As part of Ovarian Cancer Awareness Month, we take a look at the issues affecting not only awareness of the illness, but also current ovarian cancer treatment, screening and research.
The statistics for ovarian cancer are frightening. Whereas early detection tests for breast cancer are relatively commonplace, 75-85% of women with ovarian cancer are diagnosed only at a late stage, when the cancer has spread and prognosis is poor.
About 22,000 women are diagnosed with ovarian cancer each year and more than 14,000 die annually from this disease. A woman has a 1 in 70 risk of being diagnosed with ovarian cancer in her lifetime.
As there is no effective surveillance technique for detecting early stage ovarian cancer, physicians are focused instead on identifying women at risk and finding effective preventive methods.
Identifying women at risk
“It isn’t clear what can be done to improve the early detection of ovarian cancer,” Dr. Robyn Andersen, an expert in ovarian cancer symptoms and screening at Fred Hutchinson Cancer Research Center in Seattle, WA, told Medical News Today, adding:
“Scientists are working on tests, but there is no simple procedure or screening test to recommend right now for most women. We don’t know of anything that works really well, but there are a few things that can be done that we believe will help women in high-risk families – that’s part of the reason for making sure high-risk women know that ovarian cancer is a possible problem.”
Of particular concern to Dr. Andersen is raising awareness among women of the genetic factors that can contribute to ovarian cancer risk.
In a recent study published in the journal Behavioral Medicine, Dr. Andersen and her colleagues at Fred Hutchinson found that 75% of women at high risk for BRCA mutations were unaware that these gene mutations increase chance of ovarian cancer.
What is more well known, however, is that BRCA1 and BRCA2 increase risk for breast cancer.
Surveying 1,900 Seattle-area women aged 35-80 with family histories that suggest BRCA mutations, Dr. Andersen’s study found that only about 22% of high-risk women and 7.4% of moderate-risk women were aware that they were at increased risk of developing ovarian cancer.
Given that the respondents were located in an area that has high levels of education and health awareness, as well as good access to genetic counseling and testing, Dr. Andersen hypothesizes that awareness among women in areas with less education and fewer resources may be even worse.
So why is this at-risk group largely unaware of their risk for ovarian cancer, which Dr. Andersen describes as being “in many ways, the more frightening cancer”?
Dr. Andersen suggests it could partly be an issue of media representation.
“Sometimes people write about the BRCA mutations as genes for breast and ovarian cancer but often they don’t, and even when an article does include ovarian cancer as a risk, often only breast cancer makes the headline,” she says.
However, breast cancer is the more common cancer – about 1 in 8 American women develop breast cancer during their lifetime.
Also, while a BRCA1 mutation will increase risk of ovarian cancer by 50%, the increased risk of breast cancer from this mutation is higher, at 87%.
“Even in families with multiple family members affected by BRCA1- or BRCA2-linked cancers, most of the cancers in a family – frequently all of the cancers in the family – have been breast cancer,” admits Dr. Andersen. “Of course people pay attention to that.”
Connection between breast cancer and ovarian cancer ‘not intuitive’
It may not be intuitive for women who have family members with breast cancer to assume that they are also at risk for ovarian cancer. “The connection to ovarian cancer is something that patients need to be educated about,” says Dr. Andersen, adding that it is not surprising patients do not make the connection between breast cancer and ovarian cancer if their doctors do not tell them.
“I really think this is an issue for doctors and other providers (gynecologists, internists, any primary care provider) and for medical care systems,” she stresses.
“Yes, we can also try and inform the general public that BRCA mutations are risks for both cancers, but this is an issue for a small percentage of women, and asking about a family history should be routine at least in mammography settings if not also in primary care. It seems appropriate for the doctors to provide medical advice about cancer risk based on learning a woman’s family history, just as they would provide advice when responding to her symptoms or a high blood pressure reading.”
Dr. Andersen says it should be routine for doctors to refer their patients to a genetic counselor if there are multiple relatives with breast or ovarian cancer.
Yet, in her study, only 15% of women considered to be at high-risk received genetic counseling about their cancer risk during the study period 2006-08.
New biomarker for ovarian cancer identified
An area that may allow earlier detection of ovarian cancer is screening for biomarkers. Recent research from A*STAR’s Institute of Medical Biology in Singapore identifies a new biomarker of ovarian stem cells.
This molecule, called Lgr5, resides on a subset of cells in the ovarian surface epithelium. Previously, Lgr5 has been used to identify stem cells in the intestine and stomach, but this is the first time the molecule has been identified in the ovary.
The epithelial cells that produce Lgr5 also control the development of the ovary, and detaching this biomarker should allow ovarian cancer to be diagnosed earlier.
In addition, the A*STAR researchers have conducted a bioinformatics analysis on cancer genomics data and found a gene that they believe could be an effective prognostic marker of patient survival.
This gene, called Checkpoint Kinase 2, is associated with poor response to existing cancer treatments. The researchers hope that its identification will encourage the development of personalized medicine for ovarian cancer patients.
Hyperthermic intraperitoneal chemotherapy – new treatment at phase 2 trial stage
One new treatment that has reported positive results in initial trials is hyperthermic intraperitoneal chemotherapy (HIPEC).
HIPEC is an innovative take on chemotherapy delivery, where, instead of chemotherapy circulating throughout the body, it is delivered directly to cancer cells in the abdomen.
To do this, a chemotherapy “bath” heated to 41-42 degrees Celsius is circulated throughout the abdomen for 1.5 hours before being drained from the body.
The solution is delivered after tumor-removing surgery, with the aim of destroying any remaining, undetected cancer cells that could form into a new tumor. Heating the solution improves the ability of the chemotherapy to be absorbed into the cancer cells.
In HIPEC, because the chemotherapy is targeted to the cancerous area, without affecting the rest of the body, doctors are able to deliver higher doses of chemotherapy than normal without increasing side effects.
Currently being tested as a first-line treatment for ovarian cancer, patients who are interested in participating in this phase 2 trial can enroll by contacting Mercy Medical Center at 410-332-9294 or emailing Chief Surgical Oncologist Dr. Armando Sardi at [email protected]
Written by David McNamee