Cancer of the ovary is a particularly nasty disease. It often remains asymptomatic until it has reached an advanced, incurable stage, and scientists have been unable to develop an effective screening test for the disease like the ones in widespread use for cancers of the breast and cervix.

The dismal status of ovarian cancer screening was underscored a year ago when an NIH-sponsored study showed that over 70% of cancers detected by transvaginal ultrasound and CA 125 biomarker testing—the two best ovarian screening tests we’ve got—had reached stage III or IV at the time the patients screened positive. That’s about what happens when women aren’t screened at all.

That wasn’t the worst of it, however. In just the first year of that screening program, positive test results obligated 566 surgical procedures which uncovered only 18 cancers. That’s an awful lot of unnecessary surgery and associated morbidity right there. Things were no better on the false-negative side of things. Overall, 89 cases of ovarian cancer were diagnosed during the NIH study, and a third of them had been missed by both screening modalities.

What’s New?     The NIH study didn’t evaluate the impact of screening on ovarian cancer mortality, but a recent study by Laura Havrilesky and colleagues at Duke did indeed address the point. Sadly, the results were abysmal.

Havrilesky’s team developed a modified a Markov model to characterize the natural history of ovarian cancer, and used it to show that mortality would fall by a paltry 11% if a widespread screening program (in this case, CA 125 biomarker testing followed by pelvic ultrasound imaging for women with abnormal results) was put into place. 

The scientists emphasized that the protean nature of ovarian cancer—not just its tendency to remain asymptomatic until an advanced stage—was a huge challenge in developing an effective screening tool. According to their analysis, some ovarian cancers tend to grow slowly, taking nearly 3 years before progressing to an advanced stage. Other ovarian cancers are more aggressive, reaching an advanced stage after only 13 months.

“If we assume ovarian cancers grow and spread at different rates, the best screening strategy available will only reduce the number of women dying from the cancer by 11%,” Havrilesky said in a press release. “This is partially because the slower growing cancers are more likely to be caught by a screening test.”

The authors didn’t exactly throw up their hands in disgust at the poor prospects for ovarian screening, but they did suggest that policy makers consider directing funds towards prevention and treatment of the disease, and away from screening.

That said, most experts do recommend routine screening for ovarian cancer in women that have a family history of the disease and in those who carry genes known to increase the risk of developing it. As always, women with questions about these issues should consult their doctors.

Havrilesky’s write-up appears in Cancer.

This post first appeared on HCPLive.com/Psychiatry.

Women that have been diagnosed with cancer or multiple sclerosis are 6 times more likely to be separated or divorced than their male counterparts, according to a study in Cancer.

To reach this conclusion, Marc Chamberlain and colleagues enrolled 515 patients at 3 medical centers beginning in 2001, and followed them for 5 years.

During the study period, 11.6% of the patients either divorced or separated, a rate similar to that found in the general population.

However, the rate was 20.8% when the woman was the patient and just 2.9% when the patient was male.

The scientists also detected correlations between age and length of marriage, and the risk of divorce or separation. Older woman, it turned out, were more likely to experience a break-up, although longer marriages tended to remain intact.

Regardless of gender, divorced or separated patients were found to have an increased reliance on antidepressants, less frequent participation in clinical trials, more frequent hospitalizations, and failure to complete radiation therapy.

“Female gender was the strongest predictor of separation or divorce in each of the patient groups we studied,” Chamberlain–a professor of neurology and neurosurgery at the University of Washington School of Medicine–told Newswise.

The authors speculated that men were more likely to leave a sick spouse because they were less willing or able to commit to being a caregiver, while women were more able to assume the task of maintaining home and family.

“We recommend that providers be sensitive to early suggestions of marital discord in couples affected by a serious medical illness, especially when the woman is the affected spouse and it occurs early in the marriage. Early identification and psychosocial intervention might reduce the frequency of divorce and separation, and improve quality of life and quality of care,” concluded the authors.

Cancer research trials published in peer-reviewed journals tend to include a disproportionately small number of women, according to a study published in Cancer.

To reach this conclusion, Reshma Jagsi and her colleagues at the University of Michigan reviewed 661 prospective studies involving more than a million subjects who had non-gender specific cancers like those of the colon, head and neck, lung, brain and lymphomas.

“In the vast majority of studies we analyzed, fewer women were enrolled than we would expect given the proportion of women diagnosed with the type of cancer being studied,” Jagsi told BurrillReport.

Jagsi added, “we’re seeing it in all cancer types. We know there are biological differences between the sexes, as well as social and cultural differences. Studies need to assess whether there are differences in responses to treatment between women and men.”

The practice flies in the face of the NIH’s Revitalization Act of 1993, which highlighted the need to include women in research studies in numbers sufficient to support gender-specific subgroup analyses.

Government-funded studies did include slightly higher numbers of female participants: 41% of subjects in such trials were women, whereas only 37% of the subjects in non-government-funded studies were women.

The authors suggested several reasons for the discrepancy. For example, scientists tend to avoid including “vulnerable populations,” such as women of childbearing age in their studies. “By protecting them from research, we’re excluding them,” the scientists concluded.

Other barriers are thought to include a lack of information, fear, and a belief that the studies interfere with individual responsibilities including child care.

The authors suggest that among other things, investigators should reimburse participants for transportation and child care expenses incurred during the study.

Nearly 20% of breast cancer patients either delayed radiation therapy or did not finish a full course of therapy following breast-conserving surgery, and they experienced worse outcomes as a result, according to a study in Cancer.

Scientists at Weil Cornell Medical College studied 7,791 patients who were at least 66 years old and had been diagnosed with Stage 1 breast cancer between 1991 and 1999.

They found that 16% experienced a delay in the onset of radiation therapy of at least 8 weeks following surgery, and 3% did not complete a full course of therapy, defined as less than 3 weeks instead of the usual course of 5-7 weeks.

 African-Americans were 50% more likely to delay treatment, and women living in high poverty areas were less likely to complete their treatments.

Women who delayed radiation therapy for at least 8 weeks were 40% more likely to experience a recurrence of breast cancer. Those who waited more than 12 weeks were 4 times more likely to experience a recurrence.

Patients who did not complete their radiation therapy had a 32% higher mortality.

“One of the big problems is that care has to be coordinated to avoid these kinds of delays and lack of completion, especially for patients from a lower socioeconomic status,” study leader Heather Taffet Gold told the New York Times.

That’s easier said than done.