11 juli 2012: een van de laatste studies naar vroege diagnose van eierstokkanker is deze: Assessment of symptomatic women for early diagnosis of ovarian cancer: results from the prospective DOvE pilot project in de The Lancet maart 2012 gepubliceerd:
Assessment of symptomatic women for early diagnosis of ovarian cancer: results from the prospective DOvE pilot project.
Source
Gynecologic Oncology Unit, McGill University Health Centre, Montreal, QC, Canada. lucy.gilbert@mcgill.ca
Abstract
BACKGROUND:
Around 90% of deaths from ovarian cancer are due to high-grade serous cancer (HGSC), which is frequently diagnosed at an advanced stage. Several cancer organisations made a joint recommendation that all women with specified symptoms of ovarian cancer should be tested with the aim of making an early diagnosis. In the Diagnosing Ovarian Cancer Early (DOvE) study we investigated whether open-access assessment would increase the rate of early-stage diagnosis.
METHODS:
Between May 1, 2008, and April 30, 2011, we enrolled women who were aged 50 years or older and who had symptoms of ovarian cancer. They were offered diagnostic testing with cancer antigen (CA-125) blood test and transvaginal ultrasonography (TVUS) at a central and a satellite open-access centre in Montreal, QC, Canada. We compared demographic characteristics of DOvE patients with those of women in the same age-group in the general population of the area, and compared indicators of disease burden with those in patients with ovarian cancer referred through the usual route to our gynaecological oncology clinic (clinic patients).
FINDINGS:
Among 1455 women assessed, 402 (27·6%) were in the highest-risk age group (≥ 65 years). 239 (16·4%) of 1455 required additional investigations. 22 gynaecological cancers were diagnosed, 11 (50%) of which were invasive ovarian cancers, including nine HGSC. The prevalence of invasive ovarian cancer, therefore, was one per 132 women (0·76%), which is ten times higher than that reported in screening studies. DOvE patients were significantly younger, more educated, and more frequently English speakers than were women in the general population. They also presented with less tumour burden than did the 75 clinic patients (median CA-125 concentration 72 U/mL, 95% CI 12-1190 vs 888 U/mL, 440-1936; p=0·010); Eight (73%) tumours were completely resectable in DOvE patients, compared with 33 (44%) in clinic patients (p=0·075). Seven (78%) of the HGSC in the DOvE group originated outside the ovaries and five were associated with only slightly raised CA-125 concentrations and minimal or no ovarian abnormalities on TVUS.
INTERPRETATION:
The proportion of HGSC that originated outside the ovaries in this study suggests that early diagnosis programmes should aim to identify low-volume disease rather than early-stage disease, and that diagnostic approaches should be modified accordingly. Although testing symptomatic women may result in earlier diagnosis of invasive ovarian cancer, large-scale implementation of this approach is premature.
FUNDING:
Canadian Institutes of Health Research, Montreal General Hospital Foundation, Royal Victoria Hospital Foundation, Cedar's Cancer Institute, and La Fondation du Cancer Monique Malenfant-Pinizzotto.
Copyright © 2012 Elsevier Ltd. All rights reserved.
Comment in
- Screening of symptomatic women for ovarian cancer. [Lancet Oncol. 2012]
- Gynecological cancer: DOvE pilots its way to intriguing results. [Nat Rev Clin Oncol. 2012]
- Screening of symptomatic women for ovarian cancer. [Lancet Oncol. 2012]
- Early detection of ovarian cancer in symptomatic women. [Lancet Oncol. 2012]
- Screening of symptomatic women for ovarian cancer. [Lancet Oncol. 2012]
- PMID:
- 22257524
- [PubMed - indexed for MEDLINE]
11 mei 2005: Bron: Medscape en PNAS doi:10.1073/pnas.0502178102
Een combinatie van vier verschillende eiwitmarkers in het bloed - leptin, prolactin, osteopontin, en insulin-like groei factor-II - geven een 95% betrouwbare diagnostisch beeld van eierstokkanker stadium I en II blijkt uit studie gedaan bij 106 ziektevrije volwassenen en bij 100 volwassenen met reeds gediagnosteerde eierstokkanker. 95% betrouwbaarheid zou een grote vooruitgang betekenen in het vroegtijdig opsporen van eierstokkanker en van grote betekenis kunnen zijn voor de behandeling ervan. De onderzoekers zeggen dat hiernaar nu grootschaliger testen mee uitgevoerd zullen worden.
Serum Protein Panel Accurately Detects Early Ovarian Cancer
NEW YORK (Reuters Health) May 09 - A panel of four serum protein markers accurately detects early ovarian cancer, according to a report in the May 9th PNAS Early Edition. The identification of cancer-specific markers that accurately detect early ovarian cancer is essential for decreasing the morbidity and mortality of this disease, the authors explain. Dr. Gil Mor from Yale University School of Medicine, New Haven, Connecticut and colleagues developed a blood test based on leptin, prolactin, osteopontin, and insulin-like growth factor-II and examined its ability to discriminate between 106 disease-free subjects and 100 ovarian cancer patients, including 24 diagnosed with stage I/II disease. Prolactin and osteopontin levels were significantly elevated in serum from women with early ovarian cancer, the authors report, whereas leptin and insulin-like growth factor-II levels were significantly reduced. These four proteins were able, when used together, to completely discriminate between control and cancer groups in the test sample, the report indicates. Using a split-point analysis (with split points of 2.5 for leptin, 10 for prolactin, 21 for osteopontin, and 491 for insulin-like growth factor-II), the presence of at least 2 abnormal values was associated with a sensitivity of 95%, specificity of 95%, positive predictive value of 95%, and negative predictive value of 94%, the researchers note. "It has been suggested that any screening strategy for early detection must achieve a minimum of 99.6% specificity," the investigators write. "Thus, there is significant need for further improvement of the four-analyte test reported here if the assay is to be used for general population screening." "The extent to which leptin, osteopontin, prolactin, and insulin-like growth factor-II can serve as potential biomarkers of cancers other than early ovarian cancer must be investigated rigorously," the authors conclude. "Nevertheless, the data presented here support the existence of a highly accurate and distinct multiplex proteomic set that can accurately distinguish between normal and early ovarian cancer patients, including stage I and II." PNAS Early Edition 2005. doi:10.1073/pnas.0502178102
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