Early detection of ovarian cancer

Abstract

Incidence, prevalence, mortality rates, and natural history Ovarian cancer is a heterogeneous and rapidly progressive disease of low prevalence and poor survival. In developed countries, the number of deaths attributed to ovarian cancer approximates all other gynecologic malignancies combined [1]. Globally, approximately 225,000 women are diagnosed with ovarian cancer with 140,000 deaths annually [2]. Within the United States, ovarian cancer is the most lethal of all gynecologic malignancies and is the fifth leading cause of cancer-related deaths and ninth most common malignancy [3]. An estimated 21,880 new cases of ovarian cancer were diagnosed in 2010 within the United States with the expectation of 13,850 women dying from this disease [4]. The lifetime risk of developing ovarian cancer in the general population, without any risk factors, is 1 in 72 (1.39%) [5,6]. The lifetime risk of dying from ovarian cancer for women living in the United States is 1 in 96 (1.04%) [5]. In the post-menopausal population the incidence is 1 in 2,300. Ovarian cancer carries a high case-to-fatality ratio. Compared with breast cancer, it is more lethal by a factor of 3. Unfortunately, the majority of ovarian carcinoma cases are diagnosed at advanced stages (stages III and IV), when the disease has already metastasized to the peritoneal cavity or other surrounding organs, such as the liver or lungs [4]. Less than 20% of ovarian cancers are detected when the cancer is still confined to the ovary (stage I). Women who are diagnosed with early stage ovarian cancer (stages I to II) have 5-year survival rates that range from 57 to 90% [7]. In contrast, the 5-year survival rates for patients who are diagnosed with advanced stage disease range from 18 to 45% [7]. Despite advances in surgery and platinum-based chemotherapy the mortality rates of individuals with ovarian cancer remain poor. In the past 40 years, the median 5-year survival rate for women with advanced-stage cancer has increased from 37 to 46% [8,9]. Ovarian cancer is rarely seen in women under 40. The average age at diagnosis is 58 years and the highest incidence occurs from 65 to 75 years of age.