Executive Summary of the Ovarian Cancer Evidence Review Conference

IF 4.3 4区 医学 Q1 OBSTETRICS & GYNECOLOGY
William Burke, Joel Barkley, Emily Barrows, Rebecca Brooks, Kimberly Gecsi, Kathryn Huber-Keener, Myrlene Jeudy, Shirley Mei, Julia Sage O’Hara, David Chelmow
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引用次数: 0

Abstract

ABSTRACT Ovarian cancer has the 17th highest incidence among all cancers in the United States; however, it is the deadliest gynecologic cancer and the fifth most common cause of cancer-related death in women in the United States. The Centers for Disease Control and Prevention funded the American College of Obstetricians and Gynecologists (ACOG) to create educational materials for clinicians on the early diagnosis and prevention of gynecologic cancers. This article is an evidence summary based on ACOG's extensive literature review on the early diagnosis and prevention of ovarian cancer. An expert panel was recruited from the Society for Academic Specialists in General Obstetrics and Gynecology and the Society of Gynecologic Oncology to review and summarize evidence from articles published between January 2000 and October 2021. Topics used to frame the literature review included the epidemiology of ovarian cancer, risk factors, prevention and risk reduction, screening strategies and early detection, health disparities, diagnosis and care coordination by primary care providers, and special considerations. The Ovarian Cancer Evidence Review Conference occurred in February 2022 where the expert panel and stakeholder professional and patient advocacy organizations discussed their findings and drafted summaries to develop educational materials. Review of the epidemiology revealed that in 2022 there were 19,880 new cases of ovarian cancer, 12,810 women died of ovarian cancer, 5-year survival is 49.7% and correlates strongly with stage at diagnosis, and fewer than 10% of women with stage 1 disease will have recurrence. Risk factors for ovarian cancer include older age, inactivity, nulliparity, early menarche, late menopause, postmenopausal hormone therapy, genetic mutations such as BRCA1 and BRCA2 , and endometriosis. Risk-reducing bilateral salpingo-oophorectomy reduces incidence of ovarian cancer by 80% in BRCA1 and BRCA2 carriers (95% confidence interval, 0.12–0.39) and is recommended by ACOG for women at increased risk of ovarian cancer. Contraception, physical activity, and lactation may help reduce the risk of ovarian cancer. The most common methods studied for screening include transvaginal ultrasonography, bimanual palpation, and measuring tumor marker CA-125. The Risk of Ovarian Cancer Algorithm uses CA-125 and transvaginal ultrasound to estimate the risk of ovarian cancer based on age and change in CA-125; however, it is still being studied, and no established screening method exists for asymptomatic women. Several organizations including ACOG support identifying women at high risk and subsequent genetic counseling. Symptoms of ovarian cancer are nonspecific and include abdominal distention and pain, and while workup should include ultrasonography and CA-125 measurement, no high-quality studies have compared imaging, biomarkers, risk algorithms, or multimodal risk assessment tools for the primary evaluation of patients with high-risk symptoms. Regarding disparities, Black women consistently had worse outcomes compared with their White counterparts, and little evidence regarding other racial and ethnic groups or gender minorities was identified. Finally, care coordination is critical, and ACOG recommends a low bar for referral to a gynecologic oncologist for patients with suspicion of ovarian cancer, which has been shown to increase survival and offer other advantages. This evidence review identifies many research gaps and opportunities for ovarian cancer and provides a high-level educational summary of current best practices in the risk stratification, diagnosis, and prevention of ovarian cancer.
卵巢癌证据审查会议执行摘要
卵巢癌在美国所有癌症中发病率排名第17位;然而,它是最致命的妇科癌症,也是美国女性癌症相关死亡的第五大常见原因。疾病控制和预防中心资助了美国妇产科医师学会(ACOG),为临床医生制作妇科癌症早期诊断和预防的教育材料。这篇文章是基于ACOG关于卵巢癌早期诊断和预防的大量文献综述的证据总结。从普通妇产科学术专家学会和妇科肿瘤学会招募了一个专家小组来审查和总结2000年1月至2021年10月发表的文章的证据。用于构建文献综述的主题包括卵巢癌的流行病学、风险因素、预防和降低风险、筛查策略和早期发现、健康差异、初级保健提供者的诊断和护理协调以及特殊考虑。卵巢癌证据审查会议于2022年2月举行,专家小组和利益相关者专业组织和患者倡导组织讨论了他们的发现并起草了摘要,以编写教育材料。流行病学回顾显示,2022年有19,880例卵巢癌新病例,12,810名妇女死于卵巢癌,5年生存率为49.7%,与诊断阶段密切相关,不到10%的1期妇女会复发。卵巢癌的危险因素包括年龄较大、缺乏运动、无产、月经初潮早、绝经晚、绝经后激素治疗、BRCA1和BRCA2等基因突变以及子宫内膜异位症。降低风险的双侧输卵管-卵巢切除术可使BRCA1和BRCA2携带者的卵巢癌发病率降低80%(95%可信区间,0.12-0.39),ACOG推荐卵巢癌风险增加的女性接受该手术。避孕、体育活动和哺乳可能有助于降低患卵巢癌的风险。最常用的筛查方法包括经阴道超声检查、双手触诊和测量肿瘤标志物CA-125。卵巢癌风险算法使用CA-125和经阴道超声根据年龄和CA-125的变化来估计卵巢癌的风险;然而,它仍在研究中,没有针对无症状妇女的既定筛查方法。包括ACOG在内的一些组织支持识别高风险妇女并随后提供遗传咨询。卵巢癌的症状是非特异性的,包括腹胀和疼痛,虽然检查应包括超声检查和CA-125测量,但没有高质量的研究比较影像学、生物标志物、风险算法或多模式风险评估工具对高危症状患者的初步评估。在差异方面,黑人女性的结果一直比白人女性差,几乎没有证据表明其他种族和族裔群体或性别少数群体存在差异。最后,护理协调是至关重要的,ACOG建议对怀疑卵巢癌的患者转诊妇科肿瘤科医生的门槛较低,这已被证明可以提高生存率并提供其他优势。本证据综述确定了卵巢癌的许多研究差距和机会,并对卵巢癌的风险分层、诊断和预防方面的当前最佳实践提供了高水平的教育总结。
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来源期刊
CiteScore
2.70
自引率
3.20%
发文量
245
审稿时长
>12 weeks
期刊介绍: ​Each monthly issue of Obstetrical & Gynecological Survey presents summaries of the most timely and clinically relevant research being published worldwide. These concise, easy-to-read summaries provide expert insight into how to apply the latest research to patient care. The accompanying editorial commentary puts the studies into perspective and supplies authoritative guidance. The result is a valuable, time-saving resource for busy clinicians.
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