What Factors Influence Perception of Risk and Screening Behavior

Screening asymptomatic women at average risk of ovarian cancer with available methods transvaginal ultrasound and the CA-125 test has not been shown to be effective and is, therefore, not recommended. Clinical trials currently underway, however, may offer further insight. Such screening procedures, as well as genetic counseling, are recommended for women with a strong family history of cancer indicative of a hereditary genetic mutation, such as BRCA1 or BRCA2. Although the literature demonstrates a positive association between family history and screening behavior, several recent studies have found that women most likely to report high levels of perceived risk and high levels of screening for ovarian cancer were not women at highest risk. In addition, women at high risk for ovarian cancer may not be receiving recommended clinical evaluations. Gaining a comprehensive understanding of the role of risk perception in cancer screening adherence is a priority area for behavioral research in cancer prevention and control. Identifying and elucidating the processes by which women arrive at their perceptions of vulnerability to cancer can shed light on how they make decisions to undergo screening or engage in preventive behaviors. To examine the determinants of perceived risk and its influence on screening behaviors, DCPC is conducting a study of approximately 2000 women at average, elevated, and high risk who will be randomly selected from enrollees in a managed care organization with a racially diverse population. As part of the study, Risk Perception, Worry, and Use of Ovarian Cancer Screening among Women at Average, Elevated, and High Risk of Ovarian Cancer, women will be interviewed by telephone to collect information on family history of cancer, perceived risk, cancer worry, anxiety, personal experiences with cancer in family or friends, and intent to undergo screening or actual screening behavior. A 1-year follow-up telephone interview will be conducted to assess changes in perceived risk or family history of cancer and additional screening activity. The results of this investigation could have important implications for encouraging the appropriate use of screening and for informing educational and communication efforts to maximize screening effectiveness and minimize worry for women at average and elevated risk.

Patterns In The Diagnosis Of Ovarian Cancer

Delays in the diagnosis of ovarian cancer have been attributed to the absence of ovarian cancer symptoms or vague symptoms at an early stage, delays in careseeking among symptomatic women, and physician delays in considering ovarian cancer in the differential diagnosis. Early-stage symptoms may be subtle, seemingly unrelated, and not necessarily gynecological in nature, and a woman may undergo a number of medical tests before ovarian cancer is considered a possible diagnosis. The most common diagnostic pathways from first provider visit to diagnosis of ovarian cancer are not known and are likely to vary by age and risk factors related to the patient, the symptoms reported, the specialty of the physician initially consulted, and myriad other patient, provider, and healthcare setting characteristics. In addition, a substantial proportion of ovarian masses detected during diagnostic workup are benign. Aggressive follow-up of ovarian abnormalities to detect cancer must be balanced with appropriate assessment to reduce the number of women who undergo unnecessary diagnostic surgery. If surgery identifies ovarian cancer, the specialty of the attending surgeon can affect the quality of staging and tumor debulking procedures conducted and, ultimately, the disease-free survival time. To discover if such interventions as physician guidelines, educational materials, or other actions can significantly reduce the time to diagnosis, detect the cancer at earlier stages, or improve surgical evaluation, a great deal more information is needed about the symptoms reported and the current diagnostic process. A specific component in the diagnostic pathway is the management of ovarian masses, and DCPC is currently conducting a study, Clinical Practice in the Follow-Up of Ovarian Masses. This study will search for clinical findings that could be used by clinicians to more effectively differentiate between women with potentially malignant masses who require immediate surgery and women with benign abnormalities. Set in a managed care organization, the goals of the study are to investigate the symptoms or other conditions that lead to a diagnosis of an ovarian mass, the radiological characteristics of masses most likely to be malignant, and the diagnostic pathways commonly followed. Medical records, imaging studies, and surgical reports will be abstracted for a cohort of women aged 40 and older who have an ultrasound-identified ovarian mass. Data will be collected on mass characteristics, medical and family history, symptoms, findings, diagnoses, and related diagnostic tests and treatment. Researchers will assess the prevalence, characteristics, symptoms, and diagnostic management of benign vs. malignant ovarian masses.

Ovarian Cancer Surgery

Surgery is crucial in Ovarian Cancer treatment and should be performed by specialists. Primary treatment of Ovarian Cancer is largely surgery-based, and studies have shown that optimal surgery can significantly increase survival rates (37 vs 17 months) and complete response to chemotherapy (50% vs 20%). It is also reported that survival is dependent on
the expertise and degree of specialization of the surgeon, with a 25% improvement in 3-year survival among patients whose ovarian tumors are removed by a specialized gynecologist. Nevertheless, often times neither surgery nor staging are optimal, rendering the interpretation of some studies difficult. Chemotherapy is currently given after surgical resection of the tumor has been performed, and replacing surgery with chemotherapy is not recommended. However, several clinical trials based around new treatment strategies are currently underway, and these may well offer an alternative approach to therapy in the future.
Designing clinical trials of new drug combinations for OC is complicated by the great heterogeneity of patients with this disease. In 2004, the 3rd International OCCC made a number of recommendations regarding the extent of surgery for patients taking part in first-line chemotherapy trials. Staging should be performed according to FIGO guidelines. For example, this includes at least lymph node sampling and peritoneal staging in early-stage invasive disease (FIGO I–IIA). Up-front maximal surgical effort at cytoreduction with the goal of no residual disease should be undertaken. Conservative surgery should only be considered in
specific cases like well-differentiated (grade 1) stage IA, young patient with low parity, and ability for close follow-up. The role of cytoreductive surgery (CS) in recurrent ovarian cancer (ROC) has not been clearly defined.