Monitoring for ovarian cancer is beneficial for high-risk women

The BRCA1 and BRCA2 gene alterations are known to greatly increase a woman’s risk of developing ovarian cancer. Preventative surgery to remove the ovaries and fallopian tubes is currently the only way to avoid the disease.

It is recommended that carriers of the BRCA alterations undergo the procedure from the age of 35 (for BRCA1) or age 40 (for BRCA2). However, as the surgery can lead to infertility and early menopause, many women choose to defer.

The new research, published in the Journal of Medical Genetics, found that regular monitoring can be a short-term option for these women to catch concerning developments at earlier stages, before they develop into a more serious problem.

Dr Adam Rosenthal (UCL EGA Institute for Women’s Health & consultant gynaecologist at UCLH) who led the pilot NHS research programme, known as ALDO (Avoiding Late Diagnosis of Ovarian cancer), said: “Whilst we continue to recommend that all BRCA-carriers should undergo risk-reducing surgery when they feel able to do so, these encouraging results indicate that surveillance is a better option than waiting for symptoms to prompt diagnosis in those women who choose to defer surgery.”

ALDO used a specially designed algorithm called the Risk of Ovarian Cancer Algorithm (ROCA) test to assess regular blood results from the 767 women who underwent surveillance.

The participants had an average age of 40 and were recruited from across England and Wales through the Genetics Centre or Familial Cancer Clinics.

They received a ROCA test every four months during the study period, between October 2019 and November 2020. Depending on each ROCA test result, further tests and clinical assessments may have been needed.

Of the 767 participants, eight had surgery for suspected cancer - six of which had ovarian/fallopian tube cancer confirmed and two women had what turned out to by cysts or endometriosis. Half of the women had their cancers detected before there were visible tumours beyond the pelvis, and all but one had the visible tumour completely removed at surgery.

These results were similar to previous research trials using the ROCA test and indicate that the test diagnoses cancers earlier, when less extensive surgery is needed to remove tumours completely.

The new research paper also includes economic modelling by experts at the London School of Economics, who found that surveillance would increase the amount of time each woman with ovarian cancer enjoyed a good quality of life by around two months.

There would also be a treatment cost saving of around £100,000 for each woman compared with no surveillance, primarily due to a reduction in the use of expensive cancer treatment.

The research was funded by the North Central London Cancer Alliance and research company Abcodia.

Links

• Research in the Journal of Medical Genetics
• Dr Adam Rosenthal’s academic profile
• UCL EGA Institute for Women’s Health
• UCL Population Health Sciences

Image

• Credit: SB Arts Media on iStock

Media contact 

Poppy Danby 

E: p.danby [at] ucl.ac.uk