Ovarian cancer, one of the deadliest malignancies, is actually a constellation of different cancers that may originate in other organs and should not be treated as a single disease, concludes a new congressionally mandated report on the state of ovarian cancer incidence, treatment and research. The report, published by the Institute of Medicine (IOM) of the National Academies of Sciences, Engineering, and Medicine, also highlights persistent serious disparities in delivery of care across different groups of women in the U.S., and suggests promising areas for further research.
"When we look at ovarian cancers at the molecular level, we can see that many of these tumors arise in other organs or cell types and then metastasize to the ovary," notes report co-author Kunle Odunsi, MD, PhD, FRCOG, FACOG, Deputy Director and Chair of Gynecologic Oncology at Roswell Park Cancer Institute (RPCI). "This is a striking finding that changes our fundamental understanding of ovarian cancer, but it also underscores how much we have yet to learn about ovarian cancer subtypes and their progression."
The report notes that the five-year survival of women with the most common and fatal type of ovarian cancer, high-grade serous carcinoma, has increased from 36 percent to nearly 46 percent over the past four decades as a result of advances in specialty care and the development of effective first-line chemotherapy.
"While progress has been made in ovarian cancer research over the past few decades, much remains to be learned," says Jerome F. Strauss III, MD, PhD, chair of the committee that researched and wrote the report and also Executive Vice President for Medical Affairs and Dean of Virginia Commonwealth University School of Medicine. "The more that is understood about the basic biology of various types of ovarian cancers, such as where they originate in the body, the more rapidly we can move toward advances in prevention, screening, early detection, diagnosis, treatment, and supportive care."
The authors note that better methods for identifying high-risk women could facilitate the prevention or early detection of ovarian cancers.
"The study reinforces the need for genetic counseling and testing," says Dr. Odunsi, who is also Executive Director of the Roswell Park Center for Immunotherapy and Co-Director of the Familial Ovarian Cancer Registry, the world's largest source of genetic data and family history profiles for research of familial ovarian cancer. "Every woman with ovarian cancer should be referred for genetic counseling and potential testing. This has implications for identifying risk for other family members and for therapy selection. "There are new treatments available to women with mutations in genes responsible for inherited predisposition to ovarian cancer."
Among other key findings, the committee also reports that:
•Less than one-half of women with ovarian cancers are receiving care in accordance with national guidelines, disparities that disproportionately affect women of color and, if addressed through further research, could lead to further reductions in morbidity and mortality related to ovarian cancers.
•The majority of women with ovarian cancers do not have an inherited gene mutation or a significant family history. Researchers should determine the analytic performance and clinical utility of testing for other gene mutations beyond BRCA1 and BRCA2.
•Additional potential risk factors for ovarian cancers not related to genetics — such as hormonal, behavioral, social and environmental factors - should be identified and evaluated toward the goal of developing better risk assessment tools.
Although it is relatively uncommon, ovarian cancer is the fifth leading cause of cancer deaths among American women. More than 21,000 women in the U.S. are diagnosed with ovarian cancer each year, and more than 14,000 die from the disease.
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