Report delves into ‘surprising gaps’ found in ovarian cancer research
March 3, 2016 12:00 AM
Shiho Fukada/The New York Times
Deborah Denehy of Amesbury, Mass., received chemotherapy directly to her abdomen to treat ovarian cancer, a treatment that remains underused in the U.S.
Artist: Maura Kearns/Post-Gazette
By Anya Sostek / Pittsburgh Post-Gazette
Ovarian cancer isn’t actually just one type of cancer. It isn’t — as it has been described — “a silent killer.” And it often doesn’t start in the ovaries.
So says a new report from the National Academies of Sciences, Engineering & Medicine — commissioned by Congress — that describes “surprising gaps” in the understanding of ovarian cancer.
“While progress has been made in ovarian cancer research over the last few decades, much remains to be learned,” said Jerome F. Strauss, chair of the committee that carried out the study.
Ovarian cancer accounts for only 3 percent of cancer diagnoses in women but is the fifth-leading cause of cancer-related death. With roughly two-thirds of women diagnosed when the cancer is at an advanced stage, the five-year survival rate for ovarian cancer is less than 46 percent.
Ovarian cancer is actually a “constellation of cancers,” said committee member Heidi Donovan of the University of Pittsburgh School of Nursing, with “emerging evidence around recognizing that ovarian cancer is not a single disease.” The report recommends prioritizing research on one of those types of cancer, high-grade serous carcinoma, which accounts for about 70 percent of deaths.
Recent research shows that most cases of high-grade serous carcinoma actually originate in the fallopian tubes and spread to the ovaries, where the cancer grows and is eventually discovered. “The ability to spread is a marker of an aggressive tumor,” said Ms. Donovan, a professor at Pitt’s nursing school and vice chair of research in the Department of Health and Community Systems. “Once we find them, they’ve already metastasized.”
High-grade serous carcinoma tends to respond well initially to aggressive chemotherapy, she said, but usually recurs within a couple of years.
On the flip side, other forms of ovarian cancer, which are easier to detect and usually caught in earlier stages, might be being overtreated, she said.
“These are really very distinct cancers and need to be treated as distinct cancers — the past practice of lumping them together should be a thing of the past,” she said. “The goal is to get away from giving almost everybody this very toxic chemotherapy.”
Ovarian cancer has been described over the years as a “silent killer,” she said, under the idea that it appears without causing symptoms. She called that a misnomer, noting that most women do actually experience symptoms, but often ignore them as part of daily life. Those symptoms can involve abdominal bloating, cramping, feeling of fullness or urinary problems, and women who experience them for more than two weeks should see their gynecologist and ask about being screened for ovarian cancer.
While there is no effective routine screening for ovarian cancer, women who have symptoms should be tested with a blood test and ultrasound, she said. As for prevention, women with a family history or known genetic risks have the option of surgery, as was publicized by movie star Angelina Jolie. One of the few promising research findings for prevention has come from what are commonly known as birth control pills — women who have taken oral contraceptives for more than five years cut their chance of developing ovarian cancer in half.
The report also delves into the quality of care received by women with ovarian cancer. Less than half of women with ovarian cancer are receiving the recommended standard of care, which is most likely if women are treated by a gynecologic oncologist or at a high-volume hospital or cancer center.
“Ovarian cancer is a disease worth traveling for,” said Ms. Donovan. “This is a missed opportunity for women to achieve twice as long survival rates by accessing experts.”
Anya Sostek: firstname.lastname@example.org or 412-263-1308.
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