Prevention of Ovarian Cancer in Women Participating in Mammography

简介(申请人提供)：参加乳腺摄影的妇女中卵巢癌的预防摘要：我们寻求推动的循证政策是在卵巢癌高危(HR)妇女中降低风险的输卵管卵巢切除术(RRSO)。阻碍这一政策成功转化的因素是，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。我们促进这一政策的广泛采用和制度化的战略是利用乳房X光检查系统中可用的家族史(FH)数据，以便系统地识别HR妇女，以便转介到风险/遗传咨询(R/GC)。此外，我们将探索使用血清标志物作为风险预测工具来补充FH。我们的长期目标是预防卵巢癌。一种干预措施已被证明是有效的：一旦生育完成，预防性切除卵巢和输卵管。虽然向所有女性推荐这一手术是不合适的，但建议对有强烈FH遗传易感性的女性，特别是那些BRCA1或BRCA2基因有记录的突变的女性。第一个障碍是，没有系统地识别人力资源妇女，可以使用现有的数据和系统加以解决。更多的障碍是，大多数卵巢癌发生在没有突变或FH的女性身上，这些女性的RRSO时间还不确定，这需要一种新的方法。我们将探索使用血清标志物来预测HR人群中卵巢癌的诊断。我们将根据每年进行乳房X光检查时的FH确定HR的女性，以便转介给遗传顾问(GC)。一项随机对照试验(RCT)将在瑞典乳腺癌中心(SBCC)进行，以评估该策略在提高RRSO发生率方面的有效性。同样的策略的有效性研究将在普吉特湾的团体健康(GH)进行，以了解如何在实践中采用接收R/GC的指南。此外，我们将探索风险预测血清标记物的新用途，以预测参与研究的HR妇女的恶性肿瘤或癌前病变的诊断。这项工作将提供必要的证据，以优化战略，以广泛采用和制度化系统地识别HR妇女，以进行适当的干预，以预防卵巢癌的发病率和死亡率。关键词：卵巢癌，预防，预防性手术，风险，生物标记物，筛查，症状陈述我们将评估一项系统范围的战略，定期识别有明显乳腺癌和卵巢癌家族史的女性，以便遗传顾问能够告知她们患这些癌症的高风险。我们的目标是促进卵巢和输卵管手术切除这些癌症的高危女性，因为有明确的证据表明，这种手术可以将卵巢癌的风险降低90%以上，如果在更年期之前进行手术，患乳腺癌的风险也可以降低50%。我们工作的一个新方面是，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，以帮助高危妇女就预防行动的时机做出决策。

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.