Ovarian Cancer Screening and Its Role in BRCA Mutation Carriers

In 2009, about 21,550 new cases of ovarian cancer were diagnosed in the United States and 14,600 deaths resulted from the disease, making it the deadliest gynecologic cancer. Of the newly diagnosed cases, 8% to 13% occurred in women with BRCA1 or BRCA2 mutations. Studies have shown that women with BRCA1 mutations have a 39% to 46% lifetime risk of developing ovarian cancer, whereas those with BRCA2 mutations have a lifetime risk of 12% to 20%. This is especially significant when considering that the average lifetime risk of ovarian cancer in the general population is approximately 1.8%.

Ovarian Cancer Screening

Escaleira and Ferrer note that ovarian cancer screening includes a gynecologic examination, transvaginal color-Doppler ultrasonography, and CA-125 screenings twice annually. In high-risk populations, screening should be initiated at age 30 to 35 years or 5 to 10 years earlier than the youngest age at which an individual’s family member received an ovarian cancer diagnosis. After the patient completes bearing children or reaches age 40, risk reduction surgery (RRS) should be discussed.

The MSKCC Experience

Escaleira and Ferrer note that identifying BRCA mutation carriers is important because there may be benefits to screening, and they relay the findings regarding BRCA mutation carriers treated at MSKCC between 1995 and 2001. Of the 62 BRCA mutation carriers who underwent surveillance, 22 (35%) had at least one abnormal ultrasound or CA-125 screening. Of the 10 with persistent abnormalities, 5 were found to have ovarian or Fallopian tube cancers (4 were Stage I or II) and 5 had benign findings. In addition, 2 patients who had normal screenings were found to have cancer during RRS.

Conclusions

Escaleira and Ferrer conclude that equivocal evidence suggest that screening can detect ovarian cancer at an early stage, when the chance for cure is greatest; however, they warn that there is no evidence yet to suggest that screening results in a survival benefit in women who carry BRCA mutations. They also suggest that until further data become available, “ovarian cancer screening should only be though of as a bridge until a woman with a BRCA mutation is ready to undergo RRS.”

At the Oncology Nursing Society 35th Annual Congress, Danielle C. Escaleira, RN, MA, OCN, and Danielle Ferrer, RN, BSN, Memorial Sloan-Kettering Cancer Center (MSKCC), New York, New York, presented a poster that described ovarian cancer screening, including who it is recommended for, its effectiveness, the implications for oncology nurse practice, and the significance of BRCA mutations.