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Ovarian Cancer Prevention and Screening

Menon, Usha, MD, FRCOG; Karpinskyj, Chloe, BSc; Gentry-Maharaj, Aleksandra, PhD

doi: 10.1097/AOG.0000000000002580
Contents: Clinical Expert Series
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There has been much progress in ovarian cancer screening and prevention in recent years. Improved tools that combine genetic and epidemiologic factors to predict an individual's ovarian cancer risk are set to become available for tailoring preventive and screening approaches. The increasing evidence on tubal origins of a proportion of ovarian cancer has paved the way to use of opportunistic bilateral salpingectomy at tubal ligation and hysterectomy in the general population. Clinical trials are in progress to estimate the long-term effects on endocrine function. In women at high risk, risk reducing salpingo-oophorectomy remains the standard of care with the current focus on management of resulting noncancer outcomes, especially sexual dysfunction in younger women. This has led to evaluation of early bilateral salpingectomy and delayed oophorectomy in this population. Meanwhile, modeling suggests that BRCA mutation carriers should consider using the oral contraceptive pill for chemoprevention. In the general population, the largest ovarian cancer screening trial to date, the UK Collaborative Trial of Ovarian Cancer Screening reported a stage shift with annual multimodal screening using the longitudinal CA 125 Risk of Ovarian Cancer Algorithm but not with annual transvaginal ultrasound screening. There was no definitive mortality reduction with either screening strategy compared with no screening. Further follow-up until December 2018 in now underway. Stage shift and higher rates of optimal cytoreduction were also reported during 3- to 4-monthly multimodal screening in the United Kingdom and U.S. high-risk screening trials. Although all agree that there is not yet evidence to support general population screening, recommendations for high-risk screening vary between countries. A key finding from the screening trials has been the better performance of longitudinal algorithms compared with a single cutoff for CA 125. A major focus of ovarian cancer biomarker discovery work has been tumor DNA markers in both plasma and novel specimens such as cervical cytology samples.

Advances in ovarian cancer prevention and screening include improved risk prediction models, mounting use of bilateral salpingectomy, proven stage shift with multimodal screening, superior performance of longitudinal biomarker algorithms compared with cutoffs, and an increasing focus on tumor DNA in both blood and novel specimens such as cervical cytology samples.

Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, United Kingdom.

Corresponding author: Usha Menon, MD(Res), FRCOG, Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, Maple House 1st Floor 149, Tottenham Court Road, London W1T 7DN, UK; email: u.menon@ucl.ac.uk.

Financial Disclosure Prof. Menon has stock ownership and has received research funding from Abcodia Ltd, a UCL spinout company with an interest in biomarkers and commercial rights of the Risk of Ovarian Cancer Algorithm used in ovarian cancer screening. The other authors did not report any potential conflicts of interest.

Continuing medical education for this article is available at http://links.lww.com/AOG/B84.

Each author has indicated that she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.