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New Criteria Finds 87 Percent of Ovarian Cancer in
Older Women Without Symptoms
March 24, 2006 - In the largest study of its kind,
researchers found new criteria for detecting ovarian cancer malignancy
in postmenopausal women, 55 to 74 years old. Utilizing the new criteria,
researchers determined that they could accurately predict 93 percent of
the advanced ovarian cancers and 87 percent of the early ovarian cancers
in asymptomatic women enrolled in an annual screening program and found
to have an abnormal screen.
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Reporting on the study today at
the Society of Gynecologic Oncologists 37th Annual Meeting on Women's
Cancer, researchers said they used this new criteria successfully with
women enrolled in an annual screening program and found to have an
abnormal screen.
The study, "Determining the Risk of Ovarian
Malignancy in Postmenopausal Women with Abnormal Findings in the PLCO
Screening Trial: A Guide for Physicians," was led by Edward E.
Partridge, M.D., University of Alabama at Birmingham, Birmingham, AL.
"Until we have an accurate screening test to
identify ovarian cancer in asymptomatic women, we must have guidelines
to help doctors evaluate common test abnormalities and detect the
malignancy with as much precision as possible," said, Dr. Partridge.
"The results of this study are immediately useful for guiding
interpretation of ultrasound and CA-125 abnormalities in asymptomatic
postmenopausal women."
Early diagnosis of ovarian cancer is vital to
reducing mortality. This is the largest prospective cancer screening
study to evaluate the risk of malignancy in an exclusively
postmenopausal population, ages 55-74, when there are no symptoms. This
study is particularly noteworthy because the described screening tests
(ultrasound and CA-125) are immediately available to women today.
"The dilemma we face with screening for a disease
with low prevalence, like ovarian cancer, is false positive results,"
commented Dr. Andrew Berchuck, co-director of the Breast/Ovarian Cancer
Program of the Duke University Comprehensive Cancer Center. "This study
is important because it provides guidelines to better interpret the
ultrasound and CA 125 testing we have available. Accurate interpretation
of test results could ultimately help to save the lives of
postmenopausal women who do not present with symptoms but have ovarian
cancer, as well as save women who receive ambiguous results from
invasive surgery when there is no real malignancy."
"These new guidelines are a significant step
forward in the fight against women's cancers," explained Dr. Partridge.
"We hope this will encourage further efforts to validate and refine
these criteria in other populations so more women can be properly
diagnosed and treated for ovarian cancer."
Ovarian cancer is the leading cause of death from
gynecologic malignancies, according to the American Cancer Society.
Annually, over 22,000 women in the U.S. will develop ovarian cancer and
more than 16,000 will die from this disease.
Science Overview
Results from the first three years of The Prostate, Lung, Colorectal and
Ovarian (PLCO) Cancer Screening Trials were reviewed to establish
scoring criteria for distinguishing malignant from benign processes.
Women enrolled in the study had annual screening
for lung, colorectal and ovarian cancer. Although historically a CA-125
level over 35 has been considered abnormal, the authors found that a
CA-125 of greater than 65 was the best predictor of ovarian cancer in a
postmenopausal asymptomatic woman with an initial abnormal screen. In
follow-up screening the following criteria, applied in a hierarchical
manner, appear to be accurate at detecting malignancy:
● CA-125 > 65;
● Or a CA-125 increase of > 40 points;
● Or a CA-125 change of > 10 with an ovary/cyst > 3 cm:
● Or an ovary/cyst change of > 6.5 cm.
Using the above criteria for a single screen, 15 of
the 20 cancers in the initial or baseline screening group (T0) would
have been detected.
The study found that subsequent annual screenings
provided the opportunity to compare current CA-125 levels and/or
transvaginal ultrasounds (TVU) findings with the previous screen.
Utilizing the above criteria for distinguishing benign from malignant
masses in women with more than one screen, doctors would have been able
to detect all 29, or 100 percent of the women with invasive cancer.
"Determining the Risk of Ovarian Malignancy in
Postmenopausal Women with Abnormal Findings in the PLCO Screening Trial:
A Guide for Physicians," was conducted by Edward E. Partridge, M.D.,
University of Alabama at Birmingham, Birmingham, AL; Robert T. Greenlee,
Marshfield Clinic Research Foundation, Marshfield, WI; Thomas L. Riley,
Information Management Services, Inc., Rockville, MD; Craig Williams,
Information Management Services, Inc., Rockville, MD; Lawrence R. Ragard,
Westat, Rockville, MD; Jian-Lun Xu, National Cancer Institute,
Rockville, MD; Saundra S. Buys, Huntsman Cancer Institute, Salt Lake
City, UT; and Philip C. Prorok, National Cancer Institute, Rockville,
MD.
The 2006 Annual Meeting on Women's Cancer is the
premier educational and scientific event for physicians and health care
professionals involved in the field of gynecologic oncology and is being
held March 22 - 26 at the Palm Springs Convention Center in Palm
Springs, California. For more information visit,
www.sgo.com.
About SGO
The SGO is a national medical specialty organization of physicians who
are trained in the comprehensive management of women with malignancies
of the reproductive tract. Its purpose is to improve the care of women
with gynecologic cancer by encouraging research, disseminating knowledge
which will raise the standards of practice in the prevention and
treatment of gynecologic malignancies and cooperating with other
organizations interested in women's health care, oncology and related
fields. The Society's membership is primarily comprised of gynecologic
oncologists, as well as other related medical specialists such as,
medical oncologists, radiation oncologists and pathologists. SGO members
provide multidisciplinary cancer care including chemotherapy, radiation
therapy, supportive care and surgery. More information on the SGO can be
found at
www.sgo.com.
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