Insights from outside BJOG

There is no clinically reliable screening test for ovarian cancer, and late presentations with poor prognoses remain the rule. Recent work suggests that cellular proliferations in the fallopian tube may be precursors to cancer in the ovary which is a slow process, taking years to develop. Early intra-epithelial fallopian tube neoplastic changes and progression to highgrade serous epithelial ovarian cancer seem to be associated with a pathogenic genetic variant located in the TP53 gene. The TP53 variants could be markers of future malignancy predisposition. In established gynaecological cancers, DNA variants have been recovered in cytological samples obtained from the genital tract, raising the possibility of screening for molecular variants in cells that are exfoliated. Researchers selected 17 patients with ovarian cancer and looked for TP53 variants in cytology specimens taken years earlier as part of these women’s routine Pap smear testing (Paracchini et al. JAMA Netw Open 2020;3:e207566). In 11 women, they found DNA with TP53 variants – in some cases 6 years prior to the ovarian malignancy appearing clinically. The authors are extremely cautious about the hypothesis they are raising – namely the possibility of using Pap smear molecular testing as a screening test for future ovarian cancer risk. They make the case for large, long, prospective studies to guide investigations. They conclude their article with ‘Our results hint at a promising prospect to significantly improve the future diagnosis’ of ovarian cancer. This report is potentially very exciting.