HCPLive Network

Ovarian Cancer Screening and Its Role in BRCA Mutation Carriers

In 2009, about 21,550 new cases of ovarian cancer were diagnosed in the United States and 14,600 deaths resulted from the disease, making it the deadliest gynecologic cancer. Of the newly diagnosed cases, 8% to 13% occurred in women with BRCA1 or BRCA2 mutations. Studies have shown that women with BRCA1 mutations have a 39% to 46% lifetime risk of developing ovarian cancer, whereas those with BRCA2 mutations have a lifetime risk of 12% to 20%. This is especially significant when considering that the average lifetime risk of ovarian cancer in the general population is approximately 1.8%.

At the Oncology Nursing Society 35th Annual Congress, Danielle C. Escaleira, RN, MA, OCN, and Danielle Ferrer, RN, BSN, Memorial Sloan-Kettering Cancer Center (MSKCC), New York, New York, presented a poster that described ovarian cancer screening, including who it is recommended for, its effectiveness, the implications for oncology nurse practice, and the significance of BRCA mutations.
 
Ovarian Cancer Screening
Escaleira and Ferrer note that ovarian cancer screening includes a gynecologic examination, transvaginal color-Doppler ultrasonography, and CA-125 screenings twice annually. In high-risk populations, screening should be initiated at age 30 to 35 years or 5 to 10 years earlier than the youngest age at which an individual’s family member received an ovarian cancer diagnosis. After the patient completes bearing children or reaches age 40, risk reduction surgery (RRS) should be discussed.
 
The MSKCC Experience
Escaleira and Ferrer note that identifying BRCA mutation carriers is important because there may be benefits to screening, and they relay the findings regarding BRCA mutation carriers treated at MSKCC between 1995 and 2001. Of the 62 BRCA mutation carriers who underwent surveillance, 22 (35%) had at least one abnormal ultrasound or CA-125 screening. Of the 10 with persistent abnormalities, 5 were found to have ovarian or Fallopian tube cancers (4 were Stage I or II) and 5 had benign findings. In addition, 2 patients who had normal screenings were found to have cancer during RRS.
 
Conclusions
Escaleira and Ferrer conclude that equivocal evidence suggest that screening can detect ovarian cancer at an early stage, when the chance for cure is greatest; however, they warn that there is no evidence yet to suggest that screening results in a survival benefit in women who carry BRCA mutations. They also suggest that until further data become available, “ovarian cancer screening should only be though of as a bridge until a woman with a BRCA mutation is ready to undergo RRS.”


Further Reading
Dronabinol, commonly used as a nausea treatment, could be effective treatment for non-cardiac chest pain patients.
A considerable proportion of patients who did not meet the Seventh Report of the Joint National Committee blood pressure management goals do meet the new goals based on the 2014 expert panel recommendation, according to a study published in the Dec. 2 issue of the Journal of the American College of Cardiology.
Pneumococcal conjugate vaccine 13 should be administered to certain children aged 6 through 18 years who are at high risk of invasive pneumococcal disease, according to a policy statement published online Nov. 24 in Pediatrics.
Related CE/CME
More Reading
Dronabinol, commonly used as a nausea treatment, could be effective treatment for non-cardiac chest pain patients.