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

• Published in: British journal of cancer Vol. 94; no. 6; pp. 814 - 819
• Main Authors: OEI, A. L, MASSUGER, L. F, BULTEN, J, LIGTENBERG, M. J, HOOGERBRUGGE, N, DE HULLU, J. A
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 27-03-2006
• Subjects: Adult; Age Factors; Aged; Biological and medical sciences; CA-125 Antigen - analysis; Clinical Study; Female; Female genital diseases; Genes, BRCA1; Genes, BRCA2; Genetic Predisposition to Disease; Gynecology. Andrology. Obstetrics; Humans; Medical sciences; Middle Aged; Ovarian cancer; Ovarian Neoplasms - diagnosis; Ovarian Neoplasms - genetics; Pedigree; Pelvis; Physical Examination; Prospective Studies; Risk Factors; Sensitivity and Specificity; Tumors; Ultrasonography; Vagina - diagnostic imaging; Human; High risk; Ovary cancer; Malignant tumor; Hereditary; Female genital diseases; ovarian cancer prophylactic surgery; Prevention; Ovarian diseases; BRCA; Cancerology; Treatment; Surveillance; Surgery; Adult; Female; hereditary cancer; Woman
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/sj.bjc.6603015

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 high-risk 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.