title: Screening for familial ovarian cancer: poor survival of BRCA1/2 related cancers.
abstract: OBJECTIVE
  To assess the effectiveness of annual ovarian cancer screening (transvaginal ultrasound and serum CA125 estimation) in reducing mortality from ovarian cancer in women at increased genetic risk.
  
  
  METHODS
  A cohort of 3532 women at increased risk of ovarian cancer was screened at five European centres between January 1991 and March 2007. Survival from diagnosis of ovarian cancer was calculated using Kaplan-Meier analysis and compared for proven BRCA1/2 carriers with non-carriers and whether the cancer was detected at prevalence or post-prevalent scan. Screening was performed by annual transvaginal ultrasound and serum CA125 measurement.
  
  
  RESULTS
  64 epithelial ovarian malignancies (59 invasive and 5 borderline), developed in the cohort. 26 tumours were detected at prevalent round; there were 27 incident detected cancers and 11 interval. 65% of cancers were stage 3 or 4, however, stage and survival were little different for prevalent versus post-prevalent cancers. Five year and 10 year survival in 49 BRCA1/2 mutation carriers was 58.6% (95% CI 50.9% to 66.3%) and 36% (95% CI 27% to 45%), which was significantly worse than for 15 non-BRCA carriers (91.8%, 95% CI 84% to 99.6%, both 5 and 10 year survival p = 0.015). However, when borderline tumours were excluded, the difference in survival between carriers and non-carriers was no longer significant.
  
  
  CONCLUSIONS
  Annual surveillance, by transvaginal ultrasound scanning and serum CA125 measurement, in women at increased familial risk of ovarian cancer is ineffective in detecting tumours at a sufficiently early stage to influence substantially survival in BRCA1/2 carriers.
authors.affiliation: Academic Unit of Medical Genetics and Regional Genetics Service, St Mary's Hospital, Manchester, UK. gareth.evans@cmft.nhs.uk
authors.forename: D G
authors.initials: DG
authors.lastname: Evans
authors.forename: K N
authors.initials: KN
authors.lastname: Gaarenstroom
authors.forename: D
authors.initials: D
authors.lastname: Stirling
authors.forename: A
authors.initials: A
authors.lastname: Shenton
authors.forename: L
authors.initials: L
authors.lastname: Maehle
authors.forename: A
authors.initials: A
authors.lastname: Dørum
authors.forename: M
authors.initials: M
authors.lastname: Steel
authors.forename: F
authors.initials: F
authors.lastname: Lalloo
authors.forename: J
authors.initials: J
authors.lastname: Apold
authors.forename: M E
authors.initials: ME
authors.lastname: Porteous
authors.forename: H F A
authors.initials: HF
authors.lastname: Vasen
authors.forename: C J
authors.initials: CJ
authors.lastname: van Asperen
authors.forename: P
authors.initials: P
authors.lastname: Moller
mesh_terms: D018394:CA-125 Antigen / Q000097:blood; D015331:Cohort Studies; D053843:DNA Mismatch Repair; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005820:Genetic Testing / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000235:genetics*; D011379:Prognosis; D014463:Ultrasonography
chemical_list: D018394:CA-125 Antigen