Performance characteristics and stage distribution of invasive epithelial ovarian/tubal/peritoneal cancers
Prof Usha Menon - University College London, London, UK
Despite significant advances in the treatment of ovarian cancer, only about 45% of women survive five years and this is because the majority of the women are diagnosed with late stage disease. In the UK collaborative trial of ovarian cancer screening we have worked to determine whether screening by picking up the disease earlier could impact on mortality. We have completed a huge randomised controlled trial; tomorrow I’m going to present some of the key results of that trial.
Could you tell us what results we can look forward to?
In this trial we were comparing two forms of screening, a multimodal screening which is based on a blood test for CA125 which we need to produce in and ultrasound screening where the women come in every year and have an annual ultrasound scan. So in this very large, in fact the largest, randomised controlled trial with 202,000 women tomorrow’s results will show what is the difference, how the two screening strategies performed and whether there is a stage shift in the screened arms compared to the control arm.
From the multimodal side of things, what kind of impacts are you seeing there with the regular check-ups?
In both arms really the women had screening every year for about a median of eight years, a range of 7-11 years. We followed them up for a median of 11.1 years. In the multimodal group what we see is that the screening strategy picked up 86% of the invasive primary epithelial ovarian peritoneal and tubal cancers which were diagnosed within one year of the screen. We undertook four operations for each ovarian cancer that was detected. Another key finding is that we had a significant stage shift, so while only 26% of women in the control arm were stage 1, 2 or 3a, in the multimodal arm 40% overall were stage 1, 2 and 3a so there was a significant stage shift. That is the most exciting results from this time’s ASCO presentation.
By catching the cancer earlier have you had any patient feedback, for example, any anecdotal evidence for people who have been involved in the trial?
They’ve come year on year for many years, like eleven years many of them, so in those who have been detected early we have had lots of individual letters. But, of course, the most important thing is that we have followed up everybody through follow-up questionnaires and through linkage to look whether they have lived or died as of December 2014. This was already published in The Lancet previously and what we have seen is that this stage shift that we are presenting tomorrow may translate, though we don’t have absolutely definitive results, into a possible 20% reduction in mortality. But in a mortality analysis the results are not entirely significant so we are going to follow up the cohort for another four years to confirm that the stage shift does have an impact on mortality.
Has there been any information coming out of that for people who are advancing from stage to stage if there’s any developments? For example catching things before they become metastatic up to stage 4?
No, this is very much about picking up the cancer earlier, not about post-diagnosis, not about recurrence or treatment post-diagnosis.
Is there anything that you would like to add?
UKCTOCS is the largest ovarian cancer screening trial and we enrolled just over 202,000 women who were randomised to a control arm, 100,000 who had no screening, and a screen arm where the women had two forms of screening as I described. It’s funded by the big public funding bodies in the UK - the Medical Research Council, Cancer Research UK and the NIHR, together with the Eve Appeal, and it’s a thirteen centre randomised controlled trial.