Journals and Media

Cancer Australia CEO Dr Helen Zorbas about what GPs need to know on testing for ovarian cancer in asymptomatic women

Cancer Australia CEO Dr Helen Zorbas about what GPs need to know on testing for ovarian cancer in asymptomatic women

The latest evidence does not support any tests or combination of tests for screening or surveillance of ovarian cancer.


Ovarian cancer has been called a ‘silent killer’, as it tends to either have no symptoms or symptoms that can easily be interpreted as other, less malign health issues. This can make it hard to detect the disease early and provide the best possible chance for patient treatment.

‘Unfortunately, survival rates [of ovarian cancer], although they have improved over the past 20 years, still remain low at 45.7% five-year relative survival,’ Cancer Australia Chief Executive Dr Helen Zorbas told newsGP.

‘So there is a great interest amongst women and health professionals to not miss the disease and diagnose it early.’  

To mark Ovarian Cancer Awareness Month, Cancer Australia has released its updated position statement, ‘Testing for ovarian cancer in asymptomatic women’. This represents the statement’s first update in 10 years and incorporates the latest evidence in the field, much of which has been focused on whether there is a feasible option for screening or surveillance testing for ovarian cancer.

‘It was considered important to review the evidence and to provide up-to-date guidance, particularly to GPs who are at the frontline of women who may be concerned about risk of ovarian cancer, or who may be hearing about the disease and want to understand how to be screened for it,’ Dr Zorbas explained.

On the basis of this evidence, the advice in the position statement further underlines that of its 2009 predecessor; however, Dr Zorbas believes this is just as important to publicise as would be the fact of a new test or procedure.

‘I guess it’s regrettable we don’t have a better news story, if you like. But, importantly, they’re very clear recommendations to guide women and health professionals in relation to the lack of evidence to support the use of any particular test or combination of tests to reduce mortality from ovarian cancer,’ Dr Zorbas said. 

‘So not as a screening test or an early detection test for women at population risk, or even for women at potentially high risk of ovarian cancer.’

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Cancer Australia Chief Executive Dr Helen Zorbas wants to provide GPs with up-to-date, evidence-based recommendations on identifying and testing for ovarian cancer.

Part of the reason such testing for the purposes of surveillance or screening is not feasible is that many current procedures are very invasive.

‘For example, a potential positive finding on one of those tests as a diagnosis for ovarian cancer would require removal of an ovary – surgery so that tissue could be examined,’ Dr Zorbas said.

‘Therefore, there are significant risks associated with such procedures and we would need to have strong evidence of a survival benefit to justify women undergoing them.’

Dr Zorbas believes the lack of screening or surveillance testing is especially important to emphasise, as knowledge among the public about how to detect ovarian cancer has not kept pace with awareness of the disease itself. 

‘Even well-educated and well-versed women still confuse the idea of the cervical screening test and the detection of cervical cancer with the detection of ovarian cancer as well, and of course it does not have a role in detecting ovarian cancer,’ she said.

Dr Zorbas confirmed that the current advice for GPs is to focus on symptoms.

‘If there are symptoms, it’s really important to have them investigated early and appropriately; there are algorithmsGPs can follow in terms of the appropriate investigation of symptoms that could be ovarian cancer,’ she said.

It is also very important to investigate women with a strong family history risk.

‘For women who have a family history of either ovarian cancer, breast cancer or colon cancer, because of Lynch Syndrome: if they’ve got particularly close relatives who have had those cancers at an age under 60, or, any blood relative on the same side of the family with ovarian cancer, particularly if there’s more than one blood relative, that’s really important history to report to the GP to have an assessment of family history,’ Dr Zorbas said.

‘If it’s then deemed appropriate, based on that potential high risk, it is important to have that assessment more accurately undertaken through a cancer clinic.

‘Because the women at high risk for family cancer, particularly if they’ve got a faulty gene in the BRCA1 on BACA2 or Lynch Syndrome gene, could potentially benefit greatly from discussing and undertaking risk-reducing surgery which would be removal of the ovaries and fallopian tubes, and they should really seek advice around these options in order to make an informed decision in their particular circumstances.’

However, Dr Zorbas re-emphasised the fact there is no evidence to support routine testing in asymptomatic women, regardless of whether they have a family history of the disease.

‘There are a number of tests that have been studied; a CA 125, or a transvaginal ultrasound, or combination of tests – none of those have been found to actually impact on mortality from the disease in asymptomatic women,’ she said.

JeneScreen – Free BRCA Founder Mutation Testing for Jews

The JeneScreen research project is open to residents of Sydney and Melbourne, and will test for the three BRCA faults that are common in the Jewish population. Please click here for more information about how you can be involved in the research project.

Triple-Modality Screening Trial for Familial Breast Cancer

TRIPLE-MODALITY SCREENING TRIAL FOR FAMILIAL BREAST CANCER UNDERLINES THE IMPORTANCE OF MAGNETIC RESONANCE IMAGING AND QUESTIONS THE ROLE OF MAMMOGRAPHY AND ULTRASOUND REGARDLESS OF PATIENT MUTATION STATUS, AGE, AND BREAST DENSITY

Purpose

To evaluate the breast cancer screening efficacy of mammography, ultrasound, and magnetic resonance imaging (MRI) in a high-risk population and in various population subgroups.

Patients and Methods

In a single-center, prospective, nonrandomized comparison study, BRCA mutation carriers and women with a high familial risk (> 20% lifetime risk) for breast cancer were offered screening with mammography, ultrasound, and MRI every 12 months. Diagnostic performance was compared between individual modalities and their combinations. Further comparisons were based on subpopulations dichotomized by screening rounds, mutation status, age, and breast density.

Results

There were 559 women with 1,365 complete imaging rounds included in this study. The sensitivity of MRI (90.0%) was significantly higher (P < .001) than that of mammography (37.5%) and ultrasound (37.5%). Of 40 cancers, 18 (45.0%) were detected by MRI alone. Two cancers were found by mammography alone (a ductal carcinoma in situ [DCIS] with microinvasion and a DCIS with < 10-mm invasive areas). This did not lead to a significant increase of sensitivity compared with using MRI alone (P = .15). No cancers were detected by ultrasound alone. Similarly, of 14 DCISs, all were detected by MRI, whereas mammography and ultrasound each detected five DCISs (35.7%). Age, mutation status, and breast density had no influence on the sensitivity of MRI and did not affect the superiority of MRI over mammography and ultrasound.

Conclusion

MRI allows early detection of familial breast cancer regardless of patient age, breast density, or risk status. The added value of mammography is limited, and there is no added value of ultrasound in women undergoing MRI for screening.

To read more please go to the article.

Pollution Linked To Higher Breast Cancer Risk in Biggest Study Yet

Women living in areas with high air pollution are more likely to have dense breasts, boosting their chances of developing breast cancer, a major new study has found.Breast density has been shown to have a strong link to breast cancer. Women with the most dense breasts — the highest proportion of fibroglandular, rather than fatty, tissue — are three to five times more likely to develop the disease than those with the least.

To read more please go to the article.

Atypical Hyperplasia of the Breast – Risk Assessment and Management Options

Lynn C. Hartmann, M.D., Amy C. Degnim, M.D., Richard J. Santen, M.D., William D. Dupont, Ph.D., and Karthik Ghosh, M.D

Breast biopsies are commonly performed to evaluate mammographic or palpable findings that are of concern, and the majority reveal benign findings. More than 1 million of the breast biopsies that are performed annually in the United States are found to be benign.1 On the basis of the histologic findings, it is possible to stratify women with benign biopsy findings into groups with significantly different risks of later breast cancer.2,3 Atypical hyperplasia is a high-risk benign lesion that is found in approximately 10%of biopsies with benign findings.4 In this article, we examine these benign lesions because they have special importance as a predictor of future breast cancer. There are two types of atypical hyperplasia, as classified on the basis of microscopic appearance: atypical ductal hyperplasia and atypical lobular hyperplasia; these occur with equal frequency and confer similar risks of later breast cancer ( Table 1 Risk of Breast Cancer among Women with Atypical Hyperplasia.). 2,3,9,10 Thus, throughout this article, the varieties will be referred to together as “atypical hyperplasia.”

To read more please go to the article.

How Many People Will Be Diagnosed With Cancer In Your Suburb in 2018?

More than 46,000 people in NSW will be told they have cancer in 2018, official projections show.

The sobering forecast also predicted the number of new breast, lung, bowel cancer and melanoma patients who will be diagnosed across every Sydney local government area (LGA) this year.

To read more please go to the article.

Exercise is Best For Reducing Breast Cancer Recurrence

By Ana Sandoiu

Breast cancer survival rates are very high compared with other forms of cancer, but in some cases, the cancer does comes back. New research highlights key recommendations that breast cancer survivors can incorporate into their lifestyle so as to reduce the risk of breast cancer recurrence.

To read more please go to the article.

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