|
Editorial NOVEMBER 2006
Ovarian Cancer: It’s Time to Act
Lee P. Shulman, MD
Ovarian cancer kills. Each year in the United States, more than
25,000 women are diagnosed with this insidious disease, and 16,000
women die from it. This is not a great epiphany to any of you who
read The Female Patient, but it has been a fact of life
for patients and health care professionals for too long a time.
Great strides have been made in detecting breast, cervical, and
endometrial cancer in earlier—and far more treatable—stages.
Indeed, we have recently seen the introduction of a vaccine against
certain human papillomavirus (HPV) subtypes that can prevent cervical
dysplasia and cancer and anogenital warts in “naïve”
women with no previous HPV exposure, and reduce their occurrence
in non-naïve women.
The facts about ovarian cancer have not changed markedly over
the past decades. Very simply, if epithelial ovarian cancer is detected
early, then the chance of long-term survival is excellent. However,
the vast majority of cases are detected after the malignancy has
spread outside the pelvis, and such cases are characterized by poor
outcomes despite the best efforts of gynecologic oncologists and
the development of new surgical and
chemotherapeutic approaches.
The late detection of ovarian cancer is primarily due to the absence
of specific symptoms associated with early disease and the lack
of a test or screening/diagnostic algorithm for effective early
detection. Whereas breast cancer can be detected with mammography,
endometrial cancer with endometrial biopsy, and cervical cancer
with the Papanicolaou smear and HPV typing, diagnosis of ovarian
cancer relies on ultrasonography and nonspecific serum markers—both
of which have poor positive predictability.
Recently, OB/GYNs have been bombarded with mass e-mailings about women diagnosed
with advanced ovarian cancer—the message being that if they
had been offered ultrasonography or a CA-125 assay, the cancer would
have been detected at an earlier, more treatable stage. Unfortunately,
this is not true. While there are cases of serendipitous detection
of ovarian cancers with ultrasonography or an elevated CA-125 value,
most such findings lead not to early detection, but to unnecessary
interventions.
Without the requisite tools, what are we to do? Firstly, we must
talk with our patients to ascertain their risk of ovarian cancer
in terms of family history. We must become better listeners; when
the nonspecific symptoms of early ovarian cancer—eg, bloating,
unexplained weight gain/loss, back pain, adnexal mass—present
as relatively new complaints, timely recognition could lead to appropriate
evaluation and early detection. Secondly (and possibly more importantly),
we must recognize that while we cannot screen for incipient ovarian
cancer, we do have the tools to prevent it. The literature clearly
shows that the use of oral contraceptives (OCs) is highly effective
in reducing the incidence of ovarian cancer, as is tubal ligation
in women who have completed childbearing. These points should be
raised early in the reproductive years with women who are at increased
risk for ovarian cancer, as long-term use of OCs—along with
pregnancy and breast-feeding—have been shown to reduce the
rate of ovarian cancer by up to 60%, even in women carrying breast
cancer gene mutations.1,2
Thirdly, we must strongly encourage governmental and private support
for research into the development of more effective screening and
therapeutic modalities. Dilgeet Singh, MD, and I codirect the Northwestern
Ovarian Cancer Early Detection and Prevention Program, a large early-detection
program for ovarian cancer that has benefited from generous contributions
from the National Institutes of Health and private foundations including
Friends of Prentice, the Northwestern Memorial Foundation, Bears
Care, and the Kaplan Family Foundation. These organizations have
supported the scientific, clinical, research, and educational missions
of this program, and its physicians and patients are indebted to
them. Other, similar programs throughout the United States need
your support—from referral of patients to financial contributions—to
expedite our common goal of lifting the death sentence from women
diagnosed with ovarian cancer.
We have made great progress in the care and treatment of women with many types
of gynecologic cancer. We are not where we want to be, but we are
moving forward. However, we have not yet begun to move forward with
ovarian cancer, although promising research with proteomics, serum
markers, and novel chemotherapeutic regimens gives reason to hope.
We owe it to our patients to make sure that this hope becomes a
promise, and soon.
Lee P. ShuLman, MD
Associate Editor
back
to top
References
- Narod SA, Risch H, Moslehi R, et al. Oral contraceptives
and the risk of hereditary ovarian cancer. Hereditary Ovarian
Cancer Clinical Study Group. N Engl J Med. 1998;339(7):424-428.
- Hanna L, Adams M. Prevention of ovarian cancer.
Best Pract Res Clin Obstet Gynaecol. 2006;20(2):339-362.
back
to top
|
