SGO Issues August 31, 2017
Annual Meeting abstract deadline extended to Sept. 18
Updated Practice Bulletin on HBOC Syndrome released
SGO and ACOG address role of OBGYN in early detection of ovarian cancer
Support clinical trials for Gynecologic Cancer Awareness Month
SGO announces staffing changes
Due to the impact of Hurricane Harvey on the residents of Texas and Louisiana, SGO is extending the SGO Annual Meeting on Women’s Cancer deadline for abstract and surgical film submissions to Monday, Sept. 18, 2017, at 11:59 p.m. Central Time. On behalf of the Society, our thoughts are with all of our members and their patients who have been affected by the severe weather.
On Aug. 22, a joint Practice Bulletin between the American College of Obstetrician and Gynecologists (ACOG) and SGO: Hereditary Breast and Ovarian Cancer Syndrome, recommended genetic counseling for all women with ovarian epithelial cancer (including fallopian tube cancer or primary peritoneal cancer) and for individuals who have a personal or family history of breast cancer or ovarian cancer. This Practice Bulletin was developed by the ACOG Committee on Practice Bulletins–Gynecology and Committee on Genetics in collaboration with Susan C. Modesitt, MD, and Karen Lu, MD, and by SGO in collaboration with Lee-may Chen, MD, and C. Bethan Powell, MD.
In the Practice Bulletin, the following recommendations are based on good and consistent scientific evidence (Level B):
- Genetic counseling is recommended for all women with ovarian epithelial cancer (this includes fallopian tube cancer or primary peritoneal cancer) and for individuals who have a personal or family history of breast cancer or ovarian cancer.
- Women with BRCA mutations or who carry another actionable deleterious mutation that is predisposing to breast cancer should be offered risk-reducing bilateral mastectomy.
- Women with BRCA mutations or who carry another actionable deleterious mutation predisposing to ovarian cancer should be offered risk-reducing bilateral salpingo-oophorectomy.
- For a risk-reducing bilateral salpingo-oophorectomy, all tissue from the ovaries and fallopian tubes should be removed.
Updates since 2009 Practice Bulletin:
- More genes have been discovered which are associated with inherited predisposition to cancer.
- Assessment of lifetime risk if a woman carries a genetic mutation is more accurately described.
- Emphasis is placed on the role of primary care and ob/gyns in taking a family history and identifying women who may be at increased inherited cancer risk and should be referred for evaluation of HBOC. Recommendations for identification of women who should be referred to genetic counseling have been expanded and include all women with a personal history of ovarian cancer.
- Specific recommendations have been updated for cancer surveillance and prevention. Discussion of salpingectomy for risk reduction is included. Age recommendation for removal of tubes and ovaries for BRCA2 carriers is expanded to up to age 45.
Dr. Powell explained that although more women with a family history of ovarian, breast or colon cancer are getting referred to genetic counselors, only 10 to 15 percent of those family history are appropriately referred to genetic counselors.
“Better strategies for improving testing of women with a personal history of ovarian cancer are still needed,” said Dr. Powell. “Particularly now that there are targeted therapies which are effective in BRCA related ovarian cancers and other treatment strategies which may be appropriate for these women.” Dr. Chen added that the SGO White Paper on genetic services published in the August 2017 edition of Gynecologic Oncology, addresses barriers to genetic testing and potential solutions such as direct testing by providers.
The most recent Practice Bulletin notes that women tested before 2009 may not have had large gene rearrangement testing in the BRCA genes (i.e., the BRCA Rearrangement Test), and women tested before 2013 would not have had access to multigene panel testing.
“Women who have strong personal or family history of breast and ovarian cancer who underwent BRCA testing and no deleterious mutation was found, should re-contact their genetic counselor and discuss the appropriateness of performing a HBOC gene panel test to rule out other nonBRCA genes associated with HBOC,” said Dr. Powell.
“The Role of the Obstetrician–Gynecologist in the Early Detection of Epithelial Ovarian Cancer in Women at Average Risk,” was released last week by the American College of Obstetricians and Gynecologists (ACOG) and SGO. With no current strategy for the early detection of ovarian cancer, the Committee Opinion advised, “Taking a detailed personal and family history for breast, gynecologic, and colon cancer facilitates categorizing women based on their risk [average risk or high risk] of developing epithelial ovarian cancer.” This document was developed by ACOG’s Committee on Gynecologic Practice and SGO, in collaboration with committee member Kristen A. Matteson, MD, MPH, and SGO members Camille Gunderson, MD, and Debra L. Richardson, MD.
In the Committee Opinion, ACOG and SGO offer the following recommendations and conclusions:
- Currently, there is no strategy for early detection of ovarian cancer that reduces ovarian cancer mortality.
- The use of transvaginal ultrasonography and tumor markers (such as CA 125), alone or in combination, for the early detection of ovarian cancer in average-risk women have not been proved to reduce mortality, and harms exist from invasive diagnostic testing (e.g., surgery) resulting from false-positive test results.
- Epithelial ovarian cancer is most commonly detected in an advanced stage (65 percent of cases are stage III or stage IV) when the cure rate is only 18 percent.
- Early stage (localized) ovarian cancer is associated with improved survival.
- Taking a detailed personal and family history for breast, gynecologic, and colon cancer facilitates categorizing women based on their risk (average risk or high risk) of developing epithelial ovarian cancer.
- The patient and her obstetrician–gynecologist should maintain an appropriate level of suspicion when potentially relevant signs and symptoms of ovarian cancer are present.
The new document is an update of the Committee Opinion published in March 2011. Dr. Richardson noted that the biggest change in the document is including the study data from “Ovarian cancer screening and mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial,” published by The Lancet in 2016.
“This is the largest study to date done for ovarian cancer screening,” said Dr. Richardson. “Unfortunately, even after long follow up—a median of 11 years—no survival advantage was seen in either of the two screening arms.”
In the updated Committee Opinion, taking a detailed personal and family history for breast, gynecologic, and colon cancer has been added to the recommendations, but current methods of early detection of ovarian cancer for average-risk women, (transvaginal ultrasound, CA125, direct-to-consumer tests) are still not considered to be fully effective.
“Hopefully there will be better serum tests developed in the future to help detect early stage cancer and stratify individual risk,” said Dr. Gunderson.
September is Gynecologic Cancer Awareness Month (GCAM). Join the Society of Gynecologic Oncology and the Foundation for Women’s Cancer in bringing awareness about gynecologic cancers and #sharethepurplelove by donating to help end women’s cancer today. During this year’s GCAM, SGO and FWC will also take a special focus on clinical trial awareness. With the decline in enrollment for stage III clinical trials for gynecologic cancers, SGO members are encouraged to let their patients know about available clinical trials and share GCAM social media posts using the hashtags #Trials4GynCancerNOW #EndWomensCancer and #sharethepurplelove.
Nancy Stonis, RN, has been named Interim Director of Education. Nancy has worked at two Level I trauma centers and several nonprofit health care associations, including Director of Professional Affairs at the Emergency Nurses Association, Director of Program Development at the National Association of Neonatal Nurses, and Practice Manager of Accreditation at the American Association of Diabetes Educators. Kayla Westman, MSL, CMP, has been promoted to Director of Meetings, and Tori Scatena is now Manager of Meetings. Newly hired SGO staff members include Traci Schwendner, Clinical Practice Coordinator, and Megan Stankewicz, Office and CEO Administrative Assistant.
The SGO website has a new directory featuring photos, job responsibilities, biographies and contact information of SGO and FWC staff.