Note: The information on this website is not a substitute for
diagnosis and treatment by a qualified, licensed professional.
NIH consensus conference. Ovarian cancer. Screening, treatment, and follow-up.
NIH Consensus Development Panel on Ovarian Cancer.
JAMA, 273(6):491-7 1995 Feb 8.This article informs on the conclusions reached by a 14-member panel of experts indicating that available ovarian cancer screening programs consisting of tumor marker monitoring and ultrasound evaluation are not associated with improved survival and may in fact result in increased rather than decreased, morbidity and mortality. The experts also emphasized that adjuvant therapy following surgery is not recommended for women with stage I A grade 1 and stage 1 B grade 1 ovarian cancer.
Screening people with a family history of cancer. Benefit of screening for ovarian cancer is unproved.
Bell R; Petticrew M.
BMJ, 315(7118):1306 1997 Nov 15.This article illustrates how there is no evidence indicating that ovarian cancer screening reduces mortality from ovarian cancer, while there is unquestionable proof that it causes harm. Screening is associated with significant false positive rates. Women with falsely positive test results undergo unnecessary surgery to determine whether they have cancer or not, and surgery is associated with appreciable rate of complications and even death. Therefore, the recommendation that women at risk of developing ovarian cancer should undergo screening is unjustified.
Cancer Prevention in Primary Care: Screening for ovarian, prostatic, and testicular cancers.
J Austoker.
BMJ 1994;309:315-320 (30 July).This article emphasizes that currently there is no evidence demonstrating that ovarian cancer screening reduces mortality from ovarian cancer or that the putative benefits of screening outweigh the possible harm derived by it.
Benign ovarian cysts and ovarian cancer: a cohort study with implications for screening.
Crayford, TJB. et al.
Lancet 2000; 355: 1060 -1063.The results of this study indicate that early removal of ovarian cysts detected during screening does not result in a decreased number of deaths from ovarian cancer. The study was conducted on 5,135 women who underwent screening with ultrasound for ovarian cancer prevention between 1981 and 1987, and were subsequently followed-up for 15 years. Ninety-three women were found to have persistent ovarian cysts: they were of benign nature in 88 cases, and malignant in 5. Removal of ovarian cysts did not result in a decreased rate of death from ovarian cancer, indicating that most ovarian cysts in middle-aged women are benign and will not evolve in cancer. These results also imply that ovarian cancer screening programs would not be cost-effective, and would not likely reduce mortality rates from this disease.
The National Cancer Data Base report on ovarian cancer.
American College of Surgeons Commission on Cancer and the American Cancer Society.
Averette HE, Janicek MF, Menck HR.
Cancer. 1995 Sep 15;76(6):1096-103.The results of this study show that, despite the use of more aggressive treatment in women diagnosed with ovarian cancer during the late 1980s and early 1990s, survival rates in women with the disease remained practically unchanged in the period 1975-1991.
Was chemotherapy beneficial for the patients with advanced ovarian cancer? A comparison of survival and resource use in two different time periods.
Bertelsen K; Kruhoffer A.
Ugeskr Laeger, 158(34):4767-70 1996 Aug 19.This study evaluated whether the introduction, at the beginning of the 1980s, of aggressive treatment measures consisting of extensive surgery and combination chemotherapy for the management of women with ovarian cancer, resulted in improved survival. When survival rates in patients treated between 1973 and 1978 were compared to those of women treated between 1981 and 1986, it was demonstrated that aggressive treatment resulted in improved average survival but not in improved 5-year survival. Furthermore, women who were treated in 1981-1986 spent seven times more time in the hospital, compared to those treated in 1973-1978.
Is stage I epithelial ovarian cancer overtreated both surgically and systemically? Results of a five-year cancer registry review.
Finn CB, Luesley DM, Buxton EJ, Blackledge GR, Kelly K, Dunn JA, Wilson S.
Br J Obstet Gynaecol 1992 Jan;99(1):54-8.The results of this study show that women with stage I ovarian cancer treated with chemotherapy have lower survival rates, compared to women not receiving chemotherapy. Furthermore, peritoneal washing was shown to have a negative impact on survival in patients with early ovarian cancer.
Management of epithelial ovarian tumors of low malignant potential.
Trimble CL, Trimble EL.
Gynecol Oncol 1994 Dec;55(3 Pt 2):S52-61.The results of this study show that women with ovarian tumors of low malignant potential (LMP) treated with surgical removal of the uterus and both the ovaries followed by adjuvant therapy (radio- or chemotherapy), die more often from complications of treatment than from the disease itself. These results suggest that the best treatment for ovarian tumors of LMP is removal of either the tumor only, or of the affected ovary, without further intervention.
Natural history and prognosis of untreated stage I epithelial ovarian carcinoma.
Ahmed FY; et al.
J Clin Oncol, 14(11):2968-75 1996 Nov.This study evaluated survival rates of 194 women with stage I epithelial ovarian cancer
treated with surgical tumor resection only. During the10 years after surgery, patients were evaluated for tumor recurrence with physical examination, serum CA125 screening, and computed tomographic scan at various intervals. Five-year survival rates were as follows: stage IA, 93.7%; stage IB, 92%; and stage IC, 84%. This study is important because it describes the natural history of patients with stage I epithelial ovarian cancer treated with surgery and no adjuvant therapy.
High-dose chemotherapy in ovarian carcinoma.
Herrin VE; Thigpen JT.
Semin Oncol, 26(1):99-105 1999 Feb.This review presents the results of several years of research investigating the effects of high-dose chemotherapy in patients with ovarian cancer. It is shown that high-dose chemotherapy, with or without the support of autologous stem cell transplant, although associated with higher rates of tumor responses (tumor shrinkage) compared to standard-dose chemotherapy, does not prolong survival in women with ovarian cancer and is associated with important toxicity.
The National Cancer Data Base report on ovarian cancer treatment in United States hospitals.
Partridge EE et al.
Cancer, 78(10):2236-46 1996 Nov 15.The results of this study, conducted on 15,254 women with ovarian cancer, show that chemotherapy does not improve survival in women with stage I disease, nor in women with stage II and stage III low-grade disease. Chemotherapy seemed beneficial in patients with high-grade stage II and stage III disease, and in those with stage IV disease. It was also demonstrated that from 1988 to 1993, screening for ovarian cancer did not result in higher rates of early cancer detection.
Does aggressive therapy improve survival in suboptimal stage IIIc/IV ovarian cancer?
A Canadian-American comparative study.
LoCoco S, et al.
Gynecol Oncol, 59(2):194-9 1995 Nov.The results of this study show that women with advanced ovarian cancer undergoing aggressive surgical and chemotherapy treatment fare no better in terms of survival, than those who receive less aggressive treatment. The study compared survival rates of women with high-grade stage III and stage IV ovarian cancer at two institutions in Canada and the United States. Women treated in the U.S. underwent more surgical procedures than those treated in Canada, with an average 2.5 laparotomies per woman in the U.S. compared to 1.7 in Canada. Similarly, American women received significantly more chemotherapy regimens and a higher total number of courses compared to Canadian women (3.0 and 12.6 vs 2.4 and 8.8, respectively). The increased aggressiveness of treatment did not translate in better survival rates, while adding to general toxicity, side effects, and treatment costs.
Staging procedures, clinical management, and survival outcome for ovarian carcinoma.
Hand R. et al.
JAMA 269(9):1119-22 1993 Mar 3.The results of this study, conducted on 2,669 women with ovarian cancer, show that extensive surgery does not prolong survival in women with stage I and stage II ovarian cancer, while it does so in women with stage III ovarian cancer. A survival advantage was observed in women with stage III disease receiving cisplatin-based chemotherapy, however, this benefit seems due to a bias in patients' selection, i.e. women treated with cisplatin-based chemotherapy were of younger age compared to those who did not receive it.
Role of puncture and aspiration in expectant management of simple ovarian cysts: a randomised study.
Zanetta G, Lissoni A, Torri V, Dalla Valle C, Trio D, Rangoni G, Mangioni C.
BMJ 1996 Nov 2;313(7065):1110-3.The results of this study show that needle aspiration of an ovarian cyst detected by ultrasounds is no better than simple expectant management to monitor tumor development. Expectant management for three to six months results in spontaneous resolution of the cyst in over a third of cases and is devoid of the risks and the costs of unnecessary surgery.
