Endometriosis is protective

Ovarian cancer prognosis in women with endometriosis. A retrospective nationwide cohort study of 32,419 women.

https://tinyurl.com/y376m5jz

 

         Endometriosis is associated with ovarian cancer; the risk of developing ovarian cancer is put at between 5 and 10%. Often the cancer is of the subtypes endometrioid or clear cell cancer. These cancers present earlier and are commonly unilateral.

         It was thought that women who develop ovarian cancer having previously been diagnosed with endometriosis had better survival rates. This study of the Dutch cancer population revealed 32,000 case of ovarian cancer, 6% had suffered from endometriosis prior to diagnosis.

         Those women who had been endometriosis patients were younger and had more easily resected cancer on presentation. Even after allowing for the bias due to the more easily treated disease, having been diagnosed with endometriosis was protective, with survival being two times better than that of other patients who had not.

Smarter risk reduction

Attitudes towards risk‐reducing early salpingectomy with delayed oophorectomy for ovarian cancer prevention: a cohort study

https://tinyurl.com/yyk5q4k4

 

         Risk reduction surgery is being offered more often to reduce the risk of developing ovarian cancer for women who have a genetic predisposition. The level of risk had been set at 10%, meaning that one in ten women would develop ovarian cancer before the age of 60, now women with only a 5% risk are being encouraged to consider surgery.

         Traditionally the operation performed was bilateral resection of ovaries and fallopian tubes. Because of the loss of fertility and premature menopause there has been a move to a two-stage procedure with initial tube resection and delayed removal of the ovaries.

         This study looked at 683 women all of whom had an increased genetic risk of ovarian cancer and half of them had agreed to risk reduction surgery. Of those who did not have operative therapy approximately 50% said they would find the two-stage procedure acceptable.

         Amongst those women who had agreed to have risk reduction surgery almost 10% of premenopausal women, who had initial complete resection, regretted that choice. 

 

Old technology, new purpose

Detection of TP53 Clonal Variants in Papanicolaou Test Samples Collected up to 6 Years Prior to High-Grade Serous Epithelial Ovarian Cancer Diagnosis

https://tinyurl.com/y2oddycf

 

         The cervical or Pap smear was first described in 1928; the ability to detect pre-cancerous change revolutionized the management of cervical cancer preventing millions of deaths. Now DNA testing of Pap smear cells is being promoted as an aid to early diagnosis for ovarian cancer.

         High Grade Serous Ovarian Cancer (HGSOC) is highly lethal, especially because it presents late.  Most HGSOC develops first in the Fallopian tube. A DNA sequence; TP53 clone is a marker for cancer and the precursor.

         This small study of 17 women with HGSOC looked at Pap smears obtained on presentation and in the years prior to diagnosis. 64% (11) of these patients showed the TP53 clone at presentation. 2 of these women had serial Pap smears prior to diagnosis; the clonal marker was present on all the smears, in one case up to 68 months prior to diagnosis.

 

What price a year of life?

 

 

Economic Evaluation of Population-Based BRCA1/BRCA2 Mutation Testing across Multiple Countries and Health Systems

https://tinyurl.com/y3xjl36s

 

         This recent paper, an analysis of the economic value of BRCA genetic screening of the whole population used the Quality Adjusted Life Year (QALY) as a measure of cost. The QALY measures what price is reasonable for an extra year of life without disease. The amount is indeterminate and varies in different countries.

         Society values a QALY less than an individual; Drug companies when promoting their product usually apply a QALY of about $45,000. Non-commercial health interventions may have two QALYs; the social value at about $20,000, the individual payer $25,000.

         The study used the non-commercial criteria and found that in advanced economies the result from whole of population genetic screening for BRCA was cost saving, meaning the economic justification is sound. 

NHS criteria of cost effectiveness