Alcohol Consumption and Breast and Ovarian Cancer Development: Molecular Pathways and Mechanisms https://tinyurl.com/39h72xhz A link between alcohol consumption and increased risk of breast cancer is well known. It now is becoming clear that a similar association with  ovarian cancer exists albeit less clear cut. Alcohol abuse is common , it is estimated that alcohol is the cause of 5% of a ll deaths. The exact mechanism of increased cancer risk remains uncertain. Recent understanding suggest s  that   in the case of ovarian cancer three important mechanisms are responsible. These are ; hormonal modulation,  DNA damage , and cellular  oxidation . Alcohol is metabolised in the liver ,   w ith acetaldehyde as an in termediate product. Both these substances can damage DNA and disrupt r epair. The presence of alcohol in the body causes oxidative  stress, with an imbalance of free ra dicals and antioxidants . In good health free radicals ,  which are o...

The prognostic influence of hospital type, method of first histological confirmation and time to chemotherapy in patients with advanced primary ovarian cancer https://tinyurl.com/cburpu7d There is a constant effort to improve the management of ovarian cancer.  It is clear that the  best chance of complete cure is at the time of the  initia l  surgery. If the cancer can be completely cleared ,  survival is more likely. Towards this end a proposed change in management has been developed,  w it h a two-stage process ,  whereby   an  initia l  limited procedure is performed ,  to obtain a tissue biopsy ,  prior to complete clearance. This review of 115 women with ovarian cancer ,  looks at whether there is any difference in outcome when the two- stage process is used. Also, the hospit al type where the first procedure  occurred  may be significant ,  in that complete surgery at a centre  of excellence has b...

Outdoor Air Pollution Exposure and Ovarian Cancer Incidence in a United States–Wide Prospective Cohort Study https://tinyurl.com/yjzydbdz Ever increasing rates of cancer in young patients has raised the concern that this is a consequence of pollution. For the fi rst time evidence supporting this theory  in  relation to ovarian  cancer  is available. Pollution presents  mainly in  two forms: particulate material such as   micro plastics  and  sulphur ,   or gaseous such as nitrous dioxide  and  ozone . Using information from the” Sisters ” study ,  which enrolled  more than 50,000 women who had at least one sister with a history of breast cancer, it  was possible to show how rates of ovarian cancer varied in relation to different geographic areas, with different pollution   levels. Results from this prospective analysis showed a positive association with increased nitrous dioxide levels but no association wit...

Cost and Clinical Implications of Utilizing Homologous Recombination Deficiency Status to Guide First-Line Maintenance Therapy Selection in Advanced Ovarian Cancer https://tinyurl.com/yrydv7t8 With success comes overuse. A typical example of this is the widespread use of enzyme inhibitors ,  such as PARP i in ovarian cancer ,  for women who because of their genotype are unlikely to have any benefit. The current cost in the US to treat 100 women with PARPi for ovarian cancer is  just over  $US 62 million for the 5-year treatment course.  This imposes a   strain on personal and community finances. If these patients are screened  using a biomarker guide (BMG), th e  cost overall is reduced ,   (by  17.5%),  de spite the  significant cost   of performing  BMG  on  100 women . Savings f ro m treatment also include reduced clinical costs due to prolonged survival and better health.  For  costly tre atmen...

Timing of Palliative Care, End-of-Life Quality Indicators, and Health Resource Utilization https://tinyurl.com/yc2bf5p3 For most  ovarian  cancer patients  and their carers  there comes a time for acceptance and a need for support and compassion.  This is best provided through Palliative  C are  (PC) . This study looks at the benefits to the individual and  community  which result from earlier referral to  P C . Retrospective analysis of the outcomes of more than 8000 women with ovarian cancer showed   survival of  about 3 years with death around the age of  Seventy .  98%   of these women received P C .  One third of the women did not start PC before the last 3 months of life There was a significant difference in the amount of aggressive end-of - life care ,  with f ewer admissions to ICU, consultations with specialists ,  and  less  late  stage  chemotherapy  for those wo...

Regulatory histories of recently withdrawn ovarian cancer treatment indications of 3 PARP inhibitors in the US and Europe: lessons for the accelerated approval pathway https://tinyurl.com/3mrm6z4r The recent decision by the FDA to withdraw  access to PARP inhibitors for patients with recurrent ovarian cancer has raised issues about the  approval process and questions about the efficacy of these drugs Personalised therapy with enzyme inhibitors such as  PARPi  has revolutionised the treatment of  ovarian cancer. The success, in terms of increased survival ,  led to pressure for the use of such drugs to be expanded beyond the  initial   target group to more women. Real-world experience often causes reappraisal of the  benefits  and it is now clear that use of  PARPi  for treat ment of recurrent ovarian cancer increases  the likelihood  of major adverse effects such as marrow suppression .   A   decrease in su ...

Ovarian cancer risk among older patients with stable adnexal masses https://tinyurl.com/5fytnf57 Benign ovarian masses are common .  About  30% of women  with a normal menstrual cycle will develop an ovarian mass .   F or women with irregular menstruation   this figure increases to 50%. It is important to recognise this and avoid invas ive surgery. This study looks at older women  of  over 50 years  in  age and  demonstrates  that ,   for   s table  tumours smaller than 10 cm in size ,  there is a low likelihood of cancer . Almost   5000  women  in this age group ,   presented to one community health organisation with ovarian masses ,  during the period  2016-2020 . Of whom, more than 4000  had a stable appearance at  repeat ultrasound examination 6 weeks  later .   Those women ,  with stable appearances ,  did not have surgery.  During the almost 4...

Reducing ovarian cancer mortality through screening: an impossible dream? https://tinyurl.com/4524jh8f The history of screening tests for ovarian cancer is not good. Two huge trials; the UKCTOCS with  more than 200,000 recruits over 20 years and the PLCO trial with more than 3 million pathology samples  sho wed no benefit in terms of survival from ovarian cancer. This article addresses the stages of ovarian cancer using  an alternative approach called the clinical continuum,  which divides cancer into 3 phases ,  no disease, pre-clinical  (detectable disease) , and  clinical (overt cancer). Obviously for a screening test to be effective ,   cancer needs to be detected before the clinical  phase. However, ovarian cancer is unlike other cancer in that the precursor occurs in the fallopian tube and the re is an argument to say that ,  by the time ovarian cancer has occurred ,  it is always advanced and metastatic .   T his time in...

The Gut Microbiome in Ageing and Ovarian Cancer https://tinyurl.com/yk8nt6w6 Ovarian cancer is mostly a disease of the seventh decade. The reasons for this are unclear. One suggestion is that changes in the Gut bacterial flora or microbiome may be associated. This review looks at which bacteria become more common with age and which decrease. Using data from previously published material, it is clear that bacteria which increase inflammatory change become more common, and that bacteria which assist oestrogen metabolism decrease. The overall complexity of the microbiome changes with age, with some loss of diversity. However, no correlation of ovarian risk to bacterial diversity has been shown. Most women with ovarian cancer receive antibiotic therapy during chemo, this has been shown in mice to change the microbiome and decrease survival from ovarian cancer. No definite association between ovarian cancer and the aged microbiome is known but the inflammatory changes and altered oestrogen ...

FIGO position statement on opportunistic salpingectomy as an ovarian cancer prevention strategy https://tinyurl.com/4db8sj3y The importance of pre-cancerous change in the fallopian tubes as a precursor to ovarian cancer has  led to suggest that removal of the fallopian tubes at the time of other abdominal surgery is  a significant protective measure. Now FIGO ,  (The Internationa l Federation of Obstetrics and Gynaecology) have  issued a position statement saying they firmly support this. Evidence for this position is linked to  pilot studies in Canada which showed significant reduction in subsequent ovarian cancer  rates  when the tubes were removed at the time of hysterectomy, (this is not usual pra ctice).  In addition ,  an Austrian study showed good acceptance of additional surgery .   W hen women facing gallbladder removal were offered tube resection ,  60% accepted .   T he  average increase in operating time was 13...

The impact of inter-cycle treatment delays on overall survival in patients with advanced-stage ovarian cancer https://tinyurl.com/mrxpksk9 Many patients with ovarian cancer have interruption of their chemo. This may occur because of adverse side effects of treatment,  or  external factors  such as other priorities  and  logistic issues. This interruption may cause anxiety which can be expressed as concern that the chemo is less effective. This retrospective study looked at more than 1500 women with advanced ovarian cancer first diagnosed  during the period 2015-2019. The two-year survival for women who had an  uninterrupted chemo  course was  compared to those whose chemo was unavoidably  disrupted. Disruption is common with 37% having breaks of at least 7 days . No difference in survival was seen in the two groups. Knowledge that chemo is just as effective despite interruption means that factors which affect the patient's quality of l i...

Study Finds Nearly $70 Billion in Socioeconomic Losses Across 11 Countries Attributable to Ovarian Cancer https://tinyurl.com/4spw37yz Ovarian cancer is extremely costly to the individual, the state and the family of each patient. This  study uses a true cost of illness app roach to assess the annual economic burden of each case of ovarian cancer in  high-, middle-, and low-income  countries. Factors included in this determination include cost of treatment , the opportunity cost of loss of productivity for the individual and the carers and t he  often-forgotten  cost of unpaid carer time. The sums are  mind-boggling  with an estimate of almost $70 Billion  total   annual  expenditure and indiv i d ual costs of  up to 120 times the usual health expenditure per capita for low-income countries . Obviously, there  is concern about whether this is sustainable and shows the urgent need to reduce the incidence of ovarian cancer.

Impact of metformin, statins, and beta blockers on survival in patients with primary ovarian cancer: combined analysis of four prospective trials of AGO-OVAR and ENGOT/GCIG collaborators https://tinyurl.com/597m54hb Anecdotal experience has previously suggested that off-label   use of s ome commonplace drugs may improve survival for patients with ovarian cancer . This meta-analysis of 4 prospective  randomised  t rials  looks at the effect of some of these . Data was obtained from the trials which recorded use of the  additional  drug tre atment. The prime purpose of the trial s  having been  assessment of efficacy of the enzyme inhibitor ,  Pazopanib . From the data ,  patients could be subdivided into two groups; those who had received  additio nal  drug therapy and those who had not. Finding from the results show that  use of o f f-label drugs was associated with great er  co-morbidity. Neither metformin  or ...

Incidental Findings of Borderline Ovarian  Tumo u r  or Ovarian Cancer -Real-World Data on Surgical and Oncological Outcome https://tinyurl.com/5n8284dj Sometimes ovarian cancer is found by chance during surgical procedures performed for other reasons. The standard of care for such cases is to undergo a repeat surgical procedure at a specialised surgical oncology centre.  This study looks at real-world cases and seeks to determine whether this course of action results in worse outcomes.  This retrospective survey of 390 patients at Bern Hospital  during a 10 - year period from 2010 showed 228 cases of either borderline ovarian  tumour or  ovarian cancer. The outcomes for these women were compared to those  for women who were known to have ovarian cancer prior to single stage surgery at the same centre. Apart from a small delay in starting chemo for those women who has a second operation ,  no  difference in outcomes which include morbidi...

Charlson’s comorbidity and remission outcomes in women diagnosed with epithelial ovarian cancer. https://tinyurl.com/2hmnmvp9 Any surgery carries risk. Complex surgery such as that required for total clearance of o varian cancer has a mortality of  4 % . For some women this risk is increased by pre-existing medical conditions known as comorbidity. This retrospective cohort study seeks to measure the risk inc rease in the presence of comorbidity. Using the Char l son  comorbidity index, which shows associated significant  pre-existing disease as a  risk factor, even the lowest measure at more than 1 significantly decreased the pro s pect of complete  remission  and survival  f rom  ovarian cancer. This means that patients who have one or more other major health issues are less likely to benefit from  intensive primary treatment and that maybe alternative therapy ,  such as maintenance  with personalised car e  should be consider...