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  • Ovarian cancer:

    Proactive approach to symptoms advised

    June 13, 2007 -- Cancer experts have identified a set of health problems that may be symptoms of ovarian cancer and they are urging women who have the symptoms for more than a few weeks to see their doctors.

    The new advice is the first official recognition that the disease, long believed to give no warning until it was far advanced, does cause symptoms at earlier stages in many women.

    The symptoms to watch out for are bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, and feeling a frequent or urgent need to urinate. A woman who has any of those problems nearly every day for more than two or three weeks is advised to see a gynecologist, especially if the symptoms are new and quite different from her usual state of health.

    Doctors said they hoped that the recommendations will make patients and doctors aware of early symptoms, lead to earlier diagnosis and, perhaps, save lives, or at least prolong survival.

    But it is too soon to tell whether the new measures will work or whether they will lead to a flood of diagnostic tests or even unnecessary operations.

    Cancer experts said it was worth trying a more aggressive approach to finding ovarian cancer early. It is among the more deadly types of cancer, because most cases are diagnosed late, after the disease has begun to spread.

    This year, 22,430 new cases and 15,280 deaths are expected in the United States alone.

    If the cancer is found and surgically removed early, before it spreads outside the ovary, 93 percent of patients are still alive five years later. Only 19 percent of cases are found that early and 45 percent of all women with the disease survive at least five years after the diagnosis.

    By contrast, among women with breast cancer, 89 percent survive five years or more.

    The recommendations, expected to be formally announced on June 25, are being made by the Gynecologic Cancer Foundation, the Society of Gynecologic Oncologists and the American Cancer Society.

    More than 12 other groups have endorsed them, including CancerCare; Gilda's Club, a support network for families and friends of cancer patients; and several medical societies.

    "The majority of the time, this won't be ovarian cancer, but it's just something that should be considered," said Barbara Goff, the director of gynecologic oncology at the University of Washington in Seattle and an author of several studies that helped identify the relevant symptoms.

    In a number of studies by Goff and other researchers, those symptoms stood out in women with ovarian cancer as compared with other women.

    "We don't want to scare people, but we also want to arm people with the appropriate information," said Goff, who is also a spokeswoman for the Gynecologic Cancer Foundation.

    She emphasized that relatively new and persistent problems were the most important ones. So, the transient bloating that often accompanies menstrual periods would not qualify, nor would a lifelong history of indigestion.

    Goff also acknowledged that the urinary problems on the list were classic symptoms of bladder infections, which are common in women. But it still makes sense to consult a doctor, she said, because bladder infections should be treated. Urinary trouble that persists despite treatment is a particular cause for concern, she said.

    With ovarian cancer, even a few months' delay in making the diagnosis may make a difference in survival, because the tumors can grow and spread quickly through the abdomen to the intestines, liver, diaphragm and other organs, Goff said. "If you let it go for three months, you can wind up with disease everywhere," she said.

    Thomas Herzog, director of gynecologic oncology at the Columbia University Medical Center in New York, said the recommendations were important because the medical profession had until now told women that there were no specific early symptoms.

    "If women were more proactive at recognizing these symptoms, we'd be better at making the diagnosis at an earlier stage," Herzog said.

    "These are nonspecific symptoms that many people have," he added. "But when the symptoms persist or worsen, you need to see a specialist."

    Although the American Cancer Society agreed to the recommendations, it did so with some reservations, said Debbie Saslow, director of breast and gynecologic cancer at the society.

    "We don't have any consensus about what doctors should do once the women come to them," Saslow said. "There was a lot of hope that we'd be able to say, 'Go to your doctor, and they will give you this standardized work-up.' But we can't do that."

    At the same time, Saslow said, the cancer society recognized that in some cases doctors have disregarded symptoms in women who were later found to have ovarian cancer, telling the women instead that they were just growing old or going through menopause.


  • #2
    June 15, 2007 -- Doctors have made the first breakthrough in the treatment of ovarian cancer in 20 years by proving that a common breast cancer drug can significantly cut relapse rates. Tests using an anti-oestrogen drug on a small group of 44 patients extended some of their lives by up to three years and delayed the use of painful chemotherapy for others. If larger trials repeat the findings it will be the first new therapy since the 1980s for a cancer which is often deadly because early diagnosis is so difficult.

    John Smyth, professor of medical oncology at the University of Edinburgh, said: "This is a landmark. Despite intense scientific research over the past 20 years, there have been few new leads in our understanding of how this disease operates. But this study suggests that the addition of hormone therapy to our treatment strategy could extend and improve the lives of women with cancer."

    Previous studies had all but written off Letroxole as a potential treatment because its impact was too small. But this study carefully selected women whose cancers were the most sensitive to oestrogen. The results were radically better.

    By starving the site of the cancer of oestrogen, Letroxole stopped tumour growth in a quarter of the women for six months, and a third more were able to delay chemotherapy.

    The scientists say they are now able to home in on the women who will respond the best. Experts believe that such "targeting" of cancer therapies is the future for treatment.

    Up to half of ovarian cancers are oestrogen-receptive, a similar mechanism to that which works in many breast cancers. The patients in this study were in the late stages of the disease and the doctors now hope to do large-scale studies of the drug's impact earlier in the disease's progression to see whether it will "catch" it before it reaches the more dire stages.

    "Our hypothesis is that if we used hormone drugs earlier it could defer relapse, possibly for a long time. The majority of women relapse within two years, so this is very significant," said Prof Smyth.

    Ovarian cancer is notoriously difficult to treat, often diagnosed late and has a low survival rate. Each year 7,000 women are diagnosed and 4,400 die. The treatment is surgery followed by chemotherapy and, in some cases, radiotherapy.

    Most women are also prescribed platinum-based drugs, which were the last breakthrough in the 1980s.

    Annwen Jones, chief executive of Ovarian Cancer Action, said: "Ovarian cancer kills 12 women a day in the UK, and survival rates have barely improved over the past 20 years. This research shows that hormone therapy has the potential to benefit a significant minority of women with ovarian cancer. We believe that targeted therapies such as this offer the best prospect of improvements in survival."

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    • #3
      June 26, 2007 -- Ovarian cancer has long been known as the "silent killer," growing imperceptibly inside victims until the disease has spread too far to be stopped.

      Doctors knew the reputation was not entirely deserved: Women with ovarian cancer often complained of symptoms such as abdominal pain or frequent need to urinate in the months before they received the bad news. But, because most women suffer such discomforts occasionally, it was hard to distinguish those with cancer from everybody else.

      Now, Seattle researchers have come up with what may be the first early-warning system for a disease that is expected to kill 15,280 women this year, most of whom never knew they had cancer until it was too late.

      If women suddenly experience any one of six symptoms such as bloating and difficulty eating for more than two or three weeks, the researchers say, they should check with a doctor to see if they have ovarian cancer.

      Some physicians fear that the new symptom index - endorsed this month by 20 cancer advocacy groups - will result in waiting rooms flooded with women suffering everything from menstrual cramps to indigestion. But Dr. Barbara Goff, the University of Washington gynecologist who helped create it, said most women can tell the difference between a difficult period and more fundamental changes in their bodies. Until now, she said, women who reported early symptoms of ovarian cancer were often given the wrong diagnosis, such as irritable bowel syndrome.

      "We don't think these practitioners give women enough credit for knowing their own bodies," said Goff in an interview. "We can't be so paternalistic to say we know better and keep this information from women."

      In a recent study published in December in the journal Cancer, Goff found that fewer than 3 percent of women would be considered at high risk for ovarian cancer based on her symptom index, which requires that the symptoms be both recent and recurring more than a dozen times a month. Only a small fraction of those who are considered at high risk would likely turn out to have the disease, she said.

      Some cancer specialists say they have reservations about the symptom index, however, because in the absence of a definitive test for ovarian cancer, many women may end up getting unnecessary diagnostic procedures.

      If Goff's index rates a woman at high risk for ovarian cancer, doctors may feel pressured to do exploratory surgery to directly examine the ovaries, a procedure that requires general anesthesia and carries risk of infection, among other hazards.

      "We need a test for screening and early diagnosis of cancer and, right now, we are left with a less-than-perfect index to guide us," said Dr. Len Lichtenfeld, deputy chief medical officer at the American Cancer Society, which supports use of the index despite its shortcomings.

      Doctors have long hoped for a better way to detect ovarian cancer early because women are so much more likely to survive when the disease is caught before it metastasizes to other parts of the body. Thirteen out of 14 ovarian cancer patients are alive five years later if the cancer is detected before it spreads, according to the Cancer Society, while only 30 percent survive for five years if the cancer is discovered after it has spread to distant areas.

      But ovarian cancer is relatively rare - eight times less common than breast cancer - making screening tests more likely to generate false alarms than to find early cancers.

      As a result, health organizations have recommended against routine screening for ovarian cancer unless women have known risk factors, such as a family history of breast and ovarian cancer.

      Goff's research team sought to improve the odds of finding ovarian cancers by giving women early warning signs to watch for.

      Women with a pattern of symptoms should see their primary care doctor or gynecologist for an evaluation that could include a pelvic exam, an ultrasound, and a blood test that looks for the presence of a protein called CA 125 that is elevated in most ovarian cancer cells. Then, the physician and the woman can decide whether the patient should undergo exploratory surgery, Goff said.

      "We're not saying, 'If you have these symptoms you should have your ovaries out,' " said Goff, noting that the vast majority of women who are at high risk for ovarian cancer based on the index turn out to be cancer-free.

      In the long run, Goff agreed that the best solution for women would be an inexpensive, accurate screening test for ovarian cancer, noting that Yale University researchers are developing a promising blood test based on four proteins that are common in growing cancer cells. However, she said, the test is still years away from being ready for widespread use. "Until there's a test, awareness is best," she concluded.

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      • #4

        January 25, 2008 -- The contraceptive pill substantially reduces women's risk of ovarian cancer and continues to protect them for at least 30 years after they stop taking it, according to a big scientific analysis published today.

        The research, by Oxford University epidemiologists, suggests that the risk of ovarian cancer is cut by 20% for every five years that a woman has been on the pill. Those who take it for 15 years cut their risk by half. Ovarian cancer is hard to detect and kills two-thirds of those who get it.

        The public health implications are great, say the scientists. The pill has prevented about 200,000 cases of ovarian cancer and 100,000 deaths around the world - mostly in the developed countries - over the last 50 years, they say. Because women get ovarian cancer later in life, often around 55 and onwards, those numbers will rise as the preventive effect kicks in for women who took the pill years ago. Writing in the Lancet medical journal, Professor Valerie Beral and colleagues say they expect the number of cases prevented to rise to 30,000 a year.

        The large review, which included data from 45 studies involving 100,000 women, will reopen the arguments over the pill. Women deserted it in droves years ago because of fears that it might increase their breast and cervical cancer risks, but recent work has shown the increase in risk occurs as women get older, beyond the age of around 35. It also disappears almost as soon as they stop taking the pill.

        The new findings on ovarian cancer suggest that it could be beneficial for young women to take the pill for 10 years or so. An editorial in the Lancet, one of the world's leading medical journals, calls for the pill to be made easily available.

        "Women deserve the choice to obtain oral contraceptives over the counter, removing a huge and unnecessary barrier to a potentially powerful cancer-preventing agent," it says.

        Why the pill should prevent ovarian cancers is unknown.

        Two Canadian scientists, writing a commentary for the Lancet, say the study shows "that this unequivocal protective effect stems from the cumulative suppression of ovulatory cycles". It appears that oral contraceptives in young women "could help to decrease the number of cells that are likely to become malignant over a lifetime, whereas HRT after menopause could have a carcinogenic effect," write Eduardo Franco and Eliane Duarte-Franco from McGill University and the Institut National de Santé Publique du Québec.

        The results of the Oxford study are "unequivocal good news", they say, but add that women and their doctors will once more have to perform a balancing act between the risks and benefits of the pill.

        The scientists gathered data from 23,257 women who had developed ovarian cancer and 87,303 who had not. Some 31% of the first group had used the pill and 37% of the second.

        They found that in high-income countries such as the UK, where 25% of women aged 16-49 take the pill, 10 years of oral contraceptives reduced the numbers getting ovarian cancer from 12 per 1,000 to eight, and their chance of death from seven per 1,000 to five.

        The Family Planning Association said it was great news for women. "There is now substantial evidence showing that for most women the benefits of taking the contraceptive pill are far greater than any of the risks," said the association's chief executive, Julia Bentley.

        Backstory

        The pill is credited with kick-starting the sexual revolution and putting the swing into the 1960s. But in the 50 years of its existence, the pill has provoked as much angst as free love. It was developed in the US and first tested by women in Puerto Rico. Early versions contained high doses of oestrogen and progestin, the hormones involved in women's reproductive cycle. By 1969, one million women were on the pill. Now there are 3.5 million on it in the UK, and 100 million worldwide. Scares in the 80s over links to breast cancer, heart attacks, strokes and blood clots dented the pill's popularity. Low dosage formulations have since reduced many of the risks.

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        • #5


          Dana Parsons
          September 9, 2008


          Seventeen UC Irvine med students sit quietly at three long tables in the small classroom, listening to the middle-aged women tell their stories, one after the other. The students are used to hearing from doctors and other health professionals; now, in their third year of the medical school grind, they're meeting actual patients while making the rounds at hospitals.

          Chances are, though, they haven't heard things said the way the four women are saying it to them.

          "My luck ran out in the spring of 2004," says Sandi Shirey Kars.

          Skip Pedigo follows her to the lectern and tells the students: "It all started on a Friday afternoon for me."

          They and the two other women after them are talking about ovarian cancer, one of the crueler diseases because its seemingly benign symptoms can be overlooked in the early stages as no big deal. And though five-year survival rates are high when the cancer is detected early, they plummet quickly as it advances.

          But the women aren't here to talk clinically, although they do use plenty of gynecological shoptalk with the students. Nor are they necessarily telling the students things they don't know about ovarian cancer -- many, if not all, are familiar with its nature.

          The women are here to tell these future doctors how they can save lives -- not just with wonder drugs and state-of-the-art technology but by good old-fashioned listening and asking good questions. By not automatically dismissing a woman's abdominal pains or bloating as routine episodes, especially if there is a family history of female-specific cancer. By being forceful in pushing less-assertive patients to consider all possibilities for what seem like routine symptoms.

          At least for a day, there's role reversal. Instead of doctors helping patients, these are former patients hoping to help future doctors.

          Three of the women are ovarian cancer survivors; the fourth tells the story of a friend who died of the disease after being misdiagnosed for several months.

          "Please be kind," Ellen Miller asks of the students, noting that women with "twinges in our stomachs" may be anxious when discussing symptoms. "We're not neurotic," she says. "Most of us are not histrionic."

          The students, already putting in 70- to 80-hour workweeks, listen attentively. Afterward, Kelly Okazaki tells the speakers that she paid particular attention because her aunt was diagnosed several months ago with ovarian cancer.

          "It's quite special," she says later that day when asked about the effects of the women's talks. "We may hear from patients in that sort of setting maybe once or twice a year. What's so great is that it puts a human face to something."

          Typically, she says, a doctor won't think cancer when a woman complains of a belly pain or bloating. Some kind of gastrointestinal ailment is a more likely culprit. But hearing the women's stories will leave the thought in her mind to ask more questions and consider more options, Okazaki says, "especially because now there's a face to the story."

          Julio Echegoyen says the students' current eight-week rotation in obstetrics and gynecology has proved more interesting than he expected. Perhaps for that reason, he was touched by the women's stories. "To see the emotional part, that's not in the books at all," he says. "They look like someone you know from somewhere. That gives you a different kind of perspective."

          The intensity of med school sometimes makes it difficult to connect real people to the book learning, he says. And though he says UCI does a good job of impressing that on students, "you're studying so much and trying to run your own life, it's hard to find time to think about it."

          Katherine Taylor plans to specialize in ob/gyn care. "I thought it was great," she says of the women's presentations. "It was very helpful because sometimes, especially in the first two years, you're reading about diseases from a very scientific standpoint, a medical standpoint, and it doesn't really mean a whole lot, it's not really real. But listening to people talk and being able to put a face and a real story with the pathologies we learn, it kind of makes it hit home."

          A bonus, Taylor says, was hearing that the women's doctors generally were helpful and empathetic. Already fretting about the level of paperwork and insurance considerations that she may someday deal with, Taylor says it's encouraging to hear "what a difference their doctors made in their lives."

          **************************************************************************

          That's just awesome...<3

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          • #6

            June 29, 2009 -- Women are dying unnecessarily of ovarian cancer because GPs fail to spot warning signs, according to experts. Large numbers of family doctors cannot correctly identify the cancer's symptoms, according to a major study published today. It found that 37% of women visit their GP several times before their cancer is detected, and 65% are not referred for a test right away.

            The charity Target Ovarian Cancer's study, in which leading doctors played a key role, found widespread ignorance among GPs about the symptoms and that some mistook it for other, less serious illnesses such as irritable bowel syndrome. The study found that 44% of women had to wait more than six months for a correct diagnosis and 37% had to visit their GP between three and five times before they were referred to a cancer specialist. Some 65% said they were not immediately referred for a blood test or internal scan.

            "Some GPs miss ovarian cancer. That's a real problem as the delay could cost the woman her life, and at a minimum causes her a lot of anxiety. The sad fact is some women are dying from late diagnosis of ovarian cancer," said Dr Willie Hamilton, senior research fellow at Bristol University and study advisory panel member.

            Ovarian cancer claims 4,300 lives a year in the UK. It is hard to detect because it lacks one telltale symptom, unlike a breast lump in breast cancer or bleeding for bowel cancer. Some 96% of the 400 GPs interviewed in May for the study said they believed ovarian cancer is a "silent killer".

            Prompt diagnosis is crucial because while 80%-90% of women whose cancer is detected early survive for at least five years, that figure falls to just 25% when the disease is spotted late, once it has spread. Diagnosis in the UK typically takes until a year after symptoms have appeared.

            Diagnostic delays of as little as a week may impact on some chances of treatment helping prolong life, said Hamilton. "Anything that can expedite diagnosis may cut the death toll," added Hamilton. GPs who may not usually consider ovarian cancer as a possible diagnosis because of its vague symptoms should be more willing to do an internal examination or refer women for ultrasound scanning or to a gynaecologist, he said.

            "There is considerable scope for earlier diagnosis in this disease," said Professor Bob Haward, associate director of the National Cancer Research Network and chairman of the study's group of advisers. "A lot of women at present are diagnosed with advanced disease that is associated with poor survival rates. But for some earlier diagnosis may have been possible." Earlier detection could result in better prospects, he added.

            Ovarian cancer is the deadliest gynaecological cancer Some 6,800 women are diagnosed with it each year, mainly the over-50s. The UK has one of the worst survival rates for it in Europe, partly due to late diagnosis.

            Previous similar studies have also identified a trend of later diagnosis in the UK compared to other countries as a key factor in breast cancer survival, said Professor Michel Coleman, an expert in cancer diagnosis at the London School of Hygiene and Tropical Medicine.A survey of 1,000 women revealed very low knowledge levels about both ovarian cancer's symptoms, such as a distended stomach and abdominal pain, and its risk factors, which include childlessness.

            Annwen Jones, Target Ovarian Cancer's chief executive, said the Department of Health should mount an urgent, high-profile campaign to increase women's and GPs' understanding of the disease. "We're worried that women are losing their lives who might otherwise have survived. Delays in diagnosis can never be good news," she said.

            Professor Steve Field, chairman of the Royal College of General Practitioners, said the disease was "notoriously difficult to diagnose" but agreed that family doctors needed to detect it more consistently. "GPs should be more aware of the possibility of ovarian cancer and if there are any doubts should refer for a specialist opinion," said Field. "There's no doubt that the later presentation of symptoms, and on occasion delayed referral, will contribute to the death of women, and anything we can do to improve that situation, we should."

            Health minister, Ann Keen, said the study "identifies the challenges and opportunities of improving survival and quality of life for women with ovarian cancer. As a nurse, I understand how important early detection is in helping to fight this deadly disease. The Department of Health is working to improve survival rates, "especially in the area of symptom awareness amongst women and GP," she added.

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            • #7

              August 2, 2009 -- Scientists have discovered a common genetic difference in women at risk from ovarian cancer, in an important development they say could save lives. The newly discovered variation, which occurs in 55% of women, carries with it an increased risk of the disease of between 20 and 40%. It is the first time that a common variant has been linked to ovarian cancer, bringing with it the potential of future screening programmes.

              An international research group, led by scientists from the Cancer Research UK Genetic Epidemiology Unit, searched the DNA of 1,810 women across the UK with the disease and compared them to 2,535 women without the disease to look for genetic variations. They identified the genetic "letters" called single nucleotide polymorphisms (SNPs), which, when arranged slightly differently, increased ovarian cancer risk in some women.Ovarian cancer is the fourth most common cause of cancer death in women in the UK, with 4,300 deaths from the disease every year.

              Dr Simon Gayther, a senior author of the study, which was published in Nature Genetics today, said: "The human DNA blueprint contains more than 10m genetic variants. These are part and parcel of our characteristics and make-up, but a handful will also increase the chances of some women getting ovarian cancer and we have found the first one of these. There is a genuine hope that, as we find more, we can start to identify the women at greatest risk."

              Two genes that cause breast cancer were found in the late 90s to increase the risk of ovarian cancer, but they are very rare and account for less than five per cent of ovarian cancers.

              Gayther said the discovery could lead to screening programmes 10 years from now. He said: "There has been little change in the prognosis for women with ovarian cancer over the last 40 years because the diagnosis is very, very late. With ovarian cancer there is a 60% chance that a woman diagnosed will be dead within five years. The reason is that the ovaries lie deep in the abdomen and it often goes undiagnosed. It is premature to say we are in a position to set up a screening programme at the moment, but in 10 years' time we will be in a position to identify several more of these genetic factors, then you could see screening being offered on a population level. If we could combine a genetic screening programme and a programme to spot early signs of the disease we could save many lives in the future."

              Following the discovery of the genetic variant, the researchers were able to confirm their findings by using data from the Ovarian Cancer Association Consortium (OCAC) to look at an additional 7,000 women with the disease and 10,000 without the disease worldwide. The region of risk DNA is found in pairs of chromosomes and the scientists estimate that the 15% of women who carry two copies of the variant have a 40% increased risk of the disease. Forty per cent of women carry one copy of the variant, giving them a 20% increased risk of the disease.

              Dr Andrew Berchuk, head of the international Ovarian Cancer Association Consortium steering committee, said: "This study confirms that ovarian cancer risk is partly determined by genetic variants present in a large number of women. This initial discovery and others will likely follow in the future lay the groundwork for individualised early detection and prevention approached to reduce deaths."

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