This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hogg, R. Articles by Friedlander, M. Search for Related Content PubMed PubMed Citation Articles by Hogg, R. Articles by Friedlander, M.

Biology of Epithelial Ovarian Cancer: Implications for Screening Women at High Genetic Risk

From the Gynaecologic Cancer Centre, Royal Hospital for Women and the Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia.

Address reprint requests to Michael Friedlander, PhD, FRACP, Department of Medical Oncology, Prince of Wales Hospital, High St, Randwick, NSW 2031, Australia; e-mail: m.friedlander{at}unsw.edu.au

PURPOSE: Our aim was to analyze the clinicopathologic features of screen-detected ovarian cancers identified in women, either at general population risk or high genetic risk of ovarian cancer, who have participated in screening studies.

METHODS: Studies published between 1988 and April 2003 were categorized by the population screened and the primary screening modalities used. Each report was examined with reference to the histologic type, stage, and grade of screen-detected cancers. Reports of studies of prophylactically removed ovaries from women at high risk of ovarian cancer were also reviewed.

RESULTS: Of the stage I tumors detected by screening women at population risk, almost half were borderline ovarian tumors, granulosa-cell tumors, or germ-cell tumors, which is disproportionate to their frequency. Furthermore, of the stage I invasive epithelial cancers diagnosed in women at population risk, the majority were endometrioid, clear-cell, and mucinous histologic subtypes. Most ovarian cancers that occur in women at high genetic risk are high-grade serous cancers, and these are infrequently screen detected at an early stage.

CONCLUSION: The clinicopathologic features of screen-detected ovarian cancers suggest that screening may not reduce mortality in women at increased genetic risk. Prospective screening studies are required in genetically high-risk populations to answer this important question. Women electing surveillance should be aware of the lack of proven benefit and the low likelihood of detecting early stage serous cancers. Bilateral salpingo-oophorectomy appears to be the most effective approach to decrease the risk of ovarian cancer and thereby reduce mortality in high-risk women.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

This article has been cited by other articles:

				J. I. Weberpals, K. V. Clark-Knowles, and B. C. Vanderhyden Sporadic Epithelial Ovarian Cancer: Clinical Relevance of BRCA1 Inhibition in the DNA Damage and Repair Pathway J. Clin. Oncol., July 1, 2008; 26(19): 3259 - 3267. [Abstract] [Full Text] [PDF]

				L. M. Byrd, A. Shenton, E. R. Maher, E. Woodward, R. Belk, C. Lim, F. Lalloo, A. Howell, G. C. Jayson, and G. D. Evans Better Life Expectancy in Women with BRCA2 Compared with BRCA1 Mutations Is Attributable to Lower Frequency and Later Onset of Ovarian Cancer Cancer Epidemiol. Biomarkers Prev., June 1, 2008; 17(6): 1535 - 1542. [Abstract] [Full Text] [PDF]

				M. H. Greene, M. Piedmonte, D. Alberts, M. Gail, M. Hensley, Z. Miner, P. L. Mai, J. Loud, G. Rodriguez, J. Basil, et al. A Prospective Study of Risk-Reducing Salpingo-oophorectomy and Longitudinal CA-125 Screening among Women at Increased Genetic Risk of Ovarian Cancer: Design and Baseline Characteristics: A Gynecologic Oncology Group Study Cancer Epidemiol. Biomarkers Prev., March 1, 2008; 17(3): 594 - 604. [Abstract] [Full Text] [PDF]

				S.-J. Dawson, M. A. Price, M. A. Jenkins, J. M. McKinley, P. N. Butow, S.-A. McLachlan, G. J. Lindeman, P. Weideman, M. L. Friedlander, J. L. Hopper, et al. Cancer Risk Management Practices of Noncarriers Within BRCA1/2 Mutation Positive Families in the Kathleen Cuningham Foundation Consortium for Research Into Familial Breast Cancer J. Clin. Oncol., January 10, 2008; 26(2): 225 - 232. [Abstract] [Full Text] [PDF]

				L. A Devlin and P. J Morrison Inherited gynaecological cancer syndromes Obstet Gynaecol (Lond), January 1, 2008; 10(1): 9 - 15. [Abstract] [Full Text] [PDF]

				M. Fatouros, G. Baltoyiannis, and D. H. Roukos The Predominant Role of Surgery in the Prevention and New Trends in the Surgical Treatment of Women With BRCA1/2 Mutations Ann. Surg. Oncol., January 1, 2008; 15(1): 21 - 33. [Abstract] [Full Text] [PDF]

				T. G. Clark, M. Stewart, T. Rye, J. F. Smyth, and C. Gourley Validation of a New Prognostic Index for Advanced Epithelial Ovarian Cancer: Results From Its Application to a UK-Based Cohort J. Clin. Oncol., December 10, 2007; 25(35): 5669 - 5670. [Full Text] [PDF]

				N. D. Kauff and R. R. Barakat Risk-Reducing Salpingo-Oophorectomy in Patients With Germline Mutations in BRCA1 or BRCA2 J. Clin. Oncol., July 10, 2007; 25(20): 2921 - 2927. [Abstract] [Full Text] [PDF]

				J. V. Lacey Jr, M. H. Greene, S. S. Buys, D. Reding, T. L. Riley, C. D. Berg, R. M. Fagerstrom, and P. Hartge Ovarian Cancer Screening in Women With a Family History of Breast or Ovarian Cancer. Obstet. Gynecol., November 1, 2006; 108(5): 1176 - 1184. [Abstract] [Full Text] [PDF]

				J. B. Madalinska, M. van Beurden, E. M.A. Bleiker, H. B. Valdimarsdottir, J. Hollenstein, L. F. Massuger, K. N. Gaarenstroom, M. J.E. Mourits, R. H.M. Verheijen, E. B.L. van Dorst, et al. The Impact of Hormone Replacement Therapy on Menopausal Symptoms in Younger High-Risk Women After Prophylactic Salpingo-Oophorectomy J. Clin. Oncol., August 1, 2006; 24(22): 3576 - 3582. [Abstract] [Full Text] [PDF]

				I. Jacobs Screening for Familial Ovarian Cancer: The Need for Well-Designed Prospective Studies J. Clin. Oncol., August 20, 2005; 23(24): 5443 - 5445. [Full Text] [PDF]

				D. Stirling, D. G. R. Evans, G. Pichert, A. Shenton, E. N. Kirk, S. Rimmer, C. M. Steel, S. Lawson, R.M. C. Busby-Earle, J. Walker, et al. Screening for Familial Ovarian Cancer: Failure of Current Protocols to Detect Ovarian Cancer at an Early Stage According to the International Federation of Gynecology and Obstetrics System J. Clin. Oncol., August 20, 2005; 23(24): 5588 - 5596. [Abstract] [Full Text] [PDF]

				N. J. Agnantis, E. Paraskevaidis, and D. Roukos Editorial: Preventing Breast, Ovarian Cancer in BRCA Carriers: Rational of Prophylactic Surgery and Promises of Surveillance Ann. Surg. Oncol., December 1, 2004; 11(12): 1030 - 1034. [Full Text] [PDF]

				Z. Wang, C. Yip, Y. Ying, J. Wang, X.-Y. Meng, L. Lomas, T.-T. Yip, and E. T. Fung Mass Spectrometric Analysis of Protein Markers for Ovarian Cancer Clin. Chem., October 1, 2004; 50(10): 1939 - 1942. [Full Text] [PDF]