Cheers for the largest worldwide ovarian cancer screening trial
Specialist gynaecological nurse Tracie Miles reflects on the findings of the UK Collaborative Trial of Ovarian Cancer Screening
Excitement began to build just before Christmas with publication of the results of the biggest ever ovarian cancer screening trial – the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) – which found that deaths from ovarian cancer could be reduced by up to one fifth. Ovarian cancer is a brutal disease with only 46% of women diagnosed surviving for five or more years. Any steps to change these devastating statistics are welcomed by me as a gynaecological cancer specialist nurse who sees new, individual tragedies every day.
The UKCTOCS trial represents amazing achievements on many levels. It ran for over 15 years and successfully recruited more than 200,000 post-menopausal women to a randomised controlled trial in which they went through one of two types of screening method (blood test or ultrasound) or no screening (the current situation worldwide). The aim of the trial was to investigate whether annual blood tests or annual ultrasound scans would be a useful cancer screening tool for ovarian cancer in post-menopausal women.
However, the principal investigators tell us we need to be cautious. We must wait a further three years for the data to mature before they can give us the final statistical analysis. The results thus far do not demonstrate the utility of a national screening programme, and there are concerns that some women may come to harm from unnecessary surgery.
What does this mean for patients who ask us about screening for ovarian cancer and, on the basis of these latest data, what should we advise them?
The Eve Appeal charity has set up a new specialist gynaecological nurse information service – led by me – to offer information and support to women on all five gynaecological cancers. The Ask Eve service will help women ask questions about signs and symptoms, risk factors, and related issues such as genetic testing. We are already receiving enquiries about the Risk Of Cancer Algorithm (ROCA) test, which was one of the screening methods used in the trial. This involves using sequential CA125, a blood tumour marker, to predict the risk of, or need for, a definitive ultrasound test.
Advise women in higher risk groups, such as those with a BRCA mutation or family history, to talk to their doctors about the utility of the ROCA test in their individual cases.
Help women to be aware of the sometimes subtle symptoms of ovarian malignancy, and encourage them to report these to their GPs.
Educate women about reducing personal risk, for example in the use of contraceptive pill between pregnancies until the onset of menopause.
Direct women in high risk groups to research programmes, such as The Eve Appeal BRCA PROTECT Research Clinic, which is designed to support women and their families while researching into the mechanisms that cause ovarian and breast cancer.
Research continues to be vital in reducing deaths from ovarian cancer. While these latest results may not have brought us the definitive answer on ovarian screening programmes, they have helped us to understand the biology of the disease in relation to early detection.
For more information on the UKCTOCS trial, and how it may affect you and your patients, please visit www.eveappeal.org.uk
About the author
Tracie Miles is the Eve Appeal Information Specialist Service 'Ask Eve' lead and is also a gynaecology oncology clinical nurse specialist