Are We Closer to Screening Average-Risk Women for Ovarian Cancer?

By Andrea Peirce,

Gynecologic oncologist Douglas Levine in his lab .
Summary

Signs of ovarian cancer at an early stage in women with no risk factors for it are usually vague and can be easy to miss. Because the disease is often aggressive and deadly once it takes hold, researchers around the world are looking for practical ways to screen the general population. Memorial Sloan Kettering gynecologic oncologist Douglas Levine discusses the slow but steady advances being made in understanding how we can screen for and prevent deaths from this cancer.

Highlights
  • Researchers at MSK and elsewhere are making headway in developing strategies for screening women at average risk for ovarian cancer.
  • Ovarian cancer is rare but often fatal, in part because symptoms are vague and it’s challenging to find early, when it’s easier to cure.
  • Results of a major British study in December signaled potential for a multipronged screening approach that tracks CA-125 protein changes in the blood over time.
  • The study confirmed that ultrasound imaging of the ovaries isn’t effective in screening women at average risk.

A worldwide effort is under way to find new methods to screen women with no known risk factors for ovarian cancer.

The disease is often aggressive and progresses quickly; only 40 percent of women who have it survive more than five years. Yet the diagnosis often takes women by surprise, as the cancer causes few if any symptoms when first developing. (Though screening guidelines already exist for women at increased risk for the disease due to a family history of the illness.)

Early diagnosis is essential, as surgery and other currently available treatments are more effective when ovarian cancer is identified at an early stage, before it has spread beyond the pelvis. When the disease is caught early, Memorial Sloan Kettering’s specialized ovarian cancer surgery team can remove all cancerous tissue relatively easily, often saving a woman’s life and, in some cases, eliminating the need for chemotherapy or other treatments.

Through Research, Hope for Effective Screening Options

Biomarkers: Proteins or other elements in the body that can be measured as an indication of disease.

With the discovery several years ago that most cases of ovarian cancer originate at the end of the fallopian tubes, investigators are zeroing in on new biomarkers — indicators that disease is present — and also learning more about known biomarkers secreted in high concentrations near this part of the body. Other studies are determining if biomarkers can be found in the bloodstream. 

At MSK, researchers are exploring the value of “washing” the uterus with fluid and analyzing the fluid for biomarkers. This test is currently in a technology development phase (not in clinical trials), as researchers collect more samples from patients. Dr. Levine foresees its use one day in an office setting.

Nanotechnology: Science conducted on an atomic or molecular scale.

Another promising avenue of investigation utilizes nanotechnology to detect tiny bits of tumor proteins that may indicate ovarian cancer. Researchers are developing approaches to make this tactic reliably sensitive enough to spot ominous changes in both the bloodstream and fluid from uterine washings.

“Surgery to remove the ovaries and fallopian tubes has proven to be a lifesaver for women at high risk,” Dr. Levine adds. Researchers at MSK and elsewhere are planning studies to explore the removal of the fallopian tubes in average-risk women who’ve completed childbearing and are having pelvic surgery for unrelated reasons to see if there’s a protective effect.

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Major British Study Also Advances Possible Solution 

Late last year, findings from a major 14-year study in the United Kingdom — the largest randomized screening trial ever done for ovarian cancer — indicated potential for a multipronged screening approach in women past menopause.

The eagerly awaited United Kingdom Collaborative Trial of Ovarian Cancer Screening study, published in The Lancet, shows that measuring changes in the levels of CA-125 protein in women’s blood over the course of time, then using ultrasound screening for follow-up if problems are spotted, may one day lead to an approach that can save women’s lives.

Researchers followed the course of 202,638 women age 50 to 74 assigned to either this multimodal approach, no screening test at all, or an annual ultrasound scan of the ovaries.  

The study was promising in showing that if you do screening in the general population over a long enough period of time, you can detect ovarian cancer at an early stage.
Douglas A. Levine
Douglas A. Levine gynecologic oncologist

 

“The study was promising in showing that if you do screening in the general population over a long enough period of time, you can detect ovarian cancer at an early stage. But they had to screen more than 600 women for 14 years to find one case of ovarian cancer,” Dr. Levine explains, noting the substantial cost and effort required to catch just a handful of occurrences for a relatively rare disease. “With the screening methods available today, we’d miss almost half of all cases.”

Three more years of the study remain; time will tell whether this multipronged approach makes sense. Given that the approach used in the study is proprietary and not yet available in the US, Dr. Levine notes “it’s yet to be seen how the test would be practical to use here.”

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Ineffective: Screening Average-Risk Women with Ultrasound

The British study also confirms that transvaginal ultrasound technology isn’t effective for screening women at average risk for the disease, Dr. Levine notes — an insight MSK and other institutions have held for years already.

“As the first step in screening, it’s not the way to go, though we still do see average-risk women who’ve had screening ultrasounds performed elsewhere,” he says.

Meanwhile, the findings don’t in any way change MSK screening guidelines that women at average risk receive an annual gynecologic examination (with a pelvic examination) as part of a preventive healthcare plan.

 “There’s still no definitive way to screen women at average risk,” says Dr. Levine, “but progress is being made at MSK and other institutions.”

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Comments

I was diagnosed with stage 1c ovarian cancer at 58 years old in 2011. I am still cancer free 4 1/2 years later. I had the gene mutation test and it was negative. My question is, I have an identical twin sister. Is her risk greater because of my diagnosis. And is my 29 year old daughter considered high risk?

Janet, we sent your question to Dr. Levine, who replied, "This would depend on a full family history and the type of ovarian cancer that you had. We would recommend that you see a genetic counselor to discuss further or talk to the person who ordered the mutation testing in the first place.“ If you're in the New York area and would like to make an appointment with one of the genetic counselors at MSK, you can call 646-888-4050 or go to https://www.mskcc.org/cancer-care/risk-assessment-screening/hereditary-… for more information on our services. Thank you for your comment.

I was treated at MSKCC for ovarian and breast cancer in 1996 and have been cancer free since treatment. I am a carrier of the BRCA1 mutation. Is it still necessary to have the CA125 blood test each year?

Hi, Sue. We're so glad to hear you're cancer free. You should discuss what kind of follow-up care is needed with your healthcare team. Thank you for your comment.

Excellent! Informative. Extremely important for women to get pap smears annually!

I would like an appointment for screening for ovarian cancer.

Dear Patricia, if you're interested in making an appointment at MSK, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. You could also speak with your regular gynecologist about this screening. Thank you for your comment, and best wishes to you.

Gm my question is my mom and my little sister died from ovarian cancer I get checked every 6 mths but I been having alot of abnormal pain and also wt about my sisters are they at risk

Dear Celeste, we're very sorry for the loss of your mother and your sister. Because of your family history, you may wish to speak with a genetic counselor about your cancer risk. If you'd like to make an appointment with a genetic counselor at MSK, you can go to https://www.mskcc.org/cancer-care/risk-assessment-screening/hereditary-… for more information. We also recommend that you speak with your gynecologist about the pain that you're having. Thank you for your comment, and best wishes to you.

thank you for the information...i was diagnosed with stage 3 ovarian in jan 2016..had surgery and an optimal debulking. finished chemo in july2016. all my scans thus far have shown no signs of the disease. i had the genetic testing and it came back negative. my question is my 23yrold daughter...when should she be screened?she has a vagunal ultrasound and pap yearly. anything else that needs to be done ? thank you

Dear Yvette, if your BRCA test was negative, then your daughter could not have inherited that mutation from you. However, if you have a strong family history of cancer, it's possible there may be other factors that did not show up in the genetic test that you had. If you're interested in learning more, you may want to speak to a genetic counselor. If you're in the NYC area and would like to make an appointment with MSK's Clinical Genetics Service, you can call 646-888-4050 or go to https://www.mskcc.org/cancer-care/risk-assessment-screening/hereditary-… for more information. Thank you for your comment, and best wishes to you and your family.

My BREAST test was negative ( twice)
Still, can I get Ovarian Cancer?

Dear Carmenza, only a small percentage of ovarian cancers are caused by BRCA mutations (the mutations linked to breast and ovarian cancers, as well as others). So even if you don't have these gene mutations, it's still possible to develop ovarian cancer. However, ovarian cancer is rare, with a lifetime risk of about 2%. If you have any symptoms of ovarian cancer, you should discuss these with your gynecologist. You can learn more about the symptoms here: https://www.mskcc.org/cancer-care/types/ovarian/symptoms

Thank you for your comment, and best wishes to you.

Are yearly CA-125 blood tests effective for finding early stage Ovarian cancer? This article indicates yes it is. Am I correct?

Dear Peg, there are benefits and drawbacks to CA-125 testing. It is not recommended for everyone, and when it is used for those who are at highest risk of developing ovarian cancer, it is used in combination with other tests. Thank you for your comment.

I was diagnosed with BC in 2015, HER2+, ER/PR -. My screening came back that I am VUS. It was recommended that I have my ovaries removed to be safe. I had abdominal hysterectomy in 2012. I wanted to keep my ovaries and still do. Why, if it is unknown, should I have them removed? I thought that keeping ovaries gave a woman a better chance against osteoporosis, better overall health as we age (I'm 57), and reasons still unknown. I have no history whatsoever in my family of ovarian cancer. I don't know what to do.

Dear Anita, we're so sorry to hear that you're going through this. Unfortunately, we are not able to offer medical advice on our blog. If you would like to consult with an expert at MSK, we recommend that you call our Clinical Genetics Service at 646-888-4050. You can go to https://www.mskcc.org/cancer-care/risk-assessment-screening/hereditary-… for more information. If you are not in the New York area and/or not able to come to MSK, you may want to ask your doctor for a referral to a clinical geneticist who has an expertise in dealing with cancer. Thank you for your comment, and best wishes to you.

My best friend passed from OvCa in Jan 2017 (Dr Hyman and team at MSKCC were wonderful). My question is: she was positive for BRCA. She has no sisters...only a brother...who has a daughter and a son. Should his daughter be screened for BRCA mutation?

Dear Conley, we are very sorry for your loss. BRCA mutations can be carried by both men and women, and they are associated with an increase in cancer risk in cancers that can affect both genders, as well as increase in the risk of prostate cancer. If your friend's brother and his children would like to be tested, we recommend they contact a clinical geneticist who has experience working with cancer patients. If they are in the New York City area, they can contact our Clinical Genetics Service at 646-888-4050 or go to https://www.mskcc.org/cancer-care/risk-assessment-screening/hereditary-… for more information. Thank you for your comment, and best wishes to you.

Been spotting since 2015. Now a clear white discharge mixed with blood. Had 2 D&Cs in 2015 but could not dilate me! Could not get to my endometrium to get a sample. Would you e-mail me Dr. Levine number to his office. Or someone in your Middleton office.I did not start to spot until after first D&C. Then worse after 2nd one.

I am extremely glad to hear that better diagnostic tools are under study. An ultrasound test showing a solid mass in my left ovary led to my having a total abdominal hysterectomy with bilateral salpingo-oophorectomy. As it turns out, I only had a serimucinous borderline tumor, and the tissues of rest of my reproductive organs were entirely healthy. I very much regret entering surgical menopause, and I hope other women in the future can be spared this comprehensive surgery, because of your good work!

Hello, I have a history of breast cancer (maternal & paternal grandmothers) My maternal grandmothers sister had either ovarian or cervical cancer & my paternal aunt had either ovarian or cervical cancer. Does this put me & my sisters into a higher cancer bracket? Also, I get a yearly breast exam, mammogram, Pap smear, hpv test & internal sonogram. If the internal sonogram is not a good monitor for ovarian cancer & the blood test isn't either, what else can you do aside from having a hysterectomy to protect yourself from this happening? Thank you.

Dear Jeannie, we are not able to make screening or treatment recommendations on our blog, but if you would like to speak to one of our genetic counselors about your family history and your risks, you can call 646-888-4050 to make an appointment or go to https://www.mskcc.org/cancer-care/risk-assessment-screening/hereditary-… for more information. If you are found to be at higher risk, you may wish to participate in our RISE (Risk Assessment, Imaging, Surveillance, and Education) Program. You can learn more at https://www.mskcc.org/cancer-care/risk-assessment-screening/screening/i….

If you are not in the New York area and/or are not able to come to MSK, you may want to ask your doctor for a referral to a genetic counselor who specializes in cancer risk.

Thank you for your comment, and best wishes to you and your family.

Hi. I have a history of ovarian cancer and breast cancer in my family. How can I go about setting up an appointment at Sloan to do genetic testing and ovarian cancer Screening ?

What do you do if your 2 sisters had breast cancer at 42 and 47. Father passed from kidney cancer. Mother diagnosed with vaginal mucosal melanoma. I had genetic testing and have rad51c gene? I currently have an mri of breast then 6 months later do mamography and ultra sound and once a year ultra sound of ovaries. Am I doing the right things or should I be doing more?

Dear Linda, we are very sorry to hear about your family history. Unfortunately, we are not able to make screening or treatment recommendations on our blog, but if you would like to speak to one of our genetic counselors about your risks related to this gene mutation, you can call 646-888-4050 to make an appointment or go to https://www.mskcc.org/cancer-care/risk-assessment-screening/hereditary-… for more information. If you are found to be at higher risk for breast cancer, you may wish to participate in our RISE (Risk Assessment, Imaging, Surveillance, and Education) Program. You can learn more at https://www.mskcc.org/cancer-care/risk-assessment-screening/screening/i….

If you are not in the New York area and/or are not able to come to MSK, you may want to ask your doctor for a referral to a genetic counselor who specializes in cancer risk.

Thank you for your comment, and best wishes to you and your family.

I had breast cancer in 1989. I do not carry the gene but I was so afraid of ovarian cancer that I electively had my ovaries removed. One of the best decisions I ever made.

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