Abstract
A study recently published in Cancer has revealed a two-stage screening strategy that is highly specific for detecting early-stage ovarian cancer.
The single-arm, prospective study included 4051 postmenopausal women who participated over 11 years and had an annual blood test to track changes in CA125 levels, a known tumor marker in ovarian cancer. Using the Risk of Ovarian Cancer Algorithm, the researchers put the patients into three groups: women who were at low risk would have another test in 1 year; those at intermediate risk would have a repeat test in 3 months; and those at high risk were referred to a gynecologic oncologist to receive a transvaginal ultrasound.
The average annual rate for a repeat test in 3 months was 5.8% and the average annual referral rate to a gynecologic oncologist was 0.9%. Of the high-risk group, ten women underwent surgery; four were found to have invasive ovarian cancers, two had low-malignant-potential tumors, one had endometrial cancer and three had benign ovarian tumors. The four women with invasive ovarian cancer had previously had low-risk annual CA125 test values for at least 3 years, meaning that the cancers were detected at an early stage.
This represents a 40% positive-predictive value (95% CI: 12.2–73.8) for detecting invasive ovarian cancer and the specificity was 99.9% (95% CI: 99.7–100).
“…our findings suggest that using a longitudinal (or change over time) screening strategy may be beneficial…”
“The results from our study are not practice-changing at this time; however, our findings suggest that using a longitudinal (or change over time) screening strategy may be beneficial in postmenopausal women with an average risk of developing ovarian cancer,” commented Karen Lu, the lead author of the study from the University of Texas MD Anderson Cancer Center (TX, USA). “We are currently waiting for the results of a larger, randomized study currently being conducted in the UK that uses the same Risk of Ovarian Cancer Algorithm in a similar population of women. If the results of this study are also positive, then this will result in a change in practice.”
– Written by Yasmine Awwad
Sources: Lu KH, Skates S, Hernandez MA et al. A 2-stage ovarian cancer screening strategy using the Risk of Ovarian Cancer Algorithm (ROCA) identifies early-stage incident cancers and demonstrates high positive predictive value. Cancer 119(19), 3454–3461 (2013); New screening strategy may catch ovarian cancer at early stages: www.alphagalileo.org/ViewItem.aspx?ItemId=133821&CultureCode=en
More breast cancer screening needed in younger women
A new study has confirmed previously published recommendations stating the need for increased mammographic screening in younger women to reduce breast cancer mortality and prolong survival.
Previous trials and meta-analyses of breast cancer screening have demonstrated varying rates of mortality reduction, raising questions about the value of screening and whether or not treatment advances have diminished the importance of early detection. A new analysis published online in the journal Cancer has demonstrated that, despite new therapeutic drugs and protocols for treating breast cancer, regular screening is the most efficient way to further reduce the breast cancer mortality rate.
Using a technique known as ‘failure analysis’, which looks backwards from death to discover correlations at diagnosis, researchers at Harvard Medical School (MA, USA) followed 7301 patients with invasive breast cancer, diagnosed between 1990 and 1999, until 2007. Blake Cady (Harvard Medical School) and colleagues analyzed demographics, mammography use, surgical and pathology reports, disease recurrence, and deaths.
The study data suggest that women aged <50 years are the primary group that would receive the greatest benefit from increased cancer screening. The study confirmed that the 20% of the study population who did not receive regular mammograms resulted in 71% of confirmed breast cancer deaths. The majority of those who died from breast cancer had never received a mammogram prior to diagnosis, showing that treatment is not necessarily the primary survival factor. Furthermore, documented breast cancer deaths occurred in 50% of women aged <50 years, compared with 13% of those >70 years of age. The median age at diagnosis for those who died of the disease was 49 years of age, but 72 years of age for any other cause of death.
The current CDC recommendations suggest that women aged 40–49 years discuss screening mammograms with their doctor. The importance of undergoing regular screening is only emphasized in those aged >50 years, despite recommendations from the American Cancer Society, American Congress of Obstetricians and Gynecologists, American College of Radiology and Society of Breast Imaging for greater use of mammographic screening in all women aged ≥40 years.
As aggressive tumors are found more frequently in younger women, the study suggests that increasing screening in this age group would be of therapeutic benefit as, although great progress has been made in breast cancer therapeutics, early detection is still an essential factor in increasing survival. “This study should effectively end confusion over when, and particularly if, women need to begin screening,” commented Murray Rebner, president of the Society of Breast Imaging (VA, USA). “While these findings cannot bring back those already lost, they clearly demonstrate that mammography saves lives, and many more deaths can be avoided through regular screening.”
According to the study, if recommendations are followed, the breast cancer mortality rate could decrease to 5% by 2030.
Sources: Webb ML, Cady B, Michaelson JS et al. A failure analysis of invasive breast cancer: Most deaths from disease occur in women not regularly screened. Cancer doi:10.1002/cncr.28199 (2013) (Epub ahead of print); American College of Radiology press release: www.newswise.com/articles/acr-sbi-statement-on-cancer-study-more-breast-cancer-screening-needed-in-younger-women; CDC Breast cancer screening: www.cdc.gov/cancer/breast/basic_info/screening.htm
Worldwide analysis confirms the benefits of cardiac stents in women
Cardiac stents are used to reopen blocked arteries of the heart, relieving chest pain. Stents have been used for many years; however, only now has a global pooled analysis, conducted by researchers from the Mount Sinai Medical Center (NY, USA), demonstrated evidence for their benefit in women.
At the European Society of Cardiology Congress 2013 (Amsterdam, The Netherlands), Roxana Mehran (Mount Sinai Medical Center) and colleagues presented the worldwide analysis of over 11,000 female patients involved in 26 randomized stent studies. In cardiac stent clinical trials, women have typically been under-represented with just 25% or fewer of the participants being female.
“This study was not undertaken purely because of the lack of female participants,” states Usman Baber (Mount Sinai Medical Center); however, whether this has affected how heart disease has been treated in women in comparison to men in the past should be considered.
Three different generations of cardiac stent were included in this analysis, all of which were demonstrated to be effective treatments in women. A promising finding was that the newest stent, the drug-eluting stent, was safer in women than the earlier models and correlated with a notable reduction in the need to reopen the artery. Cardiac stent development is therefore progressing in a positive direction and their benefits for women are being confirmed.
Sources: Mehran R, Pocock SJ. Gender Data Forum: safety and efficacy of drug-eluting stents in women: an individual patient-level pooled analysis of 26 randomized trials including 11,557 women. Presented at: European Society of Cardiology Congress 2013. Amsterdam, The Netherlands, 30 August–3 September 2013.
Biomarker index that may accurately identify women at long-term risk of breast cancer relapse
Researchers, led by Dennis Sgroi (Massachusetts General Hospital Cancer Center, MA, USA), have determined that the breast cancer index (BCI) assay reliably identifies women who are at risk of early and late distant recurrence. The study, published in Lancet Oncology, compares the BCI with other prognostic tests investigating their ability to determine which patients are most likely to suffer relapse in future.
The typical treatment for estrogen receptor-positive breast cancer is either an aromatase inhibitor or tamoxifen, over the course of 5 years. Like with many cancers, however, the treatment is not always successful and many women run the risk of relapse in the long term. Being able to identify those women who are more likely to experience breast cancer relapse would be beneficial and influence the prolonged treatment patients would receive.
In the current study, the researchers were comparing the BCI assay with an immunohistochemical prognostic model (IHC4) and a 21-gene recurrence score (Oncotype DX, Genomic Health, CA, USA) to investigate which was the most significant prognostic test for both early and late recurrence of breast cancer. Recurrence was studied over a 10-year period in 665 estrogen receptor-positive tissues from patients already involved in the TransATAC clinical trial.
The study concluded that, although all three prognostic tests could predict the chance of relapse in the first 5 years, only the BCI assay accurately determined those with a risk of long-term recurrence. The assay distinguished between the 60% of patients at low risk from the 40% of patients who were at significant risk in the long term.
The results of this study regarding the accuracy of the BCI could be of great importance for the long-term treatment choice for breast cancer, determining who would benefit from extended endocrine therapy or an alternative treatment option.
Sources: Sgroi DC, Sestak I, Cuzick J et al. Prediction of late distant recurrence in patients with oestrogen-receptor-positive breast cancer: a prospective comparison of the breast-cancer index (BCI) assay, 21-gene recurrence score, and IHC4 in the TransATAC study population. Lancet Oncol. 14(11), 1067–1076 (2013); Biomarker Predicts Long-Term Risk of Breast Cancer Recurrence: www.sciencedaily.com/releases/2013/09/130911184819.htm
Size matters: insight into mental wellbeing and obesity
Obesity is an issue in many countries with approximately 60% of the German population being affected. However, a study published by scientists from the Institute of Health Economics and Health Care Management (IGM; Neuherberg, Germany) and the Institute of Epidemiology II (EPI II; Neuherberg, Germany) reports that, as females’ weight increases, their mental well-being actually improves.
Being overweight can have a negative impact on an individuals physical health and could lead to many serious issues, including diabetes. However, the effect of weight gain on health-related quality of life has not been clearly established. Rolf Holle and his research team (IGM and EPI II) determined the physical health deteriorations that are associated with weight gain while utilizing health-related quality-of-life scores. In a population-based cohort of over 3000 Germans assessed at baseline and after a 7-year follow-up, the study identified a positive correlation between mental health and BMI in females. Heavy weight gain, classed as ≥10%, was associated with deterioration in physical health but an improvement in mental health by more than three points on the health-related quality-of-life score.
These results could provide important information for future research investigating the best methods to treat and prevent obesity, and give insight into how to tackle whether this should be approached differently in women.
Source: Laxy M, Holle R, Döring A, Peters A, Hunger M. The longitudinal association between weight change and health-related quality of life: the KORA S4/F4 cohort study. Int. J. Public Health doi:10.1007/s00038-013-0506-x (2013) (Epub ahead of print).
Reducing the need for surgery in ectopic pregnancy: is a lung cancer drug the answer?
Researchers from the University of Edinburgh (UK) and the University of Melbourne (Victoria, Australia) have investigated the use of a lung cancer drug in combination with the conventional treatment methotrexate as an alternative treatment for ectopic pregnancy. Their results, published in the journal Obstetrics & Gynecology, may lead to a reduction in the number of patients who need to undergo surgery.
Ectopic pregnancy can be a stressful experience with both psychological and physical effects and leads to up to 8% of pregnancy-related deaths. Ectopic pregnancy occurs when an embryo incorrectly implants in the fallopian tube. During the early stages this can be treated with drugs; however, once more developed, a surgical procedure must be undertaken. The conventional drug treatment, methotrexate, acts by affecting the vitamin folate. The investigators instead prescribed methotrexate alongside a lung cancer drug, gefitinib, which blocks a protein involved in promoting cell growth and exists in particularly high levels at the location of ectopic pregnancy.
This combination, tested in a Phase I, nonrandomized, open-label study of 12 women with ectopic pregnancies, proved to be more effective at curing ectopic pregnancy then methotrexate alone. This was determined by examining human chorionic gonadotrophin decline. In the University of Edinburgh press release, Andrew Horne (University of Edinburgh) comments, “reducing the treatment time for women who do not need surgery would also have a significant impact in reducing the emotional stress of such a diagnosis.”
This combined treatment could significantly reduce the need to remove the fallopian tubes and aid the patients’ level of fertility. The results of this small, preliminary clinical trial support the need for the implementation of a larger scale study to examine the safety and efficacy of the treatment more closely.
Sources: Skubisz MM, Horne AW, Johns TG et al. Combination gefitinib and methotrexate compared with methotrexate alone to treat ectopic pregnancy. Obstet. Gynecol. doi:10.1097/AOG.0b013e3182a14cfb (2013) (Epub ahead of print); Study could help treat ectopic pregnancies: www.ed.ac.uk/news/2013/ectopic-090913
In brief…
About the Bulletin Board
The Bulletin Board highlights some of the most important events and research in the field of women's health. If you have newsworthy information, please contact:
Hannah Branch, Commissioning Editor, Women's Health, Future Medicine Ltd,