Prevention of Ovarian Cancer in Women Participating in Mammography

参加乳房X光检查的女性预防卵巢癌

• 批准号: 7497462
• 负责人: Nicole Denise Urban
• 金额: $ 44.51万
• 依托单位: FRED HUTCHINSON CANCER RESEARCH CENTER
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-30 至 2010-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7497462
• 关键词: Prevention; Ovarian; Cancer; Women; Participating

DESCRIPTION (provided by applicant): Prevention of Ovarian Cancer in Women Participating in Mammography Abstract: The evidence-based policy that we seek to promote is risk-reducing salpingo-oophorectomy (RRSO) in women at high risk (HR) for ovarian cancer. Impediments to the successful translation of this policy are that some women are not aware of their risk, and that the appropriate timing of the surgery remains unclear. Our strategy to enhance widespread adoption and institutionalization of this policy is to take advantage of the availability of family history (FH) data in mammography systems in order to systematically identify HR women for referral to risk/genetic counseling (R/GC). In addition we will explore the use of serum markers as risk prediction tools to complement FH. Our long-term goal is prevention of ovarian cancer. An intervention has been demonstrated to work well: prophylactic removal of the ovaries and fallopian tubes once child-bearing is completed. While it would be inappropriate to recommend this surgery for all women, it is recommended for women with a strong FH suggestive of an inherited susceptibility, especially for those with a documented mutation in BRCA1 or BRCA2. The first impediment, that there is no systematic identification of HR women, can be addressed using available data and systems. The additional impediments, that most ovarian cancer occurs in women without a mutation or FH and that the timing of RRSO in these women is uncertain, require a novel approach. We will explore the use of serum markers to predict diagnosis of ovarian cancer in the HR population. We will identify women at HR based on FH at the time of their annual mammogram for referral to a genetic counselor (GC). A randomized controlled trial (RCT) will be performed at the Swedish Breast Cancer Center (SBCC) to evaluate the efficacy of this strategy in increasing rates of RRSO. An effectiveness study of the same strategy will be conducted at Group Health (GH) of Puget Sound to learn how guidelines for receipt of R/GC are adopted in practice. In addition we will explore the novel use of risk prediction serum markers to predict the diagnosis of malignancy or pre-invasive cancer in HR women enrolled in the study. This work will provide the evidence needed to optimize strategies for widespread adoption and institutionalization of systematic identification of HR women for appropriate intervention to prevent ovarian cancer incidence and mortality. Keywords: ovarian cancer, prevention, prophylactic surgery, risk, biomarkers, screening, symptoms STATEMENT We will evaluate a system-wide strategy to routinely identify women with a significant family history of breast and ovarian cancer, so that they can be informed by genetic counselors of their high risk for these cancers. Our goal is to promote surgical removal of ovaries and fallopian tubes in women who are at very high risk for these cancers, because there is clear evidence that this surgery can reduce the risk for ovarian cancer by over 90%, as well as the risk of breast cancer by 50% if the procedure is performed prior to menopause. A novel aspect of our work is that we will also evaluate a panel of serum markers for its ability to predict ovarian malignancy within the next two years, to assist high-risk women in their decision-making about the timing of preventive actions.

描述（由申请人提供）：预防参与乳腺X线摄影的女性卵巢癌摘要：我们寻求促进的循证政策是降低卵巢癌高危（HR）女性的输卵管卵巢切除术（RRSO）风险。阻碍这一政策成功实施的因素是，一些妇女没有意识到自己的风险，而且手术的适当时机仍然不清楚。我们的战略，以提高广泛采用和制度化的这一政策是利用的可用性的家族史（FH）数据在乳房X光检查系统，以系统地确定HR妇女转介风险/遗传咨询（R/GC）。此外，我们将探讨使用血清标志物作为风险预测工具，以补充FH。我们的长期目标是预防卵巢癌。一种干预措施已被证明效果良好：一旦生育完成，预防性地切除卵巢和输卵管。虽然对所有女性推荐这种手术是不合适的，但建议患有强烈FH的女性，特别是那些在BRCA 1或BRCA 2中有记录的突变的女性。第一个障碍是没有系统地查明人力资源部门的妇女，这可以利用现有的数据和系统加以解决。另外的障碍，即大多数卵巢癌发生在没有突变或FH的女性中，并且这些女性中RRSO的时间不确定，需要一种新的方法。我们将探讨使用血清标志物来预测HR人群中卵巢癌的诊断。我们将在HR根据FH在他们的年度乳房X光检查时确定妇女，以便转介给遗传顾问（GC）。将在瑞典乳腺癌中心（SBCC）进行一项随机对照试验（RCT），以评估该策略在增加RRSO发生率方面的疗效。将在普吉湾的团体健康（GH）进行同一战略的有效性研究，以了解在实践中如何采用接收R/GC的指导方针。此外，我们将探索风险预测血清标志物的新用途，以预测入组研究的HR女性的恶性肿瘤或浸润前癌症的诊断。这项工作将提供必要的证据，以优化战略，广泛采用和制度化的系统识别HR妇女进行适当的干预，以防止卵巢癌的发病率和死亡率。保留字：卵巢癌，预防，预防性手术，风险，生物标志物，筛查，症状声明我们将评估一项系统范围的策略，以常规识别具有乳腺癌和卵巢癌重要家族史的女性，以便遗传咨询师告知她们患这些癌症的高风险。我们的目标是促进手术切除卵巢和输卵管的妇女谁是这些癌症的风险非常高，因为有明确的证据表明，这种手术可以降低卵巢癌的风险超过90%，以及乳腺癌的风险50%，如果该程序是在绝经前进行。我们工作的一个新的方面是，我们还将评估一组血清标志物在未来两年内预测卵巢恶性肿瘤的能力，以帮助高危妇女决定采取预防措施的时机。