Kentucky Research Study Offers Post-Menopausal Women New Information Regarding Their Ovarian Cancer Risk
Embargo expired: 5/5/1998 12:00 AM EDT
Source Newsroom: Society of Gynecologic Oncology
KENTUCKY RESEARCH STUDY OFFERS POST-MENOPAUSAL WOMEN NEW INFORMATION REGARDING THEIR OVARIAN CANCER RISK
CHICAGO, May 5, 1998 -- Should a post-menopausal woman, over the age of 50, who has been diagnosed with cystic ovarian tumors, be alarmed? According to conclusions reached in a new study, "The Malignant Potential of Small Cystic Ovarian Tumors in Women Over 50 Years of Age," published in the April issue of Gynecologic Oncology, alarm is unwarranted, but concern is appropriate.
The authors of this new research are C.L. Bailey, MD, F.R. Ueland, MD, G.L. Land, MD, P.D. DePriest, MD, H.H. Gallion, MD, R.J. Kryscio, MD, and J.R. van Nagell, Jr., MD. The study was a cooperative effort between the Division of Gynecologic Oncology and the Department of Statistics at University of Kentucky Medical Center, Lexington, KY.
Research Objectives: Early ovarian cancer rarely produces any discernible symptoms. Symptoms usually appear only when the cancer is at an advanced stage. Transvaginal sonography has demonstrated its effectiveness in screening for the disease; however, its positive predictive value (PPV) is low, requiring up to 10 women to have ovarian tumors removed in order to detect one case of ovarian cancer. Tumors are one of two types: unilocular tumors that have one compartment or cavity and tend to be benign; and complex tumors that have wall abnormalities, and tend to have a significant risk of malignancy.
The authors of this study set out to determine the potential for malignancy in tumors detected by ultrasound in asymptomatic post-menopausal women or women over 50 years of age. With this information, patient management strategies for operative intervention in this patient group could be devised.
Methodology: Patients included in this study had participated in the University of Kentucky Ovarian Cancer Screening Project from 1987 to 1995. All asymptomatic women who were at least, 50 years old and post-menopausal, were eligible to enroll in the research effort. Women with a known ovarian tumor or personal history of ovarian cancer were excluded from the study. Participating patients completed a medical history questionnaire; transvaginal sonography (TVS) was performed on each, with repeat screening performed at varied intervals, according to the test results.
Results: During the eight year period, 7,705 asymptomatic postmenopausal women were screened. The results revealed unilocular cystic ovarian tumors in 256 women (3.3%), tumors with solid and cystic components (complex ovarian tumors) were present in 250 women screened. Key characteristics of each group follow:
Women with unilocular cystic ovarian tumors
-- The mean age for this group of women was 55.5 years. A family history of ovarian cancer was found in 13.6%, and 42% of the 256 women were taking prescribed hormone replacement therapy.
-- Most of the cysts were located at the surface of the ovary, and few were located centrally. All tumors were less than 10 centimeters (cm) in diameter with 90% of those found were less than 5 cm.
-- 125 women (49%) had tumors which resolved spontaneously within 60 days of detection; the balance (131 or 51%) of the women had tumors that persisted. Of the latter group, 45 women underwent laparoscopy or laparotomy with tumor removal, and 86 elected to be followed with serial sonograms. There were no cases of malignancy found in the tumors removed or has ovarian cancer occurred in any of the women now receiving follow-up sonograms.
Women with complex ovarian tumors
-- The mean age of the 250 women in this group was 59.1 years and 10% had a family history of ovarian cancer. Hormone replacements were being taken by 100 women.
-- All of the tumors were less than 10 cm in diameter with 89% less than 5 cm. Of this group, 135 (55%) women had tumors that resolved spontaneously within 60 days of detection; 115 (45%) women had tumors that persisted. Some 114 of the 115 women with persistent complex ovarian masses underwent surgical removal of these tumors, 30 by laparoscopy and 84 by laparotomy.
-- Seven patients had ovarian cancer, one patient had primary peritoneal cancer and one had metastatic breast cancer to the ovary.
The frequency of malignancy in patients with complex ovarian tumors was 6.1% compared to 0% in patients with unilocular cysts.
Conclusion: The results led the authors to suggest that post-menopausal women with unilocular cysts can be followed by sonograms at three to six month intervals. The researchers also believed that significant risk for malignancy recommends surgical removal as the preferred treatment for post-menopausal women with complex ovarian cysts.
"This study clarifies existing information regarding the risk of ovarian cancer," said Karl C. Podratz, MD, Ph.D., President of the Society of Gynecologic Oncology and Director of the Department of Gynecologic Oncology at the Mayo Clinic. He added, "An informed patient population is key to our efforts to reduce the incidence of this insidious disease."
Gynecologic Oncology is published by Academic Press and is the scientific journal of The Society of Gynecologic Oncologists (SGO). SGO is the only United States medical organization dedicated to the prevention, detection, and cure of female cancers. More information about gynecologic cancer is available on the Internet at www.sgo.org or www.wcn.org.
- end - Editor's Note: For the full abstract of this study or questions, contact Johanna Spangenberg at (703) 527-7424.