What Will It Take to Save Women From Cancer?

What Will It Take to Save Women From Cancer?

Rachel Banov Gould was just 30 years old when she had an abnormal Pap smear, and a series of tests revealed cancerous cells in her cervix. It was February 2011, and she was newly married; she and her husband, Ben, were excited to start a family. “At first, it felt like, This is terrible, but we can beat it,” says her sister, Jessica Banov, 41, of Raleigh, NC. After all, Rachel was the kind of girl who celebrated her birthday by taking trapeze lessons: She was tenacious and brave. And she never missed an ob/gyn visit. She took her health seriously.

Although the vast majority of women survive early-stage cervical cancer, Rachel’s case was complicated because the disease had already reached two lymph nodes. She soon underwent surgery, chemotherapy, and radiation—and began planning a trip to Bali and Korea for the fall. “Rachel loved to travel. She was always making these grand plans with massive spreadsheets,” Jessica recalls. Then, in August, just a few months after she finished treatment, Rachel’s doctors found new tumors in her abdomen.

“That’s when it became a different fight,” Jessica says. “The doctors tried everything, but the cancer continued to spread.” Rachel cared less about seeing the world now. “It was more about the small moments she worried she would miss,” Jessica says. One day, Rachel insisted on taking her sister wedding dress shopping, even though Jessica wasn’t engaged. “I put on all the craziest dresses, and we took tons of pictures. She wanted us to have that experience together.”

In March 2012, just 13 months after her diagnosis, Rachel died. Four years later, Jessica still wonders how this could have happened. “Rachel was informed and proactive. She did everything right,” Jessica says. “But there’s still too much that we don’t know about these cancers.”

For nearly 40 years, gynecologic cancers— the umbrella term used for a collection of diseases, of which cervical, ovarian, and uterine cancers are the most common, followed by vaginal and vulvar—have received a fraction of the attention given to that other, much better known women’s cancer. When the Susan G. Komen Foundation pinned on its first pink ribbon in 1982, only 74 percent of women diagnosed with early-stage breast cancer lived longer than five years. Billions of research dollars later, almost 99 percent of the women in that group will survive past that benchmark. It’s been a long and arduous fight, but experts agree: We are winning the war on breast cancer by almost any medical measure. Meanwhile, about 98,000 women per year are diagnosed with some type of gynecologic cancer, and although their overall number is smaller (compared with 230,000 for breast cancer), these diseases are harder to detect, spread more quickly—and kill more of the women they affect. Only 68 percent of cervical cancer patients and less than half of ovarian cancer patients survive five years past their diagnosis. Yet in 2014, the National Institutes of Health approved $682 million in grants for breast cancer research and only $131 million for ovarian cancer, while cervical and uterine cancers received even less. “It shouldn’t be about prioritizing one type of cancer over another,” explains Ginger Gardner, M.D., a gynecologic oncologist at Memorial Sloan Kettering Cancer Center in New York City. “Doctors, researchers, and women need to band together to fight all of these diseases.” And to do that, we need to understand what’s holding us back.

A Cancer People Still Whisper About

Incredibly, embarrassment—over talking about “that part” of a woman’s body—is still a barrier to taking awareness of gynecologic cancers fully mainstream. Tamika Felder, of Upper Marlboro, MD, experienced it when she was diagnosed with cervical cancer 14 years ago. “You probably got that from sleeping around,” she remembers a friend’s husband saying. Researchers were beginning to publicize findings that a sexually transmitted infection called human papillomavirus (HPV) causes most types of cervical cancer, as well as many vaginal, vulvar, and anal tumors. “I felt shamed,” Tamika says. She particularly dreaded bringing up her cancer when she was dating (she’s now happily married). “I always thought, What is this person going to think, if they Google my kind of cancer? The stigma is very, very real.”

It’s also entirely misplaced. By the time they’re 39 years old, more than 50 percent of American women will be infected with one of the nine strains of HPV that are most likely to cause warts or cancer, according to a study in the Journal of Infectious Diseases. “And we know that estimate is low,” says Patti Gravitt, Ph.D., an epidemiologist at the George Washington University Milken Institute School of Public Health in Washington, DC. There are actually 150 strains total, a dozen of which can cause cancer. “Most of us will end up with at least one HPV infection during our lifetime,” Gravitt explains.

“It’s nothing to be ashamed of; HPV is truly an equal-opportunity virus.” Meanwhile, the causes of most other gynecologic cancers are either unknown or possibly genetic, though they may still be viewed as taboo. “We see ‘stomach’ cancer a lot in family trees, and it’s often a euphemism for a gynecologic cancer that wasn’t considered proper to talk about,” says Joy Larsen Haidle, past president of the National Society of Genetic Counselors. It may sound old-fashioned, but the uneasiness persists. “It often feels like we’re back where breast cancer was a few decades ago, when not everyone felt comfortable talking about breasts,” says Gardner, who works closely with the Foundation for Women’s Cancer.

That reluctance inspired Tamika to launch a nonprofit called Cervivor, which teaches other survivors how to talk about their cervical cancer and HPV and advocate for the HPV vaccine, which can prevent the most common cancer-causing strains of the virus. The Centers for Disease Control and Prevention (CDC) recommends that it be given to girls and boys at age 11 or 12, but that has been met with controversy, as opponents fear that inoculating kids might encourage promiscuity. There’s no evidence to support that: “Research shows that getting the HPV vaccine doesn’t lead adolescents to be more sexually active or to start having sex at a younger age,” says Lauri Markowitz, M.D., a medical epidemiologist at the CDC. “This is about preventing cancer,” Tamika says. “I can’t believe we have a vaccine and yet some people are unwilling to use it.”

You Have To Find It To Treat It

The squeamishness around below-the-belt health can cross over into the doctor’s office, where experts say women are sometimes hesitant to speak up about their symptoms. “We can tell that women aren’t happy to be there a lot of the time,” says Mary Jane Minkin, M.D., a clinical professor of obstetrics and gynecology at the Yale School of Medicine in New Haven, CT. “And every now and then, as we’re leaving the room, a patient will say, ‘By the way, I’m having some trouble…'” What follows, she says, is often the sheepish revelation of a complicated issue.

Erin Rothfuss wishes she’d had more involved conversations with her doctor. Her periods had gotten progressively worse for three years: “I knew that was weird for me, and yet I hesitated to push for answers,” she says. “It’s easy to dismiss these symptoms because they can seem so vague.” It wasn’t until she moved that her new ob/gyn decided to perform an ultrasound. She found cysts, and scheduled an appointment to have them removed, recalls Erin, now 44 and a lawyer in San Francisco. “She said it would likely require a simple laparoscopic surgery, that it should only take 45 minutes,” she says. “I woke up five hours later to learn that they had performed a total hysterectomy because I had Stage III ovarian cancer”—a decision that saved her life. “I’m grateful that I had never wanted children of my own, but it was still painful to have that door slammed shut,” she says. Yet Erin is one of the lucky ones: Following intensive chemotherapy, she’s been cancer-free for six years.

Why didn’t Erin’s doctors know that her cysts were cancerous until they began cutting them out? Because scientists have yet to develop a way to screen for tumors when they’re buried deep inside your pelvis. A staggering 70 percent of ovarian cancers reach Stage III or IV before they’re diagnosed at all—and at that point, the disease is so advanced that the five-year survival rate can be as low as 17 percent. “The breast is on the outside of your body, which makes it easier to screen and understand,” Gardner explains. “But tumors on your ovaries start out tiny. And their cells readily slough off—all it takes is a few cancerous cells free-floating in the pelvis and it’s a different ball game.” In a nationwide survey of 521 gynecologists, conducted by researchers at the University of California, San Francisco, nearly 50 percent believed that pelvic exams were “very important” in the detection of ovarian cancer. But the exam isn’t approved as a screening tool, since it can’t catch the disease early enough to dramatically improve treatment outcomes. “We can tell women to be on the lookout for symptoms like abdominal pain, bloating, or abnormally heavy periods,” says John Micha, M.D., a gynecologic oncologist in Newport Beach, CA, and president of the Nancy Yeary Women’s Cancer Research Foundation. “But by the time a woman notices anything, the cancer has likely spread.”

To detect ovarian cancer earlier, scientists need to find some subtler change in a woman’s body, one that happens before the tumor can be felt by a doctor. A blood marker known as CA-125 is elevated in ovarian cancer patients, and has long been used to track the disease once a woman is diagnosed. But since CA-125 levels also fluctuate for noncancerous reasons, including pregnancy, it was dismissed as a potential detection tool—until a recent British study suggested an algorithm for analyzing CA-125 levels in precancerous women, stoking media buzz about a breakthrough ovarian cancer test. The research has been greeted cautiously by the medical community, though a group of experts in the United States is expected to release a statement this spring about what it means for women. “We’re hopeful that it could eventually help us identify women at higher risk,” says Carmel Cohen, M.D., a gynecologic oncologist at Mount Sinai Hospital in New York City and chair of the Gynecologic Cancer Advisory Group for the American Cancer Society.

The news is slightly better for uterine cancer. While there’s no screening, its first symptom—unexplained bleeding—tends to manifest early in the disease’s progression. “We diagnose most of these cases at Stage I, when the cure rate is 95 percent,” Micha says. Still, the onus is on women to report their symptoms quickly: Once the disease reaches the lymph nodes, the five-year survival rate drops to 68 percent. It plummets even further if the cancer spreads elsewhere in the abdomen or lungs.

Cervical cancer is the only one of these types of cancers to have a reliable screening tool. “Since the Pap smear became standard protocol, the number of invasive cervical cancers we see each year has gone from 100,000 down to 10,000,” says Cohen. In some cases, the Pap smear even prevents cancer by allowing doctors to find and treat cells and lesions that could lead to cervical cancer, as well as some vaginal and vulvar cancers, before they develop into a larger problem. But new guidelines from the United States Preventive Services Task Force suggest that many women can go three to five years between Pap smears. That gap concerns some doctors. “It might mean that people won’t see their doctor at all, and you should once a year, whether you get a Pap smear or not,” says Minkin, noting that there has also been some controversy over whether women need to have an annual pelvic exam. She believes they should: “For one thing, it’s an opportunity to discuss ways to manage your risk for these cancers, from watching your weight to starting the Pill.”

For Erin, the ovarian cancer survivor, the message is clear: “You have to talk to your doctor if you’re concerned. And even if your doctor says it’s fine, don’t be afraid to push them harder.” Not sure what to say? Try “prove to me that this isn’t cancer,” suggests Cohen. Aggressive? Yes. But necessary.

So Few Options, And A Ticking Clock

With diagnoses happening late in the game, a woman with gynecologic cancer needs the best treatment, and quickly. But there simply aren’t enough gynecologic oncologists. “This specialty requires extensive training,” notes Micha. “We’re only graduating about 35 new fellows each year.” Fewer than 60 percent of patients ever even see a gynecologic oncologist, in part because they’re found mostly in high-volume treatment centers rather than local hospitals (find a center by entering your zip code at foundationforwomenscancer.org). These doctors are more likely to have access to the most promising new treatments—but even some of those are still too experimental to be widely available or covered by insurance.

But when a woman does find the right specialist, and does get cutting-edge treatment, there are moments of real hope. Stacey Cannone, a 41-year-old accountant from Lynbrook, NY, met Gardner six years ago, when a series of abnormal Pap smears revealed early-stage endocervical adenocarcinoma, an unusual form of cervical cancer. Stacey was newly married then. “You never think your first year of marriage is going to involve your husband learning to change your urinary catheter because you’ve just had cancer surgery,” she says. And as soon as she heard cancer, Stacey says, “I was already taking the idea of having a child and putting it in the garbage.”

The traditional treatment for Stacey’s cancer is a total hysterectomy, because taking out all of the reproductive organs is the most definitive way to ensure the cancer cells are completely removed. Gardner, however, was determined to preserve her patient’s fertility along with her life. So she performed a surgery known as a radical trachelectomy, removing Stacey’s cervix and upper vagina but leaving her ovaries and uterus in place, as well as a new procedure that helps doctors better evaluate the lymph nodes. Today, Stacey has been cancer-free for more than five years—and gave birth to a baby girl in December.

Stacey’s story is not typical, but it should be. Gynecologic cancers are still waiting for a groundswell of women to demand better research and more funding. “If every person in the United States donated a dollar, there would be enough money to establish a Komen for any number of cancers,” says Micha, referring to the powerhouse breast cancer charity, Susan G. Komen. And yes, even small donations help. “About 80 percent of our research grants are funded by advocacy groups and families,” says Karen Carlson, executive director of the Foundation for Women’s Cancer. Simply put: “Awareness translates into research dollars,” she says. Over the years, there have been headline-grabbing stories to remind us how devastating these cancers are, like comedian Gilda Radner’s death in the ’80s and country star Joey Feek’s recent battle with cervical cancer, shared bravely and beautifully on social media. But it’s on all of us to keep women’s cancers in the collective consciousness. If you’ve already given your dollar or 20, there are walks to join (check out globeathon.com for all women’s cancers and tealwalk.org for ovarian cancer), ribbons to wear (teal for ovarian, peach for uterine, lavender for all women’s cancers), and frank conversations to have with your own doctors, as well as your mom, your sisters, and your friends.

“In the end, Rachel’s death was a loss of such potential,” says Jessica Banov of her sister. “If she had survived, she would be the one advocating for more research and trials.” A little more than a month before she died, Rachel Banov Gould wrote a blog post about the one-year anniversary of her diagnosis. “This is not where I was supposed to be,” she said of the cancer that had by then spread to her lungs and was defying all available treatments, ruthlessly disrupting her plans for the trips she had hoped to take and the children she longed to have. “But I will tell you this, we are not giving up yet.” We can’t give up either.

To read this article, published on RedbookMag.com, click here.
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How A Master Regulator In Ovarian Cancer Can Go From Helpful To Harmful

When it comes to our immune system, dendritic cells serve as a sort of lighthouse for T-cells. These specialized immune cells break down cancer cells into smaller pieces known as antigens. Once this happens, they can signal white blood cells that are now able to recognize these matching antigens in cancer cells and respond appropriately.

Dendritic cells in ovarian cancer behave differently. When they receive activating signals, they can effectively present the antigens to T-cells. However, if the cells do not receive those signals, these dendritic cells spontaneously suppress anti-tumor immune responses. This differential behavior of dendritic cells could help explain why spontaneous immune pressure against ovarian cancer progression eventually fails, resulting in accelerated tumor progression.

Now, scientists at The Wistar Institute have defined the role of how a master genomic organizer influences the behavior of these ovarian-associated dendritic cells, revealing a previously unseen way in which cancer is able to manipulate our immune system. Study results were published in the journal Cell Reports.

A gene called special AT-rich binding protein 1 (Satb1) helps organize the genome and control phenotypes and differentiation within cells. In a prior study published in 2012, the lab of Jose Conejo-Garcia, M.D., Ph.D., professor and program leader of the Tumor Microenvironment and Metastasis Program at The Wistar Institute, found that this gene is a direct target of miR-155 – a microRNA that stimulates the immune system – in ovarian-associated dendritic cells. Conversely, when miR-155 is not stimulating the immune system, these dendritic cells produce inflammatory, tumor-promoting cytokines like interleukin-6 and galectin-1.

“We know from our previous work that Satb1 down-regulation by miR-155 supplementation is closely linked to proper immune response in tumor-bearing hosts. For this study, we wanted to know how the gene behaved when dendritic cells were transformed from a potentially immunostimulatory cell type into immunosuppressive cells,” said Conejo-Garcia, lead author of this new research paper.

Study results showed that Satb1 expression in dendritic cells is paradoxically required for proper immune response. However, Satb1 has a very narrow window in which it should be expressed. After dendritic cells mature, Satb1 should go away. If Satb1 hangs around and remains expressed, it drives immunosuppressive, pro-inflammatory behavior, which was confirmed when Satb1 was silenced in tumor-associated dendritic cells.

Silencing the gene led to reduced levels of inflammation and immunosuppression, and boosted T-cell activation and immune response. In fact, 22 percent of transcripts experienced two-fold or greater changes in these immune response levels when Satb1 was silenced, underscoring the importance of this single molecule in determining the complex transcriptional programs in dendritic cells.

Among the physiological functions of Satb1 expressed with the right temporal pattern, the researchers also linked Satb1 behavior to Notch1, a gene linked to tumor cell survival and proliferation. Notch1 is activated in a Satb1-dependent manner during the transient state when Sabt1 is about to disappear as dendritic cells mature. In inflammatory dendritic cells, Notch1 expression coincides with increased levels of a molecule MHC-II, which is required for the activation of CD4+ T-cells, also known as helper T-cells. Conejo-Garcia and colleagues found that Satb1 drives Notch1 expression, while Notch1 in turn drives MHC-II expression, thus equipping dendritic cells with the capacity to activate different T-cell populations. However, if Satb1 remains overexpressed after dendritic cells are able to produce a normal immune response, it drives the production of multiple inflammatory and immunosuppressive factors that transform dendritic cells into accomplices in malignant progression and immunosuppression.

“Our studies provide new mechanistic insight into how tumors, and in particular ovarian cancer, progressively transform myeloid cells from an immunostimulatory to an immunosuppressive cell type, which our previous studies showed to be critical to understand the evolution of ovarian cancer,” said Conejo-Garcia. “Modulating Satb1 expression, either in vivo through nanocomplexes as in our study or in vitro in dendritic cell-based vaccines, could drive stronger anti-tumor immune responses and make antigen-presenting cells more resistant to tumor-induced immunosuppressive signals.”

To read this entire article on Medical Xpress, click here.

Health Buzz: More Young Women With Breast Cancer Seeking Genetic Testing, Study Finds

Testing for BRCA1 and BRCA2 gene mutations, which significantly increase a woman’s risk of getting breast cancer and ovarian cancer, is on the rise among women ages 40 and under who’ve been diagnosed with breast cancer, suggests a study published online Thursday in JAMA Oncology.

The significance of carrying the BRCA gene was highlighted in 2013 when actress Angelina Jolie went public with her decision to undergo a preventive double mastectomy, after testing revealed she carried the BRCA1 genetic mutation. Jolie, whose mother died of ovarian cancer, reportedly faced an 87 percent risk of developing breast cancer. In 2015, Jolie announced plans for surgery to remove her ovaries and fallopian tubes.

In the new study, Dr. Ann Partridge of the Dana-Farber Cancer Institute and co-authors explored how women’s concerns about genetic risk and information affected their treatment decisions. Nearly 900 women who were diagnosed with breast cancer at 11 medical centers were included, according to a journal press release. Within one year after diagnosis, 87 percent of the women had undergone BRCA testing.

As time went on, the frequency of testing increased, the researchers found. Of women diagnosed in 2006, about 77 percent reported being tested. While that rate dipped to 70 percent for the following year, the proportion rose to nearly 97 percent for 2012 and about 95 percent for 2013.

Positive BRCA1 results were reported in 7.6 percent of women who were tested, and positive BRCA2 results were seen in 4.5 percent. Of other results, 4.6 percent were indeterminate or with unknown significance.

Of the women who were tested, 30 percent said knowledge or concern about the genetic risk of breast cancer influenced their treatment. Of the mutation carriers, 86 percent chose to have both breasts removed. Of the non-BRCA carriers, 51 percent had bilateral mastectomy. Carriers were also more likely to undergo preventive ovary removal.

Of women who did not seek testing, 32 percent did not report discussing with a physician or genetic counselor the possibility of having a BRCA mutation. Of the untested women, 37 percent were thinking of future testing.

“Given that knowledge and concern about genetic risk influence surgical decisions and may affect systemic therapy trial eligibility, all young women with breast cancer should be counseled and offered genetic testing, consistent with the National Comprehensive Cancer Network guidelines,” the authors concluded.

To read this entire article by U.S. News & World Report Health, click here.

Ovarian Cancer Has Common Symptoms, Difficult to Test For

Brittany Burns, the fiancée of Buffalo Bills linebacker Tony Steward, died Tuesday of ovarian cancer. She was 26, and died less than two months after she began fighting the disease. Ovarian cancer has vague but important symptoms to look for.

“I was diagnosed with Stage 3B ovarian cancer,” said Kathleen Maxian. The WNY Ovarian Cancer Project founder is one of the few patients with advanced ovarian cancer that is able to share her story years after a diagnosis.

“I was devastated. I didn’t know anything about ovarian cancer. I knew it was deadly, and when I asked about my prognosis, I was told by my doctor that I had a 20 percent chance of living for 5 years.”

Of the 22,000 women diagnosed every year, 15,000 will die; more than 68 percent. That’s partially because people ignore or rationalize the symptoms. They include bloating, abdominal pain, and frequent urination.

“There’s no screening test for Ovarian Cancer. There’s no definitive test, so when you go to your gynecologist, he or she can’t just give you a blood test and say yes or no, you have ovarian cancer,” Maxian said.

“It’s much more difficult to access the ovaries than it is to access the cervix or breast, so we really need to figure out what type of laboratory tests we can use, but the science really isn’t there yet,” said Erie County Health Commissioner Dr. Gale Burstein.

There are a few tests that can lead doctors to suspect ovarian cancer but the only way to know for sure is having surgery. Experts recommend a gynecological oncologist perform that surgery because they’re better trained to remove the cancer if it has spread.

Progress is being made in treatment, including two new chemotherapy drugs approved by the FDA last year. Intraperitoneal chemotherapy, or injecting chemo drugs right into the abdomen, is now becoming the standard of care and producing promising results.

“I only made it through four before it became too toxic for me, but that still has made a significant impact in my personal survival,” said Maxian.

Doctors are also looking at immunotherapy, like vaccines, to help the immune system fight alongside the chemotherapy.

“We have strategies, approaches to train the immune system and teach them to recognize the ovarian cancer cells and destroy them,” said Dr. Kunle Odunsi, Roswell Gynecologic Oncology Chair. “These studies are going on a Roswell Park. We are very excited about them. They have the potential to help and provide long-lasting remission.”

For many patients, especially those whose cancer returns, doctors say enrolling in a clinical trial might be the best option.

To read this entire article by Time Warner Cable News, click here.

Calling For A More Personalized Approach To Preventing Breast And Ovarian Cancers

It’s well known that women whose families have a history of breast and ovarian cancer are at higher risk of developing those diseases, but what’s not so clear is what can be done to improve care for these patients. Researchers from the Mayo Clinic Cancer Center took a deep look at the latest studies to help determine the best way to assess the risk for breast and ovarian cancer, the effectiveness of surgery to reduce risk and alternative approaches to prevent cancer.

“Many of the studies we discuss were published recently, so we are taking advantage of the increased knowledge of the types of cancers that these women develop and the ages at which they occur, to suggest how we can change our thinking around their management,” Dr. Lynn Hartmann, oncologist at Mayo Clinic and lead author of the article, said in a statement. “It is part of medicine today to try to individualize recommendations whenever possible.”

Women can reduce their susceptibility to these cancers by undergoing a mastectomy or having their Fallopian tubes removed, but those procedures carry certain risks of their own. A bilateral prophylactic mastectomy, for example, can potentially lead to bleeding or infection and, according to the National Cancer Institute, it can dramatically affect a woman’s psychological well-being due to the changes in body image and the loss of normal breast function.

Historically, most of the research is focused on whether those procedures can prevent cancer and to what extent, but now there is an emerging shift toward better understanding the psychological consequences of the procedures. New studies suggest that most women are pleased with the choices they made, but more research is still needed to determine how clinicians can help them deliberate their options in the most effective way.

Women who have BRCA1 and BRCA2 mutations are usually grouped into a “BRCA1/2” category, but the researchers cautioned that the likelihood of developing certain cancers can be significantly varied across those groups.

Women with BRCA1 mutations have a 67 percent average risk of breast cancer and 45 percent risk of ovarian cancer by the time they turn 80 years old, whereas women with BRCA2 mutations have a comparable risk of breast cancer (66 percent) but only a 12 percent likelihood of developing ovarian cancer.

According to the researchers, breast cancer patients with BRCA1 mutations are frequently considered to have high-grade and estrogen-receptor-negative tumors, whereas women with BRCA2 mutations are for the most part estrogen-receptor-positive. Since certain medications that reduce risk are only available for women with estrogen-receptor-positive disease, grouping the two mutation types into a single category may limit the preventative options available to BRCA2 women.

When it comes to ovarian cancer, it usually develops sooner and with greater frequency among women with the BRCA1 mutation. The current guidelines recommend that women with BRCA1 and BRCA2 mutations who are finished having children should have their ovaries and Fallopian tubes removed between 35 and 40 years of age, but women with BRCA2 mutations might be able to delay that until they are 45 years of age since they only have a 1 percent risk of ovarian cancer by 50.

The researchers — who published their article today in the New England Journal of Medicine — are calling for more studies that investigate how women decide on the best treatment as well as studies that evaluate the short- and long-term psycho-social and clinical impact that surgery, taking risk-reducing medication, and surveillance can have on women.

To read this article in its entirety on HealthCare Business Daily News, click here.

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

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

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 — indictors 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.

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.

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.

“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.”

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.”

To read this article by Memorial Sloan Kettering Cancer Center, click here.

Scientists Find New Gene Fault Behind Ovarian Cancer

Women who carry an inherited fault in the gene BRIP1 are over three times more likely to develop ovarian cancer than those without the fault, according to a study published in the Journal of the National Cancer Institute.

Around 18 women in every 1,000 develop ovarian cancer, but this risk increases to around 58 women in every 1,000 for women with a fault in the BRIP1 gene. It’s estimated that one in every 1,000 UK women have the gene fault.

“We urgently need ways to detect ovarian cancer early, as the cancer is often diagnosed when it’s too late for effective treatment because the cancer has already spread.” – Nell Barrie, Cancer Research UK

This is because faults in the gene mean the cell cannot properly repair its DNA, causing genetic damage to build up, leading to cancer.

The study, led by Cancer Research UK scientists from the University of Cambridge, UCL and Imperial College London, also showed that women who carried the BRIP1 gene mutation were more likely to be diagnosed with an aggressive cancer, at a later stage and tended to be diagnosed at an older age.

The researchers compared the genes of more than 8,000 white European women – including around 3,250 women diagnosed with ovarian cancer, 3,400 women who did not have cancer and 2,000 women who had a family history of the disease.

Professor Paul Pharoah, professor of cancer epidemiology at the Cancer Research UK Cambridge Institute, said: “Our work has found a valuable piece of the puzzle behind ovarian cancer and we hope that our work could eventually form the basis of a genetic test to identify women at greatest risk.

“Finding these women will help us prevent more cancers and save lives. This would be important in a disease like ovarian cancer, which tends to be diagnosed at a late stage when the chances of survival are worse.”

Each year in the UK around 7,100 women are diagnosed with ovarian cancer and more than 4,200 women die from the disease.

Nell Barrie, Cancer Research UK’s senior science information manager, said: “Research like this, which looks at inherited genetic changes and how they can affect a woman’s risk, is vital. We urgently need ways to detect ovarian cancer early, as the cancer is often diagnosed when it’s too late for effective treatment because the cancer has already spread. We hope this research will lead to a reliable way to spot women at a high risk, so they can be monitored to find any signs of the disease at an early stage.”

To read this entire press release on Cancer Research UK, click here.