"FDA Approves Olaparib for First-Line Maintenance of BRCA-Mutated, Advanced Ovarian Cancer https://tinyurl.com/yayx3drb On December 19, 2018, the U.S. Food and Drug Administration (FDA) approved the PARP inhibitor olaparib (Lynparza) for the maintenance treatment of adult patients with deleterious or suspected deleterious germ-line or somatic BRCA-mutated advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer who are in complete or partial response to first-line platinum-based chemotherapy. The FDA also approved BRACA analysis CDx to be used by health-care professionals to identify patients with advanced ovarian cancer who have a germ-line BRCA mutation and are eligible for olaparib following response to platinum-based chemotherapy Lynparza (olaparib), a poly ADP-ribose polymerase (PARP) inhibitor, co-developed by AstraZeneca and Merck (known as MSD outside the US and Canada), has succeeded in a phase 3 trial (SOLO-3) held in patients with rel...

  The cost-effectiveness of opportunistic salpingectomy versus standard tubal ligation at the time of cesarean delivery for ovarian cancer risk reduction https://tinyurl.com/ybevpsa4 Opportunistic salpingectomy is a cost-effective strategy recommended for ovarian cancer risk reduction at the time of gynecologic surgery in women who have completed childbearing. https://tinyurl.com/y79oseav We aimed to evaluate the cost-effectiveness of opportunistic salpingectomy compared to standard tubal ligation (TL) during cesarean delivery. In 10,000 women desiring sterilization with cesarean, opportunistic salpingectomy would result in 17 fewer ovarian cancer diagnoses, 13 fewer ovarian cancer deaths, and 25 fewer unintended pregnancies compared to TL. In women undergoing cesarean with sterilization, opportunistic salpingectomy is likely cost-effective and may be cost saving in comparison to TL for ovarian cancer risk reduction.

 “Dietary fiber intake and reduced risk of ovarian cancer: a meta-analysis https://nutritionj.biomedcentral.com/articles/10.1186/s12937-018-0407-1 To the best of our knowledge, this is the first meta-analysis to summarize evidence between total dietary fiber intake and different types or sources of dietary fiber intake and risk of ovarian cancer. The risk of ovarian cancer was reduced by 22% in the group of highest dietary fiber intake compared with the lowest” http://www.eatingwell.com/recipes/17938/holidays-occasions/christmas/ 'We bring gifts of gold, myrrh, and ovarian cancer treatment' https://lra.le.ac.uk/handle/2381/39946 Extracts from Boswellia sp. (Frankincense), used for centuries as herbal medicine in Asia, have known anti-inflammatory properties and anti-cancer potential alone or in combination with other chemotherapies. This suggests that frankincense may be useful for overcoming drug resistance, and it could also lead to an i...

“Effect of Cultural Folk and Religious Beliefs and Practices on Delays in Diagnosis of Ovarian Cancer in African American Women https://doi.org/10.1089/jwh.2018.7031 An individual's beliefs have the potential to affect cancer outcomes both positively and negatively. Religious practices and cultural/folk beliefs may be especially relevant for African Americans (AAs) with cancer. AAs are more likely than whites to have a religious affiliation and more likely to report praying, regardless of whether they identify with a specific religious affiliation. We conducted analyses among AA women in a multicenter case control study of ovarian cancer. Because many cultural/folk beliefs are intertwined with religious beliefs, our analyses evaluated specific cultural/folk beliefs as well as measures of participation in religious practices. We examined whether these beliefs and practices were associated with delays in ovarian cancer diagnosis as indicated by a later stage at d...

“Current Chemotherapy of Ovarian Cancer https://tinyurl.com/yans2wcg Optimal primary chemotherapy of advanced ovarian cancer has not substantially changed over the last few years, in spite of the extensive evaluation of new cytotoxic agents and diverse treatment strategies. The rapid development of drug resistance remains a major clinical challenge for the majority of patients While the combination of carboplatin and paclitaxel remains a well-tolerated and effective standard treatment for newly diagnosed ovarian cancer, there is continued interest in the discovery of new targets, as well as new approaches for inhibiting old targets When patients undergo complete surgical clearance and have a tumor that is limited to the ovary with the finding of clear cell histology, cure would be expected in the vast majority of cases. In contrast, early-stage serous tumors are often high-grade and have a greater risk of recurrence and are perhaps more likely to benefit from adjuva...

“Nuclear Medicine Procedures in Women: Unappreciated Risks to Reproductive Organs? https://doi.org/10.1148/radiol.2018172344 Radiation exposure in imaging include CT, PET, and an increasing number of newer diagnostic and therapeutic radio-pharmaceuticals, used primarily in cancer diagnosis, staging, and treatment are associated with a theoretical increase in the risk of secondary cancer, with younger patients at higher risk than the elderly. Women are particularly vulnerable to medical imaging radiation exposure, although the nature and extent of this vulnerability vary over time and depend on what type of imaging was performed. Accumulating evidence suggests that hormonal changes associated with the menstrual cycle are an underappreciated but avoidable source of vulnerability and risk to female reproductive organs, specifically ovaries, endometrium, and breasts. While it can be argued that the risks of diagnostic nuclear medicine procedures using relatively...

  Evaluating an Asymptomatic Adnexal Cyst Found on Pelvic Ultrasonography https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2714297 “It is well recognized that simple adnexal cysts (thin-walled round or oval cysts with anechoic fluid and through transmission) are almost always benign, but there is hesitancy to ignore these common cysts and not recommend follow-up, particularly when cysts are large or when the patient is postmenopausal. This study determines the risk for malignant ovarian cancer based on ultrasonographic characteristics of masses in the ovaries, including simple cysts. The researchers enrolled 72,093 women who underwent pelvic ultrasonography and identified 210 who were consequently diagnosed with ovarian cancer. Normal ovaries were observed in most women. A simple cyst was the second most common ovarian finding among participants after a normal ovary. Nearly 25% of participants younger than 50 years had a simple cyst, as di...

"Keys to identifying Lynch syndrome" http://www.contemporaryobgyn.net/gynecologic-cancers/keys-identifying-lynch-syndrome “Lynch syndrome is an autosomal-dominant hereditary cancer syndrome that has the same incidence in the general population as the BRCA1/2gene cancer syndrome: 1 in 400 people. Lynch syndrome is not rare, and yet it is under-diagnosed, only about 5% of Lynch syndrome carriers have been identified. The predominant risk associated is colon cancer. Lynch syndrome is caused by a mutation in a DNA mismatch repair pathway. Usually, our healthy genes can detect mistaken genes and repair them as they are growing and multiplying. However, with Lynch syndrome, the healthy cells cannot repair the errant cells, and the body continues to make more flawed cells, which will lead to a cancer. A study from MD Anderson in 2005 reported that up to 71% of women identified as having Lynch syndrome will acquire endometrial cancer (20% risk by age 50) and ...

“Survival of Women With Type I and II Epithelial Ovarian Cancer Detected by Ultrasound Screening” Obstetrics and Gynecology 132(5):1089-1090, November 2018  “The University of Kentucky Ovarian Cancer Screening Trial was initiated in 1987 to determine the effect of annual trans vaginal ultrasonography on stage at detection and ovarian cancer mortality.  Since that time, free screening has been provided to more than 46,000 women (at high risk due to familial factors).  Unscreened women with clinically detected epithelial ovarian cancer referred to the University of Kentucky-Markey Cancer Center for treatment from 1995 to 2017 served as the control group for this investigation. Women who had a normal screen were scheduled to return in 12 months for a repeat screen. Women who had an abnormal screen underwent a repeat ultrasound examination in 4–6 weeks. Criteria for abnormality included an ovarian volume greater than 20cm 3 for premenopausal women ...

" every action has a reaction" "Association of Bilateral Salpingo-Oophorectomy Before Menopause Onset With Medial Temporal Lobe Neurodegeneration" jamaneurol.2018.3057 “Women who undergo bilateral salpingo-oophorectomy (BSO) before the onset of menopause have an accelerated accumulation of multimorbidity, with an increased risk of aging-associated neurological diseases, including dementia Premenopausal oophorectomy–induced oestrogen deficiency is thought to be the primary cause of the increased risk of cognitive impairment or dementia in women with BSO before the onset of menopause.  Alzheimer Disease (AD) biomarker abnormalities have been observed more frequently in women undergoing menopause compared with premenopausal women, after controlling for age. Neurology. 2007;69(11):1074-1083 In our study, 96% of the women with BSO were treated with estrogen (primarily oral conjugated equine estrogen), for a median of 10 years after BSO; however, t...

“Association between contemporary hormonal contraception and ovarian cancer… “ https://www.bmj.com/content/362/bmj.k3609 “Previous research has shown a reduced risk of ovarian cancer in users of combined oral contraceptives, an effect that persists for many years after stopping use. Changes have occurred in formulations of combined oral contraceptives (notably reductions in oestrogen dose and the introduction of newer progestogens). It is important for users of contemporary combined oral contraceptives to know whether they are likely to experience the same pattern of ovarian cancer benefit as users in the older studies. The Danish Sex Hormone Register Study follows a national cohort of women aged 15-79 years. It was established to investigate the relation between hormone use and the risk of cancer or cardiovascular disease. We calculated age standardised incidence rates of ovarian cancers per 100 000 person years, using the age distribution of the cohort as...

World Ovarian Coalition   This information comes from: -                  https://www.eurekalert.org/pub_releases/2018-10/wocc-doo101518.php "The World Ovarian Cancer Coalition Every Woman Study is the largest ever review of the experiences of women with ovarian cancer and includes contributions from the clinical community. It presents a bleak picture of the challenges faced by women with ovarian cancer, and those who care for them. Nine in ten of the women in the Every Woman Study experienced symptoms prior to diagnosis and of these, eight in ten consulted a doctor - though less than half within a month and one in ten waited six months. Across the world, diagnosis took an estimated average of 31 weeks from a woman experiencing symptoms to her diagnosis; for one in ten women diagnosis came more than a year after visiting a doctor. A survey participant in Australia said "Governments need to do more regarding G...

“Familial risks of ovarian cancer….” This information comes from:-        https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0205000 “Ovarian cancer risk increases with aging and peaks between the ages of 50 and 80 years. In the general Swedish population, the lifetime risk of ovarian cancer is 1%.  Family history is a strong risk factor for ovarian cancer, and the relative risk is estimated to be 2.0 to 4.0 for those that have a first-degree relative affected by the disease In this study, we use the recent national Swedish Family-Cancer Database, which included 16.1 million individuals, to estimate the familial risks of ovarian cancer by age at diagnosis, affected relative (mother or sisters) and histology. In families of only mother, only sisters or both mother and sisters diagnosed with ovarian cancer, cancer risks for ovary were 2.40, 2.59 and 10.40, respectively; and were higher for cases diagnosed before the age of...

This information comes from:- https://today.uic.edu/crosstalk-between-fallopian-tube-ovary-may-drive-the-spread-of-ovarian-cancer- - https://www.cancer.gov/news-events/cancer-currents-blog/2017/ovarian-cancer-fallopian-tube-origins "Over the last several years we have come to learn that ovarian cancer cells, specifically high-grade serous ovarian cancer cells, originate in the fallopian tube and migrate to the ovary where they become established as ovarian cancer.  We don’t know yet what the fallopian tube signals to the ovary, but we know that it causes the ovary to release norepinephrine, which signals cancer cells to migrate. - There is a window of several years between the development of abnormal cells, or lesions, in the fallopian tubes and the start of ovarian cancer Most of the genetic alterations seen in ovarian tumors in these patients were present in serous tubal intraepithelial carcinomas (STICs) that had formed years earlier in their fallopi...

"Poly (ADP-ribose) Polymerase Inhibitors (PARPi)  in the Management of Ovarian Cancer"   This information comes from https://www.ptcommunity.com/journal/article/full/2018/9/549/poly-adp-ribose-polymerase-inhibitors-management-ovarian-cancer-drug - https://www.eurekalert.org/pub_releases/2018-09/waeh-dpw092618.php "Familial and hereditary factors have been identified in the development of some cases of ovarian cancer, with approximately 10% to 15% of ovarian cancer cases associated with inherited mutations of the BRCA1 and BRCA2 genes. Upon recurrence of disease, the goal of treatment is no longer curative, but instead becomes palliative, aimed at improving disease-related symptoms, prolonging survival, and trying to improve quality of life. For patients harbouring a BRCA1/2 mutation, medications targeting PARP enzymes may be an effective therapeutic option. PARP is a family of enzymes that mediate DNA repair... PARP inhibition in the settin...

"FDA Funds Cosmetic Talc Study on Ovarian Cancer Risks" This information comes from:- https://www.drugjustice.com/news/talcum-powder/cosmetic-talc-study-ovarian-cancer/ "Cosmetic talc verdicts awarded billions to plaintiffs with ovarian cancer or mesothelioma over the past year. In all cases, the plaintiffs say regular talcum powder use (which contains cosmetic talc) led them to develop terminal cancer. However, some plaintiffs say asbestos (not cosmetic talc itself) may be the real culprit". "Scientists published the first study linking talcum powder to ovarian cancer in 1971( J Obstet Gynaecol Br Commonw. ). In the study, researchers dissected ovarian tumors and discovered talc particles embedded in 75% of them. Since then, dozens of different researchers validated that first study’s results. This includes a 2013 case-control study stating regular perineal talc use increased women’s ovarian cancer risk by 33%.( https://www.ncbi.nlm.nih.g...

"Risks of ovarian, breast, and corpus uteri cancer in women treated with assisted reproductive technology in Great Britain, 1991-2010: data linkage study including 2.2 million person years of observation"  This information is taken from:- bmj.k2644 This is a massive study looking at the cancer risk in all women in the UK who underwent fertility treatment during the period 1991-2010. The incidence of breast, uterine and ovarian cancer in treated women was compared with the normal. The conclusions were:- "No increased risk of corpus uteri or invasive breast cancer was detected in women who had had assisted reproduction, but increased risks of in situ breast cancer and invasive and borderline ovarian tumours were found in this study. Our results suggest that ovarian tumour risks could be due to patient characteristics, rather than assisted reproduction itself, although both surveillance bias and the effect of treatment are also possibilities. Ongoing m...

"Risk-reducing bilateral salpingo-oophorectomy  in women with BRCA1 or BRCA2 mutations" This information is taken from this source of reference:- 30141832 The decision whether  to undertake major surgery has become a difficult choice for women who face the increased risk of  high grade serous ovarian (HGSC) and breast cancer due to genetic factors. The scientific basis remains unclear. This reference is a meta-analysis of the available literature. A meta-analysis is a review of all available information with statistical assessment to determine the significance. In this instance 10 studies were reviewed with about 3000 women who have the genetic mutations BRCA1 and/or BRCA2 (breast cancer 1 and 2 gene) and elected to have risk-reducing salpingo-oophorectomy (RRSO)  and about 5000 women who also have BRCA1 or BRCA2 mutation who did not have the surgery. The Author's conclusion included the following statement:- "There is very low-certainty ...

This information is taken from  https://www.mja.com.au/journal/2018/209/5/medicare-funded-cancer-genetic-tests-note-caution#tbox1 "these tests are now being mainstreamed and they can be ordered for selected patients, with a new Medicare benefit, by non-genetic specialists in either public or private practice".  " Breast cancer genetic tests: key points" "1.Genetic testing is not necessary for most women with breast cancer, but it should be considered in those with breast cancer at a younger age and those with a relevant family history   2. From 1 November 2017, several new Medicare Benefits Schedule (MBS) item numbers cover the cost of breast and ovarian cancer-related genetic testing, when the defined criteria are met   3.  Eligibility for the MBS rebate is based on a quantitative algorithm indicating that the patient is at > 10% risk of having a pathogenic mutation identified  4.  The item numbers cover testing fo...