Overview

There is broad agreement among experts that women with very high risk for ovarian cancer should undergo risk-reducing removal of their ovaries and fallopian tubes (also known as risk-reducing salpingo-oophorectomy, or RRSO), the timing of surgery depends on the genetic mutation. High risk women who are not ready to undergo surgery are sometimes followed with high risk screening consisting of CA125 and transvaginal ultrasound. These tests are not very accurate; false positive/negative tests are common. Even with screening, most women who develop ovarian cancer are not found at an early enough stage to improve their survival. Newer tests have been developed to try to detect ovarian cancer at an earlier stage. These tests have not been studied for screening of high risk women. This research questions proposes designing a study to see if the addition of a new blood test to current screening guidelines improves early detection of ovarian cancer. 

Prioritization Score

Our Steering Committee and Research Work Group gave this study a prioritization score
of 2.95 out of 4 points, meaning this is a medium-high priority study. 

Feasibility Score

Our Executive Committee and research team considered the feasibility of this
study through ABOUT as Low. 

Next Steps

Recommend roll back to Assessment Phase

• Need to understand what research is happening now. Would require substantial and long term resources and  funding to look at cancer outcomes.
• Consider as part of collaboration with teams already conducting ovarian cancer prevention research.
• Consider as partnership with industry and health plan who would provide provisional reimbursement during study.  

Details of Prioritization Score

Our Steering Committee prioritizes questions based on four parameters on a scale from 1-4. Here are the average scores:

• Community impact - 3.00
• Community need/urgency - 3.07
• Decision-making impact - 2.93
• ABOUT Mission - 2.80

Details of Feasibility Score

Our Executive Committee scored feasibility as low->medium based on the following considerations

• Biggest consideration is that measuring ovarian cancer diagnosis outcomes would require this to be a very large, long-term study (possibly 20 years). 
• There are other groups looking at this question.
• This might be an opportunity to partner with industry.   
• This might be an opportunity to partner with other groups doing prevention studies such as the NRG Salpingectomy proposal which would be a 20-year prevention study that might be able add a screening component.

References

NCCN Guidelines Genetic/Familial High-Risk Assessment: Breast and Ovarian