Clinical Trials for Ovarian Cancer
Dear OncoLink "Ask the Experts,"
Do you have any information as to how I can be involved in the latest trials for ovarian cancer? My mother died 2 years ago with the disease and would therefore like to refer myself onto a screening program.
Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:
About 5-10% of ovarian cancer cases appear to be hereditary, that is, they arise in families with multiple members affected by ovarian, breast, colon, or uterine cancer. Two major syndromes of familial ovarian carcinoma have been described:
- hereditary breast-ovarian cancer which has been linked to mutations in the BRCA1 and BRCA2 genes,
- and ovarian cancer associated with hereditary nonpolyposis colon cancer (HNPCC) or Lynch II syndrome, which has been linked to mutations in the DNA mismatch repair genes.
For women who are members of hereditary ovarian cancer families, the National Cancer Institute (NCI) Consensus Statement on Ovarian Cancer recommends screening for ovarian cancer with annual physical examination, transvaginal ultrasound, and a blood test for CA125. Patients with two or more first-degree relatives with ovarian cancer should undergo evaluation by a genetic counselor or gynecologic oncologist, with plans for screening individualized to each patient. Though CA125 blood tests and transvaginal ultrasounds are commonly obtained to screen for ovarian cancer, no definitive evidence exists to show that these tests can actually improve the survival of women ultimately diagnosed with the disease.
Patients at high risk for ovarian cancer have options to try to decrease their risk for developing the disease. For patients with mutations in BRCA1 and BRCA2, oral contraceptives have been shown to decrease the risk of ovarian cancer without increasing the risk of breast cancer. Because of this data, physicians may recommend oral contraceptives to women at high risk. Patients with documented genetic mutations, as well as others with a strong family history of ovarian cancer might consider prophylactic surgery to remove the ovaries once they have completed childbearing. Surgery should be undertaken only after careful counseling, with the understanding that removal of the ovaries does not eliminate a woman's risk for developing primary peritoneal carcinoma, a condition similar to ovarian cancer, which may occur in 2 to 3% of women following prophylactic surgery.
For your particular situation, I would recommend you first consult your gynecologist for recommendations for screening. Clinical trials and formal screening programs vary locally, and I would recommend you ask your physician, or consult a department of gynecologic oncology at a major university hospital near you.
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