New Technologies Aim to Improve Ovarian Cancer Detection

Encouraging trends abound in the management of ovarian cancer. As rates of ovarian disease continue to decline, there has also been a notable increase in tools for detecting it earlier in its course.



Dr Rebecca Stone

To better understand these developments, Medscape recently reached out to Rebecca Stone, MD, an ovarian cancer expert and associate professor of gynecologic oncology at Johns Hopkins University School of Medicine, in Baltimore, Maryland. This interview has been edited for length and clarity.

Medscape: There has been a decline in the rates of ovarian cancer in recent years. What are the possible causes of this?

Dr Stone: The number of new cases in the United States has actually been declining over the past two decades. This is thought to be attributable to the increased prescribing of oral contraceptive pills in the late 1990s and the uptake of preventive measures, such as risk-reducing gynecologic surgery for women with genetic predisposition to ovarian cancer, as well as opportunistic salpingectomy in the general population. Opportunistic salpingectomy was introduced about 10 years ago. It is a surgical means for primary prevention of tubo-ovarian cancer by removing both fallopian tubes at the time of elective surgery for women who have completed childbearing or in lieu of “tying the tubes” for women who desire permanent surgical sterility.

What can you tell us about a recent study suggesting that high-grade serous epithelial ovarian cancer may be detected earlier in the course of the disease by testing for TP53 clonal variants in DNA from Papanicolaou (Pap) tests performed during cervical cancer screening?

The idea here is that early mutational events that ultimately result in the development of epithelial ovarian cancer can be detected by performing gene sequencing on genetic material collected at the time of routine Pap smear screening done for cervical cancer. Pap tests are known to contain cells and genetic material shed from the fallopian tubes, where the precancerous lesions thought to give rise to epithelial ovarian cancer, predominantly serous epithelial ovarian cancers, start.

p53 gene mutations are thought to occur early in the evolution of ovarian cancer. There are data indicating that these mutations actually occur in cells lining the fallopian tubes. Polymerase chain reaction–based DNA/gene sequencing performed on cervical fluid collected by Pap smears could detect these p53-mutated cells shed from the fallopian tubes.

A strength of this study is that it included healthy controls. None of their Pap smears screened positive for the p53 mutations, unlike the Pap smears of women predating their diagnosis of ovarian cancer.

Limitations of the study include the fact that it had a small sample size. Findings will need to be confirmed in a larger patient population.

Also, the study only looked for p53 gene mutations. Ovarian cancers, like other cancers, are largely thought to occur when there is a buildup of mutations in critical genes that result in uncontrolled cell growth and division. These genetic changes/mutations are acquired during a person’s lifetime. Thus, there are likely early genetic changes/mutations that occur

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‘Landmark’ Study Pushed Detection of Covert Consciousness in TBI

Compelling advances in the ability to detect signs of consciousness in unconscious patients who have experienced traumatic brain injury (TBI) are leading to unprecedented changes in the field. There is now hope of improving outcomes and even sparing lives of patients who may otherwise have been mistakenly assessed as having no chance of recovery.

A recent key study represents a tipping point in the mounting evidence of the ability to detect “covert consciousness” in patients with TBI who are in an unconscious state. That research, published in The New England Journal of Medicine (NEJM) in June 2019, linked the promising signals of consciousness in comatose patients, detected only on imaging, with remarkable outcomes a year later.

“This was a landmark study,” said Brian L. Edlow, MD, in a presentation on the issue of covert consciousness during the American Neurological Association’s 2020 virtual annual meeting.

“Importantly, it is the first compelling evidence that early detection of covert consciousness also predicts 1-year outcomes in the Glasgow Outcome Scale Extended (GOSE), showing that covert consciousness in the ICU appears to be relevant for predicting long-term outcomes,” said Edlow, who is associate director of the Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, in Boston.

The researchers showed that 15% of unconscious patients with acute brain injury in the study exhibited significant brain activity on EEG in response to stimuli that included verbal commands such as envisioning that they are playing tennis.

Although other studies have shown similar effects with task-based stimuli, the NEJM study further showed that a year later, the patients who had shown signs of covert consciousness, also called “cognitive motor dissociation” (CMD), were significantly more likely to have a good functional outcome, said the study’s senior author, Jan Claassen, MD, director of critical care neurology at Columbia University, in New York City, who also presented during the ANA session.

“Importantly, a year later after injury, we found that 44% of patients with CMD and only 14% of non-CMD patients had a good functional outcome, defined as a GOSE score indicating a state where they can at least take care of themselves for 8 hours in a day,” he said.

“[Whether] these patients in a CMD state represent a parallel state or a transitory state on the road to recovery remains to be shown,” he said.

Jennifer Frontera, MD, a professor in the Department of Neurology at NYU Langone in New York City and co-moderator of the session, agreed that the research is “remarkable.”

“Also, it is practical, since many could potentially apply and validate his algorithms, since EEG technology is portable and widely available,” she told Medscape Medical News.

Research Has Ushered in a “Sea Change” in Neuro-Critical Care

The research has helped push forward recommendations on the treatment of unconscious patients, Edlow said.

“This has led to a sea change in our field just over the last 2 years, with multiple guidelines published suggesting that it may be time for us to consider incorporating task-based fMRI and EEG

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Cites Link to Nonalcoholic Fatty Liver Disease and Importance of Early Detection

Echosens, a high-technology company offering the FibroScan family of products, urges increased awareness of the rise of liver cancer rates, which have more than tripled since 1980, while death rates have more than doubled during this time. About 21,000 Americans are diagnosed with primary liver cancer each year—twice as common in men than in women. Risk factors include other liver diseases, including cirrhosis, chronic hepatitis B, chronic hepatitis C and non-alcoholic fatty liver disease (NAFLD). NAFLD may be a key driver of increased cancer associated with obesity, while non-alcoholic steatohepatitis (NASH) is the fastest growing cause of liver cancer among transplant candidates.

“People with NAFLD have higher rates of several types of cancer, with the greatest increase seen for liver cancer and other gastrointestinal cancers,” says Jon Gingrich, CEO, Echosens North America. “Point-of-care examinations, monitoring and ongoing assessment of liver fat and stiffness as provided by FibroScan, a rapid, non-invasive point of care examination, can identify individuals who are asymptomatic and undiagnosed for liver damage.”

Researchers have found that liver cancer, NAFLD, hepatitis C and liver transplants are prevalent in 40-80% of people who have Type 2 diabetes and in 30-90% of people who are obese. Being overweight or obese is responsible for about 85% of fatty liver disease.

“Approximately 30,000 people die from liver cancer each year and these numbers have continued to rise in recent years,” says Lynn Gardner Seim, Executive Vice President and Chief Operating Officer, American Liver Foundation. “It is essential that patients at risk for liver cancer, including those who have previously been diagnosed with hepatitis C, NAFLD, NASH and other liver diseases, talk with their doctors and have a plan in place for getting screened.”

Traditional approaches to assessing liver health, such as liver biopsy and advanced radiological imaging, may not be cost effective nor accessible to the broader at-risk population. FibroScan directly measures physical properties of stiffness and fat liver to provide reproducible results and allow for both diagnosis and monitoring of liver stiffness and liver fat. It is also recognized worldwide as the reference for non-invasive liver diagnosis supported with more than 2,000 medical publications and 40 guideline recommendations.

About Echosens

Echosens, the developer of FibroScan®, is an innovative high-technology company offering a full range of products and services supporting physicians in their assessment and management of patients with chronic liver diseases. FibroScan is supported by over 2,500 peer-reviewed publications and examinations are covered by Medicare, Medicaid and many insurance plans. For more information, please visit http://www.echosens.us and follow us on Twitter (@echosensNA).

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