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）：参与乳房X线摄影的女性预防卵巢癌摘要：我们寻求促进的基于证据的政策是卵巢癌高风险（HR）的女性中降低风险的Salpingo-opophorto术（RRSO）。对该政策成功翻译的障碍是，有些妇女不知道自己的风险，而手术的适当时机仍然不清楚。我们提高该政策的广泛采用和制度化的战略是利用乳房X线摄影系统中家族史（FH）数据的可用性，以系统地识别HR妇女以转介风险/遗传咨询（R/GC）。此外，我们将探索使用血清标记作为补充FH的风险预测工具的使用。我们的长期目标是预防卵巢癌。已经证明了一项干预措施可以很好地工作：一旦完成育儿后，预防性去除卵巢和输卵管。虽然为所有女性推荐这项手术是不合适的，但建议具有强大FH的女性暗示遗传易感性，尤其是对于BRCA1或BRCA2中有记录的突变的女性。可以使用可用的数据和系统来解决第一个障碍，即对人力资源妇女的系统识别可以解决。大多数卵巢癌发生的其他障碍发生在没有突变或FH的女性中，而这些女性的RRSO时间尚不确定，需要一种新的方法。我们将探索使用血清标记来预测人力资源人群中卵巢癌的诊断。我们将根据FH年度乳房X线照片转介给遗传咨询师（GC）时，根据FH确定女性的人力资源女性。随机对照试验（RCT）将在瑞典乳腺癌中心（SBCC）进行，以评估该策略在提高RRSO速率方面的疗效。对同一策略的有效性研究将在Puget Sound的集团健康（GH）上进行，以了解如何在实践中采用R/GC的指南。此外，我们将探讨研究风险预测的新颖使用血清标志物，以预测参加该研究的人力资源女性的恶性肿瘤或侵入前癌症的诊断。这项工作将提供所需的证据，以优化对人力资源妇女进行广泛采用和制度化的策略，以防止卵巢癌发病率和死亡率进行适当的干预。关键字：卵巢癌，预防，预防手术，风险，生物标志物，筛查，症状声明我们将评估一项全系统策略，以常规识别具有乳腺癌和卵巢癌的大家族病史的妇女，以便遗传顾问为这些癌症的高风险提供遗传顾问。我们的目标是促进对这些癌症风险很高的女性卵巢和输卵管的手术清除，因为有明确的证据表明，如果该手术在更新之前进行手术，则该手术可以将卵巢癌的风险降低超过90％，而患乳腺癌的风险会降低50％。我们工作的一个新方面是，我们还将评估一系列血清标记物，以预测未来两年内卵巢恶性肿瘤的能力，以帮助高危妇女对预防行动的决策。