Birth control pill lowers ovarian cancer risk: study By Michael Kahn - (Reuters- 24/01/2008)

Birth control pills can protect women against ovarian cancer for 30 years or longer after they stop taking them and have so far prevented 100,000 ovarian cancer deaths worldwide, British researchers said on Thursday. The longer women stay on the pill, the lower their risk of developing the disease, which is more common after age 50, the researchers wrote in the journal Lancet. For example, women who take the pill for 15 years cut their risk in half, they said. Worldwide the pill has already prevented 200,000 women from developing cancer of the ovary and has prevented 100,000 deaths from the disease, Valerie Beral of the University of Oxford and colleagues wrote in their report.

The findings are the strongest evidence yet of the benefits of the pill when it comes to ovarian cancer, and show the protection lasts far longer than people had thought, Beral said. "When you are 60 it matters whether you took it for five years or 10 years in your twenties," Beral said in a telephone interview. "The longer you took it, the better off you are when the risk of ovarian cancer is high." An estimated 300 million women have used the contraceptive pill since its introduction in the early 1960s. Hundreds of studies have looked at its safety, some suggesting benefits and others showing a raised risk of breast and cervical cancer.

Beral and colleagues said their research, analyzing 45 studies on ovarian cancer in 21 countries, shows that the benefits of the pill outweigh the risks. Ovarian cancer is particularly deadly because women often have mild or no symptoms until the disease has progressed. The breast cancer risk -- which also extends to stroke and blood clots -- is much smaller and exists only while women are taking the pill and soon after they stop, Beral added. "Whereas for ovarian cancer the protection persists for decades," Beral said.

Taking the pill for 10 years cut the risk of ovarian cancer before the age of 75 from 12 per 1,000 women to 8 per 1,000. It also reduced the risk of dying from the disease from 7 per 1,000 women to 5 per 1,000 before the age of 75, the study found. More than 100 million women now take the pill, so it will eventually prevent more than 30,000 ovarian cancer cases annually over the next few decades, the researchers wrote. The study also showed ethnicity, education, family history and other factors do not seem to make much difference in reducing risk when it comes to using the pill. The researchers said they did not know exactly why the pill provides protection but said the benefits make sense because the drug suppresses the ovaries' function when women are taking it. Worldwide there are more than 190,000 new cases of ovarian cancer a year, the International Agency for Research on Cancer says.

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New Guidelines Should Improve Ovarian Cancer Detection- (HealthDay- 28/10/2007)

Ovarian cancer has long had a reputation as a silent killer, because many people believed it gave no warning signs until far advanced. But women suffering from the disease knew differently. They knew they had certain symptoms that were common from patient to patient."Survivors for years have said there are symptoms for the disease, but no one listened to them," said Jane Langridge, chief executive officer for the National Ovarian Cancer Coalition. Now, doctors have agreed with them.

A screening test has been developed that, in one study, accurately detected early stage ovarian cancer 57 percent of the time. Based on that and similar studies, experts from the American Cancer Society, the Gynecologic Cancer Foundation and the Society of Gynecologic Oncologists have agreed on a set of symptoms that can be signs of early ovarian cancer.

"We want people to know it's not the silent killer. There are symptoms women can bring to their doctors that are important to pay attention to," said Dr. Linda Duska, a member of the National Ovarian Cancer Coalition's medical advisory board and a gynecologic oncologist at Massachusetts General Hospital Cancer Center, in Boston. "This agreement is significant in the fact that, maybe if we pay more attention to symptoms, we can catch them sooner and have more success in treating them," she continued.

Early detection of ovarian cancer is crucial. More than 22,000 U.S. women will be diagnosed with the disease this year, and three-fourths of them -- more than 15,000 -- will die from it, according to the National Cancer Institute. If caught in the early stages, the five-year survival rate for ovarian cancer is 90 percent. But 75 percent of women are still diagnosed in the advanced stages, when the prognosis is poor.

Ovarian cancer is the eighth most common cancer among American women, not including skin cancer, according to the American Cancer Society. An estimated two-thirds of women with ovarian cancer are 55 or older. "It is a disease that is detected in stage 3 and above, and that is unacceptable," said Sherry Salway Black, executive director of the Ovarian Cancer National Alliance and a survivor of the disease. "Our mortality figures are unacceptable."

The symptoms of ovarian cancer can be subtle and hard to assess, because they often mimic common digestive and gastrointestinal disorders. They include persistent swelling, bloating, pressure or pain in the abdomen, gastrointestinal upset, difficulty eating or feeling full quickly, and the frequent or urgent need to urinate. Because these symptoms are so common, women should be careful not to assume the worst, Duska said. "The goal of this is not to make everyone think they have ovarian cancer," she said. "If women have these symptoms, and they persist over time, they should have them investigated. Everyone with bloating does not have ovarian cancer."

Typically, two or more symptoms occur simultaneously and increase in severity over time, according to the National Ovarian Cancer Coalition. The screening test developed late last year involves an extensive checklist of symptoms and their frequency. It picked up early stage ovarian cancer 56.7 percent of the time, and late stage ovarian cancer 80 percent of the time. The test also produced "false-positive" findings 10 percent to 13 percent of the time. The test searches for many of the symptoms agreed upon by cancer experts as indicative of ovarian cancer.

"When women go to their doctors and have had some of these symptoms, and they are new and have persisted for two or more weeks, perhaps a doctor now would be willing to perform some pretty simple tests to rule out ovarian cancer," Langridge said. Women who have a family history of breast or ovarian cancer are at increased risk and should pay particular attention to the symptoms, Duska said. Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy. Advances in chemotherapy have made the late-stage disease more survivable, Duska said. In a more intensive regimen recently shown to improve survival, standard intravenous chemotherapy is combined with chemotherapy injected directly into the abdominal cavity. The abdominal injection exposes hard-to-reach cancer cells to higher levels of chemotherapy than can be reached intravenously. "That was a breakthrough, I think," Duska said. Other treatments being explored include new chemotherapy drugs, vaccines, gene therapy and immunotherapy, which boosts the body's own immune system to help combat cancer, according to the Mayo Clinic.

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National Effort To Preserve, Restore Fertility In Women With Cancer Underway( Science Daily- 17/09/2007)

The Oregon National Primate Research Center and the Oregon Health & Science University School of Medicine have been named to a national team of institutions hoping to preserve or restore fertility in women battling cancer. The Oncofertility Consortium, funded for five years by the National Institutes of Health, features participants from five universities and comprises researchers, physicians, engineers, educators, social workers and medical ethicists.

"Biomedical research has helped save the lives of many women battling cancer," explained Richard Stouffer, Ph.D., director of the research team at OHSU. Stouffer also directs ONPRC's reproductive sciences division and is a professor of obstetrics and gynecology in the OHSU School of Medicine. "However, the powerful chemotherapy drugs and radiation used to beat cancer can also result in a loss of reproductive function, which is a tremendous blow to young cancer patients who hope to have children. The bottom-line goal for this research team across the United States is to help these women through various avenues including research, treatment and counseling." 

Additional members of the OHSU research team include Mary Zelinski, Ph.D., an affiliate assistant scientist at ONPRC, and David Lee, M.D., an assistant professor of obstetrics and gynecology, reproductive endocrinology and infertility in the OHSU School of Medicine. Together the scientists are working on methods for restoring fertility in cancer patients by studying rhesus macaque monkeys who have reproductive systems very similar to humans. Specifically, the team is hoping to gain additional understanding about the growth of follicles in the ovaries and either to preserve or restart this function. Follicle growth is necessary for the development of oocytes (fertile eggs) in the ovaries. 

Past research has demonstrated that cancer therapies often destroy follicles in the ovaries, thereby reducing fertility. Working with researchers at Northwestern University and University of Missouri-Columbia, the OHSU group will investigate methods to freeze and store monkey ovary tissue and, following thawing, to grow follicles in culture or to promote follicle growth after transplantation back into the monkey. In 2004 Lee and colleagues published results in the journal Nature demonstrating great strides in re-establishing fertility in a rhesus macaque monkey after ovarian tissue transplantation that resulted in a successful birth. This research aims to build upon these earlier findings. 

"Because this is a relatively new field, OHSU is home to one of the only fertility preservation programs in the country," explained Lee, who serves as director of the OHSU Fertile Future Program. "Past fertility research milestones at OHSU include our research in monkeys who underwent ovarian tissue transplantation and also human studies such as the first human pregnancy from frozen-thawed eggs.  While the Oregon researchers conduct their research, other team members at the University of California, San Diego; the University of Pennsylvania, the University of Missouri-Columbia and the lead institution: Northwestern University will conduct additional studies. These studies will relate to preserving reproductive tissues for future transplantation, studying human follicles, and global and social studies of the oncofertility issue.

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Ovarian Cancer Screening Methods Inaccurate-(HealthDay- 7/11/2006) 

Two methods used to screen women for suspected ovarian cancer may identify too many false-positive test results to be useful, researchers conclude. The tests -- transvaginal ultrasound (TVU) and a screen for a protein biomarker called CA-125 -- can be used alone or together and do find cancers, a new study shows. But they also falsely identify too many 'cancers' where malignancy is not present. These false-positive results often lead to unnecessary surgeries, the researchers report in the Nov. 15 issue of the American Journal of Obstetrics and Gynecology.

Ovarian cancer is the seventh-leading cancer diagnosed in women, but because it is usually diagnosed so late it remains one of the most deadly, according to the American Cancer Society. Over 22,000 U.S. women are diagnosed with the disease each year, and more than 16,000 die from ovarian malignancies annually. Because accurate detection is key to saving lives, researchers have long sought a reliable test to identify tumors early on.

"The goal [of this study] was to determine whether screening for ovarian cancer could detect ovarian cancer at an early enough stage to increase the likelihood of cure," said lead author Dr. Saundra S. Buys, the co-director of the Family Cancer Assessment Clinic at the Huntsman Cancer Institute in Salt Lake City, Utah. "So far, it's too early yet to draw those conclusions, because we need more follow-up," she added. The long-term goal of the trial is to see if screening with TVU and/or CA-125 decreases ovarian cancer mortality in women ages 55 to 74, Buys noted.

In the study, called the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, Buys' team collected data on nearly 29,000 healthy women screened with TVU and/or a CA-125 blood test. Among these women, 1,338 had an abnormal TVU and 402 had an abnormal CA-125 blood test. In addition, 34 women received abnormal results on both tests. Despite the high number of abnormal test results, Buys' group found just 29 tumors, of which 20 were invasive cancers, the researchers report. In all, 570 women underwent a surgical procedure, but 541 did not end up having cancer. Given these results, "it does not appear that screening for ovarian cancer the way it was done in this trial is something that should be applied to the general population," Buys said.

"The biggest problem is if a lot of women go out and get these tests, there will be many more women who are going to get surgery who don't have ovarian cancer," Buys said. "And some of those surgeries have complications." Buys noted that the same high incidence of false-positives is also seen when these tests are used to screen for prostate and lung cancer. She recommended that instead of having these screenings, women should pay attention to their overall health. "If they have any abdominal symptoms, they should go to their doctor and get them fully evaluated," she said.

"It may be appropriate to screen for ovarian cancer in women who have abdominal symptoms, but for women who have no medical symptoms, doing screening for ovarian cancer results in a lot of false-positives," Buys said. In addition, Buys advises women to keep their weight at a healthy level and to get plenty of exercise. "And pay attention to any new symptoms or problems that develop," she said. One expert believes that in time a better screening test will be found.

"Screening for ovarian cancer is difficult, and unfortunately, several trials utilizing CA-125 markers and transvaginal ultrasounds have suggested that these methods are both inadequately sensitive and inadequately specific for widespread utilization in the general population," said Dr. Robert Morgan, Jr., the section head of medical gynecologic oncology at City of Hope Cancer Center, Duarte, Calif. This study showed that many women underwent invasive surgical procedures and were found to have benign conditions, while only a few women with invasive ovarian cancer were detected with early, more curable disease, Morgan noted.

"All, however, is not bleak," Morgan said. "For many years it was thought that early-stage ovarian cancer did not give symptoms. Several papers published in the past four to five years, however, have shown that 90 percent of women with early-stage ovarian cancer do have symptoms." The problem is that the symptoms are usually non-specific abdominal or urinary symptoms or discomfort during sexual activity, Morgan said. "However, persistent non-specific symptoms that occur in women, usually for only a few months, in patients who previously didn't have any symptoms, require more investigation by their physicians," he said.

Morgan added that more is being done to detect bloodstream markers, which will make screening more specific and more sensitive. "I am sure that with more research, early screening for ovarian cancer will become a reality, and we will be able to treat increasing numbers of patients for cure of this difficult disease," he said.

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Radical Surgery Best Option For Most Ovarian Cancer Patients With Cancer In Diaphragm(Yahoo News)

 In a retrospective study looking back at a decade of surgeries, Mayo Clinic Cancer Center researchers have determined that surgery to remove metastatic disease from the diaphragm, in conjunction with other procedures to remove the primary diseased tissue in ovarian cancer patients, significantly increases survival rates. Study results were published in Gynecologic Oncology online.

"Surgeons have long believed that removing as much diseased tissue as possible is important for survival of cancer patients," said William Cliby, M.D., associate professor of obstetrics and gynecology at Mayo Clinic. "The choice of many surgeons to not resect diaphragm disease in ovarian cancer patients seemed counterintuitive, but it was based on the feeling that it might not improve survival. We sought to address this issue."

Dr. Cliby's team cited lack of evidence of survival benefit, concerns over safety (related to complexity and length of the surgery) and lack of surgeon experience as justifications often given for not proceeding with diaphragmatic surgery in advanced ovarian cancer patients. This study provided strong evidence of survival benefit. The five-year survival rates for patients with diaphragm disease who had optimal residual disease (less than 1 cm) was 55 percent for those undergoing diaphragm surgery versus 28 percent for those who did not.

The study group included 244 consecutive patients with primary ovarian cancer who were operated on at Mayo Clinic from 1994 through 1998 and from Aug. 1, 2002, through Aug. 31, 2004. Dr. Cliby and his colleagues found that at Mayo Clinic, the rate of diaphragm procedures for affected patients increased from 22.5 percent in the first period compared to 40 percent in the more recent period. They attribute this to increased surgeon experience, increased recognition of the importance of maximal effort for tumor resection and the cooperative working relationships with other surgical specialties at Mayo Clinic that provide the opportunity to train interdepartmentally and improve surgical techniques. "We hope to continue improving upon our ability to remove cancer disease from all affected areas," said Dr. Cliby. "With each operation, our surgeons become better equipped to handle the most difficult of surgeries, providing hope for more patients."

The researchers conclude that while health issues in some patients will complicate the success of surgery in general, and prevent the option of radical surgery, surgeons should work to increase the rate of tumor reduction, including diaphragm surgery, in appropriate cases. In addition to Dr. Cliby, the research team included Giovanni Aletti, M.D.; Sean Dowdy, M.D.; and Karl Podratz, M.D., Ph.D.

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Women spot ovarian cancer signs early -(Reuters)

Many women with ovarian cancer complained of symptoms up to a year before diagnosis, but their doctors did not order the right tests for the fast-growing tumor until later, researchers said on Monday.Elderly women with ovarian cancer were at least twice as likely to visit a doctor and report symptoms such as abdominal swelling or pelvic pain, Dr. Lloyd Smith of the University of California at Davis School of Medicine in Sacramento and colleagues reported in Monday's issue of the journal Cancer. "Our findings suggest that ovarian cancer could be diagnosed earlier in some patients," Smith said in a statement.

For their study they looked at the claims records of 1,985 elderly women with ovarian cancer, 6,024 elderly women with breast cancer, and 10,941 Medicare-enrolled women of the same age without cancer. They compared diagnosis codes -- which doctors write down when making insurance or Medicare claims -- and claims for diagnostic procedures. They found about 40 percent of the women had physician claims indicating one or more visits for abdominal or pelvic symptoms before their ovarian cancer was diagnosed.

While abdominal pain and swelling are not always symptoms of ovarian cancer, the disease is especially deadly because it usually is diagnosed after it has spread. And it is a tumor that grows quickly, progressing from early to advanced stages in as little time as a year, so speedy diagnosis is key. This year, more than 22,000 women in the United States will be diagnosed with ovarian cancer and more than 16,000 will die of it, according to the American Cancer Society, which publishes Cancer.

It can be diagnosed with pelvic imaging, or a blood test for a protein called CA-125, although neither of these tests will detect all cases of ovarian cancer.
The CA-125 test catches about half of early, Stage I ovarian cancers and is inadequate when used alone to diagnose early ovarian cancer. For patients with later, Stage II, III or IV disease, the test is 80 percent accurate in detecting cancer.Another 20 percent of ovarian cancer patients never have increased CA-125. Only 25 percent of the ovarian cancer patients had pelvic imaging or CA-125 tests between three years and four months before diagnosis, Smith's team found.

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