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Ovarian cancer: blood tests and ultrasound scans do not save life. “Women watch out for symptoms”

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Is it possible to reduce the impact of ovarian cancer through screening? The benefits of breast, cervical and colorectal cancer prevention programs are there for all to see. And therefore it is legitimate to ask whether even for a disease for which the 5-year survival is unfortunately only 40%, screening can make a difference.

Genes are needed to save the ovary

by Tiziana Moriconi


To prove this hypothesis, the scientific community has been trying for years to evaluate a reliable monitoring method that detects disease when treatments are still effective, thus saving lives. The latest effort was the English Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), the results of which were published in the Lancet. In a nutshell, screening did not reduce ovarian cancer mortality.

I study

The study was conducted on over 200,000 women who were between 50 and 74 years old at the time of recruitment. The researchers randomly divided them into three groups: in the first – the control, about 100 thousand women – no tests were carried out to detect the disease in time. In the second, about 50 thousand women were subjected to multimodal screening, i.e. an annual dosage of the CA125 protein accompanied by a transvaginal ultrasound (CA125 is a marker whose high levels in the blood can suggest the presence of a tumor, but also a pregnancy. endometriosis or menstruation). In the third group, another 50,000 women were monitored with an annual transvaginal ultrasound. The screening lasted until 2011 and the whole sample was followed for an average of 16 years. Result: the percentage of ovarian cancer cases was the same in all three groups (1%); in the group subjected to transvaginal ultrasound and CA125 dosage, early stage diagnoses were 47% more than in the non-screened group and advanced diagnoses decreased by 24.5%, but despite this no tests led to a reduction in the number of deaths. ā€œUnfortunately, anticipating the diagnosis does not automatically mean reducing mortality […]. The study closed with negative results: ultrasound and Ca125 dosage should not be performed as a screening test, they are of no use. Results from a certain point of view disappointing, but still important, to avoid unnecessary exams and to concentrate research on other tests “, he writes on Twitter Massimo Di Maio, National Secretary of the Italian Medical Oncology Association (Aiom) and Director of Oncology of the Mauriziano Hospital, University of Turin.

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An aggressive tumor from the earliest stages

But how can it be explained? “Even the first and second stage cancers recur in a percentage of 15-30%”, he replies Sandro Pignata, Director of Uro-Gynecological Medical Oncology of the National Cancer Institute IRCCS Pascale Foundation of Naples: “This happens because ovarian cancer tends to attack the peritoneum very early, so we often find ourselves faced with tumors that are only apparently in the initial stage , but which are actually more advanced “.

For the expert, a screening as it was conceived in this study makes no sense: “It is a difficult disease – continues Pignata – and only a very early diagnosis, which occurs before the tumor develops, can lead to a reduction in mortality. This is why I believe that screening, if there is any in the future, will be of the molecular type, that is, capable of highlighting key mutations in cells before the actual tumor develops. An Italian work that studies mutations is heading in this direction. of the p53 protein in tissue collected with Pap Tests: it is still to be demonstrated, but the first data are encouraging “.

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Another message, according to Pignata, is to enhance what we now know can really make a difference, namely to identify people with BRCA mutations: “We must give even more importance to the prevention of hereditary cancers, which can be prevented by identifying patients who carry the mutations. and extending genetic testing to healthy family members. To date this is not a common clinical practice in all regions, and more investment and resources are needed. “

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We can find the tumor early, but it doesn’t help

“UKCTOCS is the first trial to show that screening can detect ovarian cancer early,” said Usha Menon, of the Clinical Trials Unit at University College London and first author of the study. , clearly states that both approaches used did not save lives, so we cannot recommend ovarian cancer screening for the general population using these methods. “

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Pay attention to small changes

While we still cannot count on an effective prevention test, it is important that women pay attention to even small changes or unusual or persistent symptoms. ā€œSymptoms of ovarian cancer can be vague and similar to those caused by less serious conditions, which can complicate the detection of the disease. Whether it’s having to go to the bathroom more often, abdominal pain, bloating, or something else, women need to talk to their doctor. In most cases it will not be cancer, but it is best to check, “added Michelle Mitchell, managing director of Cancer Research UK.” It is often said that ovarian cancer is an insidious and symptom-free tumor, but in fact patients do report often that symptoms were already present months before the diagnosis “, concludes Pignata:” The gynecological examination is essential when you have unusual disorders “.

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