title: Alternatives to risk-reducing surgery for ovarian cancer.
abstract: BRCA1 and BRCA2 mutation carriers have an 18%-60% and 11%-27% lifetime risk of developing ovarian carcinoma, respectively. Prophylactic bilateral salpingo-oophorectomy reduces the risk of this malignancy by up to 96%. Gynecological screening programs with periodical trans-vaginal ultrasound and serum CA125 assay have been widely used in women at hereditary high risk of ovarian carcinoma, but clinical results have been conflicting. These surveillance protocols have often fallen short of expectations because of the advanced stage of ovarian carcinoma in the identified screened women. Several investigations have been addressed to the detection of additional tumor markers able to generate more reliable screening tools. The combined serum assay of leptin, prolactin, osteopontin, CA125, macrophage inhibiting factor and insulin-like growth factor-II appears to have a significant better diagnostic reliability compared with serum CA125 alone in discriminating healthy individuals from ovarian carcinoma patients, and therefore, it could have a role in the screening of women at high risk for this malignancy. As far as chemoprevention is concerned, oral contraceptives significantly reduce the ovarian carcinoma risk also in BRCA mutation carriers, whereas the efficacy of fenretinide is still under investigation.
authors.affiliation: Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Gadducci
authors.forename: C
authors.initials: C
authors.lastname: Sergiampietri
authors.forename: R
authors.initials: R
authors.lastname: Tana
mesh_terms: D019313:BRCA1 Protein / Q000235:genetics*; D024682:BRCA2 Protein / Q000235:genetics*; D014408:Biomarkers, Tumor / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood; D005260:Female; D006801:Humans; D007335:Insulin-Like Growth Factor II / Q000378:metabolism; D020738:Leptin / Q000097:blood; D008263:Macrophage Migration-Inhibitory Factors / Q000097:blood; D008565:Membrane Proteins / Q000097:blood; D058990:Molecular Targeted Therapy; D009154:Mutation; D009367:Neoplasm Staging; D053495:Osteopontin / Q000097:blood; D010051:Ovarian Neoplasms / Q000097:blood* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D010052:Ovariectomy; D011388:Prolactin / Q000097:blood; D014463:Ultrasonography
chemical_list: D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human; D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D020738:Leptin; C451759:MUC16 protein, human; D008263:Macrophage Migration-Inhibitory Factors; D008565:Membrane Proteins; D053495:Osteopontin; D007335:Insulin-Like Growth Factor II; D011388:Prolactin
keywords: BRCA; CA125, ovarian carcinoma; screening; trans-vaginal ultrasound; tumor marker