Surveillance of women at high risk for hereditary ovarian cancer is inefficient

Abstract

To determine the effectiveness of annual gynaecological screening (pelvic examination, transvaginal ultrasound, and CA-125), a prospective cohort study of women at high risk for hereditary ovarian cancer was conducted. Women were offered DNA analysis followed by either annual screening or prophylactic bilateral salpingo-oophorectomy (BSO). Study population consisted of 512 highrisk women (median follow-up 2.07 years, range 0 -9.4 years): 265 women (52%) had a BRCA mutation. Persisting abnormalities indicated diagnostic surgery in 24 women resulting in one primary ovarian cancer FIGO stage IIIc was found. The effectiveness of screening was studied by calculating the probability of finding ovarian cancers in the BRCA-1 and BRCA-2 carrier group and comparing this to the identified number of ovarian cancers. The number of ovarian cancer patients found at surveillance was in accordance with the predicted number of ovarian cancers. A total number of 169 women underwent prophylactic BSO: one ovarian cancer stage IIb was found. In conclusion, the surveillance programme for hereditary ovarian cancer does identify patients with ovarian cancer but is very inefficient considering the high number of surveillance visits and the advanced stage of ovarian cancer in the identified patient. For prevention of advanced stage ovarian cancer, prophylactic BSO from age 35 -40 years is a more efficient alternative.

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

“…Although efficacy of BPSO has been demonstrated (Rebbeck et al, 2005), the efficacy of gynaecological screening with (bi) annual transvaginal ultrasonography (TVU) and the serum tumour marker CA125 (Karlan et al, 1993;Burke et al, 1997) is still unclear. To summarize the literature on gynaecological screening of BRCA1/2 carriers, including overlap with the present study, eight interval cancers among 24 cancers were diagnosed among a total of 807 BRCA1/2 carriers (Table 1) (Laframboise et al, 2002;Liede et al, 2002;Scheuer et al, 2002;Fries et al, 2004;Kauff et al, 2005;Meeuwissen et al, 2005;Vasen et al, 2005;Gaarenstroom et al, 2006;Oei et al, 2006). Regretfully, most studies did not distinguish between prevalent and incident cases.…”

Metabolic syndrome after risk-reducing salpingo-oophorectomy in women at high risk for hereditary breast ovarian cancer: A controlled observational study

“…The rationale behind ovarian cancer screening studies is that screening could detect ovarian cancer at an earlier stage and that treatment at these stages would result in higher cure rates and improved survival (90 To the current date, no studies have been able to demonstrate a reduction in ovarian cancer mortality by ovarian cancer screening, neither in the general population nor in high-risk subpopulations (92)(93)(94).…”

Familial ovarian screening – effective or ineffective?

“…We would like to comment on the paper (Oei et al, 2006) which we feel is misleading as it over-interprets data from a very small study. The authors describe the discovery of two cases of ovarian cancer during 1029 women years of screening.…”