Is it talc or asbestos?

"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.gov/pmc/articles/PMC3766843/)

But the FDA believes some study parameters may have flaws. As a result, they funded their own cosmetic talc study in 2017. The agency should publish the study’s results sometime in spring 2019".

Does fertility treatment increase the risk of cancer?

"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 monitoring of this population is essential".

In addition it was noted that:-

"Increased risks of ovarian tumours were limited to women with endometriosis, low parity, or both".

Does risk reducing surgery increase survival and reduce the risk of ovarian cancer?

"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 evidence that RRSO  may increase overall survival and lower HGSC  and breast cancer mortality for BRCA1 and BRCA2 carriers. Very low-certainty evidence suggests that RRSO reduces the risk of death from HGSC and breast cancer in women with BRCA1 mutations".

The conclusions are qualified as follows:-

"These results should be interpreted with caution due to questionable study designs, risk of bias profiles, and very low-certainty evidence".

Medicare-funded cancer genetic tests: a note of caution

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 for heritable germ-line mutations in seven genes: the two major genes involved in breast and ovarian cancer predisposition (BRCA1 and BRCA2); the breast (but probably not ovarian) cancer predisposition gene PALB2; and four genes (STK11, PTEN, CDH1 and TP53) in which mutations are associated with breast cancer, but which often present with a non-breast cancer phenotype.

 5. Testing of these additional genes in the absence of the usual syndrome features should be approached with caution 

 6. Genetic testing is complex and the identification of variants of uncertain significance (VUS) in cancer genes is a major challenge. The more genes you test, the more VUS you will find

 7. The clinician who orders the test must be able to interpret the results and communicate the implications of the results, including the uncertainties, to the patient and their genetic relatives

8. Patients must be well informed and written consent is required before genetic testing"

A podcast with more information is available here

https://www.mja.com.au/podcast/209/5/mja-podcasts-2018-episode-75-genetic-testing-cancer-aprof-judy-kirk

Incidence and mortality

Ovarian cancer

The following material has been sourced from the Australian Institute of Health and Welfare (http://www.aihw.gov.au/)

Estimated number of new cases of ovarian cancer diagnosed in 2018

1,613

Estimated % of all new cancers in females diagnosed in 2018

2.5%

Estimated number of deaths from ovarian cancer in 2018

1,069 

Estimated % of all female deaths from cancer in 2018

5.1%

Chance of surviving at least 5 years (2010–14)

45%

People living with ovarian cancer in 2013 (diagnosed in the 5 year period 2009 to 2013)

4,096

New cases and deaths

Ovarian cancer was the 8th most commonly diagnosed cancer among females in Australia in 2014. In 2018, it is estimated that it will become the 10th most commonly diagnosed cancer among females.

In 2014, there were 1,395 new cases of ovarian cancer diagnosed in Australia. In 2018, it is estimated that 1,613 new cases of ovarian cancer will be diagnosed in Australia. In 2018, it is estimated that the risk of a female being diagnosed with ovarian cancer by her 85th birthday will be 1 in 77.

In 2016, ovarian cancer was the 6th leading cause of cancer death among females in Australia. In 2018, it is estimated that it will remain the 6th most common cause of death from cancer among females.

In 2016, there were 938 deaths from ovarian cancer in Australia. In 2018, it is estimated that there will be 1,069 deaths. In 2018, it is estimated that the risk of a female dying from ovarian cancer by her 85th birthday will be 1 in 113.

1/9/18, Ovarian cancer statistics

In 2014, the age–standardised incidence rate was 10 cases per 100,000 females. In 2018, it is estimated that the age–standardised incidence rate will remain at 11 cases per 100,000 females. The incidence rate of ovarian cancer is expected to increase with age for females.

In 2016, the age–standardised mortality rate was 6.2 deaths per 100,000 females. In 2018, it is estimated that the age–standardised mortality rate will be 6.6 deaths per 100,000 females. The mortality rate of ovarian cancer is expected to increase with age.

https://ovarian-cancer.canceraustralia.gov.au/statistics