomarker for early detection and screening [50][51][52]. In fact to date, no reliable tumor marker has been identified for screening of this deadly disease.…”

Section: Discussionmentioning

confidence: 99%

Stem‐Like Epithelial Cells Are Concentrated in the Distal End of the Fallopian Tube: A Site for Injury and Serous Cancer Initiation

et al. 2012

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Section: Discussionmentioning

confidence: 99%

Stem‐Like Epithelial Cells Are Concentrated in the Distal End of the Fallopian Tube: A Site for Injury and Serous Cancer Initiation

et al. 2012

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“…With these limitations in mind, the SIRs suggest that the lead-time is very limited in the total and compliant group. In evaluating efficacy of screening, several factors hamper the comparison among various studies, (1) compliance to the intended screening procedure has not been examined in combination with efficacy, (2) generally, no distinction is made between prevalent and incident screen-detected cases, (3) the screening protocol may differ, such as the frequency of screening, the cutoff level of CA125 (15 -35 U ml À1 ) (Bourne et al, 1994;Jacobs et al, 1999;Kauff et al, 2005;Meeuwissen et al, 2005;Olivier et al, 2006), and the combined or sequential order of applying the screening tools (Jacobs et al, 1999;Scheuer et al, 2002;Meeuwissen et al, 2005;Stirling et al, 2005;Olivier et al, 2006), and (4) quality measures of screening tools, like sensitivity, are typically reported including occult tumours, while the proportion of women opting for a BP(S)O differs strongly across various countries (Wainburg and Husted, 2004). Consequently, the proportion of interval cancers detected during screening varies among studies from 5/7 ¼ 71% in the study by Liede et al (2002), 1/3 ¼ 33% in the study by Scheuer et al (2002) and 1/6 ¼ 17% in the study by Vasen et al (2005) ( Table 1).…”

Section: Discussionmentioning

confidence: 99%

No efficacy of annual gynaecological screening in BRCA1/2 mutation carriers; an observational follow-up study

et al. 2007

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BRCA1/2 mutation carriers are offered gynaecological screening with the intention to reduce mortality by detecting ovarian cancer at an early stage. We examined compliance and efficacy of gynaecological screening in BRCA1/2 mutation carriers. In this multicentre, observational, follow-up study we examined medical record data of a consecutive series of 888 BRCA1/2 mutation carriers who started annual screening with transvaginal ultrasonography and serum CA125 between 1993 and 2005. The women were annually screened for 75% of their total period of follow-up. Compliance decreased with longer follow-up. Five of the 10 incident cancers were interval tumours, diagnosed in women with a normal screening result within 3–10 months before diagnosis. No difference in stage distribution between incident screen-detected and interval tumours was found. Eight of the 10 incident cancers were stage III/IV (80%). Cancers diagnosed in unscreened family members had a similar stage distribution (77% in stage III/IV). The observed number of cases detected during screening was not significantly higher than expected (Standardized Incidence Ratio (SIR): 1.5, 95% confidence interval: 0.7–2.8). For the subgroup that was fully compliant to annual screening, a similar SIR was found (1.6, 95% confidence interval: 0.5–3.6). Despite annual gynaecological screening, a high proportion of ovarian cancers in BRCA1/2 carriers are interval cancers and the large majority of all cancers are diagnosed in advanced stages. Therefore, it is unlikely that annual screening will reduce mortality from ovarian cancer in BRCA1/2 mutation carriers.

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“…In recent randomized controlled trials, screening strategies incorporating cancer antigen 125 (CA 125) and transvaginal ultrasound imaging of the ovaries have demonstrated high specificities and acceptable positive predictive values (PPVs) but produced no measurable improvement in ovarian cancer-related mortality. 2,3 Two large trials recently reported the results from initial rounds of postmenopausal screening, but follow-up to assess the impact of screening on mortality will not be complete until 2014. 4 Another factor that potentially may have an impact on the utility of ovarian cancer screening is disease heterogeneity.…”

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confidence: 99%

Development of an ovarian cancer screening decision model that incorporates disease heterogeneity

Havrilesky

Sanders

Kulasingam

et al. 2010

Cancer

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BACKGROUND: Pathologic and genetic data suggest that epithelial ovarian cancer may consist of indolent and aggressive phenotypes. The objective of the current study was to estimate the impact of a 2-phenotype paradigm of epithelial ovarian cancer on the mortality reduction achievable using available screening technologies. METHODS:The authors modified a Markov model of ovarian cancer natural history (the 1-phenotype model) to incorporate aggressive and indolent phenotypes (the 2-phenotype model) based on histopathologic criteria. Stage distribution, incidence, and mortality were calibrated to data from the Surveillance, Epidemiology, and End Results Program of the US National Cancer Institute. For validation, a Monte Carlo microsimulation (1000,000 events) of the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) multimodality prevalence screen was performed. Mortality reduction and positive predictive value (PPV) were estimated for annual screening. RESULTS: In validation against UKCTOCS data, the model-predicted percentage of screen-detected cancers diagnosed at stage I and II was 41% compared with 47% (UKCTOCS data), and the model-predicted PPV of screening was 27% compared with 35% (UKCTOCS data). The model-estimated PPV of a strategy of annual population-based screening in the United States at ages 50 to 85 years was 14%. The mortality reduction using annual postmenopausal screening was 14.7% (1-phenotype model) and 10.9% (2-phenotype model). Mortality reduction was lower with the 2-phenotype model than with the 1-phenotype model regardless of screening frequency or test sensitivity; 68% of cancer deaths are accounted for by the aggressive phenotype. CONCLUSIONS: The current analysis suggested that reductions in ovarian cancer mortality using available screening technologies on an annual basis are likely to be modest. A model that incorporated 2 clinical phenotypes of ovarian carcinoma into its natural history predicted an even smaller potential reduction in mortality because of the more frequent diagnosis of indolent cancers at early stages. Cancer 2011;117:545-53.

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Screening for Ovarian Cancer: A Pilot Randomised Controlled Trial

Cited by 59 publications

References 0 publications

Stem‐Like Epithelial Cells Are Concentrated in the Distal End of the Fallopian Tube: A Site for Injury and Serous Cancer Initiation

Stem‐Like Epithelial Cells Are Concentrated in the Distal End of the Fallopian Tube: A Site for Injury and Serous Cancer Initiation

No efficacy of annual gynaecological screening in BRCA1/2 mutation carriers; an observational follow-up study

Development of an ovarian cancer screening decision model that incorporates disease heterogeneity

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