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Theses/dissertations from 2023 2023.

Development of Combination Therapy Strategies to Treat Cancer Using Dihydroorotate Dehydrogenase Inhibitors , Nicholas Mullen

Overcoming Resistance Mechanisms to CDK4/6 Inhibitor Treatment Using CDK6-Selective PROTAC , Sarah Truong

Theses/Dissertations from 2022 2022

Omics Analysis in Cancer and Development , Emalie J. Clement

Investigating the Role of Splenic Macrophages in Pancreatic Cancer , Daisy V. Gonzalez

Polymeric Chloroquine in Metastatic Pancreatic Cancer Therapy , Rubayat Islam Khan

Evaluating Targets and Therapeutics for the Treatment of Pancreatic Cancer , Shelby M. Knoche

Characterization of 1,1-Diarylethylene FOXM1 Inhibitors Against High-Grade Serous Ovarian Carcinoma Cells , Cassie Liu

Novel Mechanisms of Protein Kinase C α Regulation and Function , Xinyue Li

SOX2 Dosage Governs Tumor Cell Identity and Proliferation , Ethan P. Metz

Post-Transcriptional Control of the Epithelial-to-Mesenchymal Transition (EMT) in Ras-Driven Colorectal Cancers , Chaitra Rao

Use of Machine Learning Algorithms and Highly Multiplexed Immunohistochemistry to Perform In-Depth Characterization of Primary Pancreatic Tumors and Metastatic Sites , Krysten Vance

Characterization of Metastatic Cutaneous Squamous Cell Carcinoma in the Immunosuppressed Patient , Megan E. Wackel

Visceral adipose tissue remodeling in pancreatic ductal adenocarcinoma cachexia: the role of activin A signaling , Pauline Xu

Phos-Tag-Based Screens Identify Novel Therapeutic Targets in Ovarian Cancer and Pancreatic Cancer , Renya Zeng

Theses/Dissertations from 2021 2021

Functional Characterization of Cancer-Associated DNA Polymerase ε Variants , Stephanie R. Barbari

Pancreatic Cancer: Novel Therapy, Research Tools, and Educational Outreach , Ayrianne J. Crawford

Apixaban to Prevent Thrombosis in Adult Patients Treated With Asparaginase , Krishna Gundabolu

Molecular Investigation into the Biologic and Prognostic Elements of Peripheral T-cell Lymphoma with Regulators of Tumor Microenvironment Signaling Explored in Model Systems , Tyler Herek

Utilizing Proteolysis-Targeting Chimeras to Target the Transcriptional Cyclin-Dependent Kinases 9 and 12 , Hannah King

Insights into Cutaneous Squamous Cell Carcinoma Pathogenesis and Metastasis Using a Bedside-to-Bench Approach , Marissa Lobl

Development of a MUC16-Targeted Near-Infrared Antibody Probe for Fluorescence-Guided Surgery of Pancreatic Cancer , Madeline T. Olson

FGFR4 glycosylation and processing in cholangiocarcinoma promote cancer signaling , Andrew J. Phillips

Theses/Dissertations from 2020 2020

Cooperativity of CCNE1 and FOXM1 in High-Grade Serous Ovarian Cancer , Lucy Elge

Characterizing the critical role of metabolic and redox homeostasis in colorectal cancer , Danielle Frodyma

Genomic and Transcriptomic Alterations in Metabolic Regulators and Implications for Anti-tumoral Immune Response , Ryan J. King

Dimers of Isatin Derived Spirocyclic NF-κB Inhibitor Exhibit Potent Anticancer Activity by Inducing UPR Mediated Apoptosis , Smit Kour

From Development to Therapy: A Panoramic Approach to Further Our Understanding of Cancer , Brittany Poelaert

The Cellular Origin and Molecular Drivers of Claudin-Low Mammary Cancer , Patrick D. Raedler

Mitochondrial Metabolism as a Therapeutic Target for Pancreatic Cancer , Simon Shin

Development of Fluorescent Hyaluronic Acid Nanoparticles for Intraoperative Tumor Detection , Nicholas E. Wojtynek

Theses/Dissertations from 2019 2019

The role of E3 ubiquitin ligase FBXO9 in normal and malignant hematopoiesis , R. Willow Hynes-Smith

BRCA1 & CTDP1 BRCT Domainomics in the DNA Damage Response , Kimiko L. Krieger

Targeted Inhibition of Histone Deacetyltransferases for Pancreatic Cancer Therapy , Richard Laschanzky

Human Leukocyte Antigen (HLA) Class I Molecule Components and Amyloid Precursor-Like Protein 2 (APLP2): Roles in Pancreatic Cancer Cell Migration , Bailee Sliker

Theses/Dissertations from 2018 2018

FOXM1 Expression and Contribution to Genomic Instability and Chemoresistance in High-Grade Serous Ovarian Cancer , Carter J. Barger

Overcoming TCF4-Driven BCR Signaling in Diffuse Large B-Cell Lymphoma , Keenan Hartert

Functional Role of Protein Kinase C Alpha in Endometrial Carcinogenesis , Alice Hsu

Functional Signature Ontology-Based Identification and Validation of Novel Therapeutic Targets and Natural Products for the Treatment of Cancer , Beth Neilsen

Elucidating the Roles of Lunatic Fringe in Pancreatic Ductal Adenocarcinoma , Prathamesh Patil

Theses/Dissertations from 2017 2017

Metabolic Reprogramming of Pancreatic Ductal Adenocarcinoma Cells in Response to Chronic Low pH Stress , Jaime Abrego

Understanding the Relationship between TGF-Beta and IGF-1R Signaling in Colorectal Cancer , Katie L. Bailey

The Role of EHD2 in Triple-Negative Breast Cancer Tumorigenesis and Progression , Timothy A. Bielecki

Perturbing anti-apoptotic proteins to develop novel cancer therapies , Jacob Contreras

Role of Ezrin in Colorectal Cancer Cell Survival Regulation , Premila Leiphrakpam

Evaluation of Aminopyrazole Analogs as Cyclin-Dependent Kinase Inhibitors for Colorectal Cancer Therapy , Caroline Robb

Identifying the Role of Janus Kinase 1 in Mammary Gland Development and Breast Cancer , Barbara Swenson

DNMT3A Haploinsufficiency Provokes Hematologic Malignancy of B-Lymphoid, T-Lymphoid, and Myeloid Lineage in Mice , Garland Michael Upchurch

Theses/Dissertations from 2016 2016

EHD1 As a Positive Regulator of Macrophage Colony-Stimulating Factor-1 Receptor , Luke R. Cypher

Inflammation- and Cancer-Associated Neurolymphatic Remodeling and Cachexia in Pancreatic Ductal Adenocarcinoma , Darci M. Fink

Role of CBL-family Ubiquitin Ligases as Critical Negative Regulators of T Cell Activation and Functions , Benjamin Goetz

Exploration into the Functional Impact of MUC1 on the Formation and Regulation of Transcriptional Complexes Containing AP-1 and p53 , Ryan L. Hanson

DNA Polymerase Zeta-Dependent Mutagenesis: Molecular Specificity, Extent of Error-Prone Synthesis, and the Role of dNTP Pools , Olga V. Kochenova

Defining the Role of Phosphorylation and Dephosphorylation in the Regulation of Gap Junction Proteins , Hanjun Li

Molecular Mechanisms Regulating MYC and PGC1β Expression in Colon Cancer , Jamie L. McCall

Pancreatic Cancer Invasion of the Lymphatic Vasculature and Contributions of the Tumor Microenvironment: Roles for E-selectin and CXCR4 , Maria M. Steele

Altered Levels of SOX2, and Its Associated Protein Musashi2, Disrupt Critical Cell Functions in Cancer and Embryonic Stem Cells , Erin L. Wuebben

Theses/Dissertations from 2015 2015

Characterization and target identification of non-toxic IKKβ inhibitors for anticancer therapy , Elizabeth Blowers

Effectors of Ras and KSR1 dependent colon tumorigenesis , Binita Das

Characterization of cancer-associated DNA polymerase delta variants , Tony M. Mertz

A Role for EHD Family Endocytic Regulators in Endothelial Biology , Alexandra E. J. Moffitt

Biochemical pathways regulating mammary epithelial cell homeostasis and differentiation , Chandrani Mukhopadhyay

EPACs: epigenetic regulators that affect cell survival in cancer. , Catherine Murari

Role of the C-terminus of the Catalytic Subunit of Translesion Synthesis Polymerase ζ (Zeta) in UV-induced Mutagensis , Hollie M. Siebler

LGR5 Activates TGFbeta Signaling and Suppresses Metastasis in Colon Cancer , Xiaolin Zhou

LGR5 Activates TGFβ Signaling and Suppresses Metastasis in Colon Cancer , Xiaolin Zhou

Theses/Dissertations from 2014 2014

Genetic dissection of the role of CBL-family ubiquitin ligases and their associated adapters in epidermal growth factor receptor endocytosis , Gulzar Ahmad

Strategies for the identification of chemical probes to study signaling pathways , Jamie Leigh Arnst

Defining the mechanism of signaling through the C-terminus of MUC1 , Roger B. Brown

Targeting telomerase in human pancreatic cancer cells , Katrina Burchett

The identification of KSR1-like molecules in ras-addicted colorectal cancer cells , Drew Gehring

Mechanisms of regulation of AID APOBEC deaminases activity and protection of the genome from promiscuous deamination , Artem Georgievich Lada

Characterization of the DNA-biding properties of human telomeric proteins , Amanda Lakamp-Hawley

Studies on MUC1, p120-catenin, Kaiso: coordinate role of mucins, cell adhesion molecules and cell cycle players in pancreatic cancer , Xiang Liu

Epac interaction with the TGFbeta PKA pathway to regulate cell survival in colon cancer , Meghan Lynn Mendick

Theses/Dissertations from 2013 2013

Deconvolution of the phosphorylation patterns of replication protein A by the DNA damage response to breaks , Kerry D. Brader

Modeling malignant breast cancer occurrence and survival in black and white women , Michael Gleason

The role of dna methyltransferases in myc-induced lymphomagenesis , Ryan A. Hlady

Design and development of inhibitors of CBL (TKB)-protein interactions , Eric A. Kumar

Pancreatic cancer-associated miRNAs : expression, regulation and function , Ashley M. Mohr

Mechanistic studies of mitochondrial outer membrane permeabilization (MOMP) , Xiaming Pang

Novel roles for JAK2/STAT5 signaling in mammary gland development, cancer, and immune dysregulation , Jeffrey Wayne Schmidt

Optimization of therapeutics against lethal pancreatic cancer , Joshua J. Souchek

Theses/Dissertations from 2012 2012

Immune-based novel diagnostic mechanisms for pancreatic cancer , Michael J. Baine

Sox2 associated proteins are essential for cell fate , Jesse Lee Cox

KSR2 regulates cellular proliferation, transformation, and metabolism , Mario R. Fernandez

Discovery of a novel signaling cross-talk between TPX2 and the aurora kinases during mitosis , Jyoti Iyer

Regulation of metabolism by KSR proteins , Paula Jean Klutho

The role of ERK 1/2 signaling in the dna damage-induced G2 , Ryan Kolb

Regulation of the Bcl-2 family network during apoptosis induced by different stimuli , Hernando Lopez

Studies on the role of cullin3 in mitosis , Saili Moghe

Characteristics of amyloid precursor-like protein 2 (APLP2) in pancreatic cancer and Ewing's sarcoma , Haley Louise Capek Peters

Structural and biophysical analysis of a human inosine triphosphate pyrophosphatase polymorphism , Peter David Simone

Functions and regulation of Ron receptor tyrosine kinase in human pancreatic cancer and its therapeutic applications , Yi Zou

Theses/Dissertations from 2011 2011

Coordinate detection of new targets and small molecules for cancer therapy , Kurt Fisher

The role of c-Myc in pancreatic cancer initiation and progression , Wan-Chi Lin

The role of inosine triphosphate pyrophosphatase (ITPA) in maintanence [sic] of genomic stability in human cells , Miriam-Rose Menezes

Molecular insights into major histocompatibility complex class I folding and assembly , Laura Christina Simone

The role of bcl-2 in colon cancer metastatic progression , Wang Wang

A rational peptidomimetic approach towards generation of high affinity BRCT (BRCA1) inhibitors , Ziyan Yuan

D-type cyclins and breast cancer , Quian Zhang

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Ovarian Cancer Treatment Decisions: Accessing Gynecologic Oncology Care

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March 20, 2019
Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
Ovarian cancer is the most fatal gynecologic malignancy and the fifth leading cause of cancer-related deaths among women in the U.S (USCS 2015). The majority (>80%) of women is diagnosed at late stages (III or IV), often when the prognosis is poor and the 5-year survival rate is 37-45% (Howlader et al. 2015; USCS 2015). Poor prognosis has been attributed to a lack of an early detection strategy, lack of access of specialist care, variations in surgical and chemotherapeutic treatment and patient variability in uptake, as well as healthcare systems characteristics that may contribute to variable quality of care and delays (Bristow et al. 2014b; Carney et al. 2002; Cliby et al. 2015; Thrall et al. 2011). While earlier research efforts have shown treatment from a gynecologic oncologist (GO) to be associated with improved survival, studies have suggested that a substantial number of women with ovarian cancer still do not receive care from a GO at any point during their care (Vernooij et al. 2007). Less is known about when women are accessing the care from a GO (i.e. preoperative/consult only, intraoperatively, postoperatively, or continuous involvement at all phases) and how accessing a GO at different phases of care (i.e. timing) impacts survival. Furthermore, gaps still exist in the literature on the role of a patient’s psychosocial experience and voice in ovarian cancer care (Erwin 2010; Herzog et al. 2014). The overall objective of this research was to understand the effect of timing of GO involvement on mortality (Aim 1 and 2) and explore the patient-level preferences and roles around decision-making and decisional self-efficacy among women with ovarian cancer (Aim 3). Through use of cancer registries supplemented with medical record abstraction (n=2,162) and survey data (n=170), this research examined different aspects around when and where ovarian cancer patients accessed a GO and among those largely seen by a GO, we explored patient-centered factors associated with having greater decisional efficacy and/or decisional support needs. Based on our findings, differences in GO involvement were evident by patient age, race, and place of care. The patient’s perception of a GO as the most important physician in treatment decisions about care did not affect decisional efficacy, but other psychosocial domains did. Though our results likely reflects the confluence of clinical management processes, patient- and provider treatment preferences, and the complexities of the patient-provider clinical interaction that determine the extent of care, it underscores the importance of further examining equitable care delivery to all subgroups of women, particularly those whom may be vulnerable to decisional support needs. We expect that our research findings will help future efforts to identify, understand, and implement interventions to improve receipt of continuous, quality care associated with increased survival and consistent with patient needs.
decision-making
Public health
ovarian cancer
https://doi.org/10.17615/65y5-z206
Dissertation
In Copyright
Wheeler, Stephanie
Reeve, Bryce
Hall, Ingrid
Brewster, Wendy
Bennett, Antonia
Doctor of Philosophy
University of North Carolina at Chapel Hill Graduate School

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Ovarian Cancer: An Integrated Review

Affiliations.

1 Carolina's Medical Center, Charlotte, NC. Electronic address: [email protected].
2 Assistant Vice President Patient Care Services, Carolina's Medical Center, Rock Hill, SC.
3 Interim Dean, Harris College of Nursing & Health Sciences, Associate Dean for Nursing & Professor, Texas Christian University, Ft Worth, TX.
PMID: 30867104
DOI: 10.1016/j.soncn.2019.02.001

Objective: To provide an overview of the risk factors, modifiable and non-modifiable, for ovarian cancer as well as prevention, diagnostic, treatment, and long-term survivorship concerns. This article will also examine current and future clinical trials surrounding ovarian cancer.

Data sources: A review of articles dated 2006-2018 from CINAHL, UpToDate, and National Comprehensive Cancer Network guidelines.

Conclusion: There is no screening test for ovarian cancer and with diagnosis often in the late stages, recurrence is high in this population. Early identification can range from knowing the vague symptoms associated with the cancer to prophylactic surgical removal of at-risk tissue. Standard treatment for ovarian cancer is surgery followed by combination chemotherapy. Although advances are being made, ovarian cancer remains the most fatal female gynecologic cancer.

Implications for nursing practice: Becoming familiar with and educating women about risk factors and the elusive symptoms of ovarian cancer can increase patient autonomy and advocacy, as well as potentially improve patient outcomes for those affected by ovarian cancer.

Keywords: BRCA; gynecologic; oncology; ovarian cancer; prevention; risk factors.

Publication types

Ovarian Neoplasms / diagnosis
Ovarian Neoplasms / epidemiology*
Ovarian Neoplasms / prevention & control
Ovarian Neoplasms / therapy
Risk Factors

Ovarian Cancers: Evolving Paradigms in Research and Care (2016)

Chapter: 1 introduction and background.

Introduction and Background

Although recent years have seen many promising advances in cancer research, there remain surprising gaps in the fundamental knowledge about and understanding of ovarian cancer. Researchers now know that ovarian cancer, like many other types of cancer, should not be thought of as a single disease; instead, several distinct subtypes exist with different origins, different risk factors, different genetic mutations, different biological behaviors, and different prognoses, and much remains to be learned about them. For example, researchers do not have definitive knowledge of exactly where these various ovarian cancers originate and how they develop. Such unanswered questions have impeded progress in the prevention, early detection, treatment, and management of ovarian cancers. In particular, the failure to achieve major reductions in ovarian cancer morbidity and mortality during the past several decades is likely due to several factors, including

A lack of research focusing on specific disease subtypes;
An incomplete understanding of genetic and nongenetic risk factors;
An inability to develop and validate effective screening and early detection tools;
Inconsistency in the delivery of the standard of care;
Limited evidence-based personalized medicine approaches tailored to the disease subtypes and other tumor characteristics; and
Limited attention paid to research on survivorship issues, including supportive care with long-term management of active disease.

The symptoms of ovarian cancers can be nonspecific and are often not seen as indicating a serious illness by women or their health care providers until the symptoms worsen, at which point the cancer may be widespread and difficult to cure. The fact that these cancers are not diagnosed in many women until they are at an advanced stage is a major factor contributing to the high mortality rate for ovarian cancer, especially for women with high-grade serous carcinoma (HGSC)—the most common and lethal subtype. Indeed, roughly two-thirds of women with ovarian cancer are diagnosed with an advanced-stage cancer or with a cancer that has not been definitively staged, and the 5-year survival rate for these women is less than 30 percent (Howlader et al., 2015). Although many ovarian cancers respond well to initial treatment, including the surgical removal of grossly visible tumor (cytoreduction) and chemotherapy, the vast majority of the tumors recur. Recurrent ovarian cancers may again respond to further treatment, but virtually all of them will ultimately become resistant to current drug therapies.

Finally, less emphasis has been placed on research that focuses on how to improve therapeutic interventions by subtype or on how to reduce the morbidity of ovarian cancers. Little emphasis has been placed on understanding survivorship issues and the supportive care needs of women with ovarian cancer, including management of the physical side effects of treatment (including both initial and chronic, ongoing therapies) and addressing the psychosocial effects of diagnosis and treatment. The lasting impact of a diagnosis of ovarian cancer and its related treatment can be significant both for the women who experience recurrent disease and for the women who experience long (or indefinite) periods of remission. This report gives an overview of the state of the science in ovarian cancer research, highlights the major gaps in knowledge in that field, and provides recommendations that might help reduce the incidence of and morbidity and mortality from ovarian cancers by focusing on promising research themes and technologies that could advance risk prediction, early detection, comprehensive care, and cure.

STUDY CHARGE AND APPROACH

for an extended period of time before diagnosis (Goff et al., 2000, 2004). Often, due to the nonspecific nature of ovarian cancer symptoms, patients and physicians do not recognize these early symptoms as indicative of ovarian cancer (Gajjar et al., 2012; Jones et al., 2010; Lockwood-Rayermann et al., 2009).

In this context, in 2006 the U.S. Congress passed the Gynecologic Cancer Education and Awareness Act of 2005, 1 which amended the Public Health Service Act (42 U.S.C. 247b-17) to direct the secretary of the U.S. Department of Health and Human Services to launch a campaign to “increase the awareness and knowledge of health care providers and women with respect to gynecologic cancers.” The law is commonly known as Johanna’s Law in memory of Johanna Silver Gordon, a public school teacher from Michigan who died from late-stage ovarian cancer (Twombly, 2007). The law was reauthorized in 2010, 2 and, as part of the Consolidated Appropriations Act of 2014, Congress directed the Centers for Disease Control and Prevention (CDC) to use funds from Johanna’s Law to perform a review of the state of the science in ovarian cancer. 3

Study Charge

In the fall of 2014, with support from the CDC, the Institute of Medicine (IOM) formed the Committee on the State of the Science in Ovarian Cancer Research to examine and summarize the state of the science in ovarian cancer research, to identify key gaps in the evidence base and challenges to addressing those gaps, and to consider opportunities for advancing ovarian cancer research (see Box 1-1 ). The committee determined that the best way to facilitate progress in reducing morbidity and mortality would be to identify the research gaps that were most salient and that, if addressed, could affect the greatest number of women.

The committee was also asked to consider ways to translate and disseminate new findings and to communicate these findings to all stakeholders. This report, therefore, not only describes evidence-based approaches to translation and dissemination, but it also suggests strategies for communicating those approaches.

________________

1 Gynecologic Cancer Education and Awareness Act of 2005, Public Law 475, 109th Cong., 2nd sess. (January 12, 2007).

2 To reauthorize and enhance Johanna’s Law to increase public awareness and knowledge with respect to gynecologic cancers, Public Law 324, 111th Cong., 2nd sess. (December 22, 2010).

3 Explanatory statement submitted by Mr. Rogers of Kentucky, Chairman of the House Committee on Appropriations regarding the House amendment to the Senate amendment on H.R. 3547, consolidated... , 113th Cong., 2nd sess., Congressional Record 160, no. 9, daily ed. (January 15, 2014):H 1035.

BOX 1-1 Statement of Task

An ad hoc committee under the auspices of the Institute of Medicine will review the state of the science in ovarian cancer research and formulate recommendations for action to advance the field. The committee will:

Summarize and examine the state of the science in ovarian cancer research;
Identify key gaps in the evidence base and the challenges to addressing those gaps;
Consider opportunities for advancing ovarian cancer research; and
Examine avenues for translation and dissemination of new findings and communication of new information to patients and others.

The committee will make recommendations for public- and private-sector efforts that could facilitate progress in reducing the incidence of and morbidity and mortality from ovarian cancer.

The committee emphasizes that its charge was to focus on research in ovarian cancer and, particularly, to focus on the gaps in the evidence base that, if addressed, would have the greatest impact on the lives of women diagnosed with or at risk for ovarian cancer. The committee did not explore issues affecting the care of women with ovarian cancer (e.g., health insurance coverage and policy issues) in depth. For example, while the regulatory process for drug approval is interconnected with the clinical trial enterprise (e.g., the design of clinical trials may determine what data are gathered and, in turn, affect the approval process), a full examination of issues related to the approval of new drugs was beyond the scope of this report. Furthermore, it was outside the scope of this report to fully evaluate specific research programs in ovarian cancer. In addition, this report does not offer an exhaustive cataloguing of every actor engaged in ovarian cancer research, nor does it detail every effort made by stakeholders to engage in dissemination and implementation efforts. Rather, the examples given in this report are meant to highlight the efforts being made, recognizing there are many other similar efforts.

questions and concerns related to the clinical trials system are shared with all types of cancer research and could not be explored or discussed in detail. Therefore, the committee turned to previous IOM reports specific to the clinical trials system in general for guidance, and then considered aspects of the system that are particularly relevant for ovarian cancer research.

Study Approach

The study committee included 15 members with expertise in ovarian cancer, gynecologic oncology, gynecologic pathology, gynecologic surgery, molecular biology, cancer genetics and genomics, genetic counseling, cancer epidemiology, immunology, biostatistics, bioethics, advocacy, survivorship, and health communication. (See Appendix E for biographies of the committee members.)

A variety of sources informed the committee’s work. The committee met in person four times, and during two of those meetings it held public sessions to obtain input from a broad range of relevant stakeholders. In addition, the committee conducted extensive literature reviews, reached out to a variety of public and private stakeholders, and commissioned one paper.

The committee encountered a number of challenges. In some cases, it found itself limited by what was available in the published literature. At other times, it was challenged by the use of different methodologies for the classification of ovarian cancers in the research literature. For instance, many studies in the literature consolidate all types of ovarian cancer instead of studying and reporting them by subtype. In its review of the evidence, the committee discerns, where possible, whether the reported findings apply to ovarian cancers as a whole or to particular subtypes. One other major challenge to reviewing and summarizing the evidence base on ovarian cancer, particularly in summarizing the epidemiology by subtype, was the way that the grading, classification, and nomenclature for ovarian cancers have varied over the years.

In order to guide its deliberative process, the committee chose to make recommendations about research gaps based on the continuum of cancer care (see Figure 1-1 ). The committee focused on cross-cutting research areas critical to each phase of the continuum: the basic biology of ovarian cancers, innovative clinical trial design, intervention development, methods to reduce practice-related disparities, and supportive care research and practice. Finally, the committee considered evidence and strategies for the dissemination and implementation of knowledge across all of these domains.

DEFINITIONS OF KEY TERMS

This section provides definitions of several key terms that are relevant to this report, and also provides an explanation of how the committee

FIGURE 1-1 Framework for research in ovarian cancer. NOTE: Colored figures represent phases of the ovarian cancer care continuum where research can be focused. Black boxes indicate critical areas of ongoing cross-cutting research that span these phases.

selected terms for consistency throughout the report. A glossary including more terms is provided in Appendix B , and a list of key acronyms is included in Appendix A .

Target Population

This report is concerned with women with ovarian cancers. However, the committee recognizes that there is a small subpopulation of transgender men who may be at risk for ovarian cancers, particularly due to the use of testosterone therapy (Dizon et al., 2006; Hage et al., 2000).

Basic Cancer Terminology

The terms “cancer,” “carcinoma,” and “tumor” can be confused or interchanged at times. Cancer is “a term for diseases in which abnormal cells divide without control and can invade nearby tissues,” while a tumor (which can be cancerous or noncancerous) is “an abnormal mass of tissue that results when cells divide more than they should or do not die when they should” (NCI, 2015d). Carcinomas are cancers that “begin in the skin or in tissues that line or cover internal organs” (i.e., arising from epithelial cells) (NCI, 2015d). As was noted previously, this report focuses on ovarian carcinomas, because they are the most common and most lethal of the ovarian cancer subtypes.

While the committee endeavored to focus on carcinomas wherever possible, there were times when that was not possible, and the terms “cancer” and “tumor” are used when appropriate. For example, many studies are based on ovarian cancers collectively and do not analyze data based on the subtypes. The committee also uses the term “tumor” when discussing the physical mass itself. Finally, although the term “ovarian cancer” technically represents an array of disease subtypes, the committee refers to the disease in the plural form (i.e., “ovarian cancers”) whenever appropriate in order to emphasize the heterogeneity of the disease and all its subtypes.

When ovarian cancer reappears in a woman, it is usually referred to as “relapsed” or “recurrent” disease. The National Cancer Institute (NCI) defines cancer recurrence as “cancer that has recurred (come back), usually after a period of time during which the cancer could not be detected. The cancer may come back to the same place as the original (primary) tumor or to another place in the body” (NCI, 2015d). Noting that a cancer that has recurred is also called “relapsed cancer,” the NCI defines relapse as “the return of a disease or the signs and symptoms of a disease after a period of improvement.” In this report, for consistency the committee uses only the terms “recurrent” or “recurrence”—and not “relapsed” or “relapse”—but

it recognizes that there may be subtle differences, preferences, or interpretations in the use of the two terms.

DEFINING AND CLASSIFYING OVARIAN CANCERS

“Ovarian cancer” is a generic term that can be used for any cancer involving the ovaries. The ovaries are composed of several different cell types, including the germ cells, specialized gonadal stromal cells (e.g., granulosa cells, theca cells, Leydig cells, and fibroblasts), and epithelial cells; ovarian cancers can arise from any of these cell types. Ovarian cancers with epithelial differentiation (carcinomas) account for more than 85 percent of ovarian cancers and are responsible for most ovarian cancer–related deaths (Berek and Bast, 2003; Braicu et al., 2011; SEER Program, 2015; Seidman et al., 2004). Consequently, this report will focus on the biology of ovarian carcinomas, while recognizing that although other, less common types of ovarian malignancies do exist, they are responsible for a smaller fraction of ovarian cancer–related deaths.

FIGURE 1-2 Percentage of cases by major ovarian carcinoma subtype. NOTE: Other* refers to mixed or transitional carcinomas where it is not possible to categorize to a single subtype. SOURCE: Gilks et al., 2008; Seidman et al., 2003, 2004.

of mucinous carcinomas exhibit morphological features that are similar to normal epithelial cells in the fallopian tube, endometrium, and endocervix, respectively. Furthermore, clear cell carcinomas resemble cells seen in the gestational endometrium (Scully et al., 1999).

Over the past several years, researchers have developed a streamlined classification scheme in which the majority of ovarian carcinomas can be divided into five types:

Endometrioid carcinoma (EC),
Clear cell carcinoma (CCC),
Low-grade serous carcinoma (LGSC), and
Mucinous carcinoma (MC) (Gurung et al., 2013; Kalloger et al., 2011).

Some researchers have offered an even simpler classification with a scheme in which ovarian carcinomas are divided into Type I and Type II tumors based on shared features (Shih and Kurman, 2004). In this scheme, Type I carcinomas are low-grade, relatively unaggressive, and genetically stable tumors that often arise from recognizable precursor lesions such as endometriosis or benign tumors and frequently harbor somatic mutations that deregulate specific cell signaling pathways or chromatin remodeling complexes. ECs, CCCs, MCs, and LGSCs are considered Type I tumors and are often characterized by KRAS, BRAF , or PTEN mutations. Type II carcinomas are high-grade, biologically aggressive tumors from their inception, with a propensity for metastasis from small, even microscopic, primary lesions. HGSCs represent the majority of Type II tumors and are characterized by the mutation of TP53 and frequent mutations of genes (e.g., BRCA1 and BRCA2 ) that lead to homologous recombination defects (Pennington et al., 2014).

Because the data collected thus far provide compelling evidence that each of the various Type I tumors has distinct biological and molecular features, these tumors will be referred to by their specific histologic type throughout the remainder of this report. However, the Type I and Type II terminology will be used where necessary, most often in referring to studies conducted using this classification scheme. Furthermore, because the majority of ovarian carcinomas are HGSCs, and HGSCs are the subtype with the worst prognosis, this report will primarily focus on this subtype. When referring to historical or large-scale epidemiologic studies of ovarian cancer for which the tumor subtypes were not specified, readers can reasonably assume that most of the tumors were HGSCs.

After being classified by subtype, tumors are usually also assigned a grade, based on how closely the tumor cells resemble their normal counter-

parts. Both two-grade and three-grade systems have been applied in various situations; in both types of systems, the lower-grade tumors more closely resemble normal cells than the higher-grade tumors (Malpica et al., 2004; Silverberg, 2000).

OVARIAN CANCER PATTERNS AND DEMOGRAPHICS 4

Although ovarian cancer is relatively rare, it is one of the deadliest cancers. It was estimated that more than 21,000 women in the United States would receive a diagnosis of an ovarian cancer in the year 2015 5 (Howlader et al., 2015). This represents almost 12 new cases for every 100,000 women and 2.6 percent of all new cancer cases in women in the United States. Nearly 200,000 women in the United States are living with ovarian cancer in any given year, and approximately 1.3 percent of all American women will be diagnosed with ovarian cancer at some point in their lives, which qualifies ovarian cancer as a rare disease as defined by the National Institutes of Health (NIH) Genetic and Rare Diseases Information Center (NIH, 2015a). Still, according to estimates, more than 14,000 American women will have died from ovarian cancer in 2015, which corresponds to approximately 7.7 deaths per 100,000 women and 5.1 percent of all cancer deaths among American women (ACS, 2015; Howlader et al., 2015). Despite its relatively low incidence, ovarian cancer is the fifth leading cause of cancer deaths among U.S. women and the eighth leading cause of women’s cancer deaths worldwide (Ferlay et al., 2015; Howlader et al., 2015). By comparison, breast cancer is more common—among American women the estimated number of new cases of breast cancer each year is 10 times the number of new cases of ovarian cancer—but ovarian cancer is more deadly, with a death-to-incidence ratio that is more than three times higher than for breast cancer (Howlader et al., 2015) (see Figure 1-3 ).

The survival rate for ovarian cancer is quite low. For 2005 to 2011, the 5-year survival rate in the United States was just 45.6 percent. By contrast, the 5-year survival rate in the United States for the same period was nearly 90 percent for breast cancer, more than 80 percent for endometrial cancer, and nearly 70 percent for cervical cancer. However, given the typical course of initial remission and subsequent recurrence for women with ovarian cancer, the 5-year survival metric may not reflect the overall disease course. At advanced stages, MCs and CCCs in particular have poorer prognoses and survival rates than other carcinoma subtypes (Mackay et al., 2010).

4 Terminology to describe race and ethnicity reflects the terminology used in the original sources.

5 Because historical epidemiologic data typically combine the multiple types of ovarian cancer, they are discussed as a single disease in this discussion of epidemiology.

FIGURE 1-3 The ratio between the death and incidence rates for ovarian, breast, endometrial, and cervical cancers per 100,000 women in the United States, 2008–2012. SOURCE: Howlader et al., 2015.

The incidence of ovarian cancer has declined slightly since the mid-1970s, when the incidence was approximately 16 new cases per 100,000 women (Howlader et al., 2015). Mortality from ovarian cancer has also declined—from 9.8 deaths per 100,000 women in 1975 to 7.4 deaths per 100,000 women in 2012. However, the decline in mortality is relatively small when compared to reductions in death rates achieved for most other female gynecological cancers and for breast cancer in women. For example, the death rate from breast cancer fell by one-third between 1975 and 2012, from 31.4 deaths per 100,000 women to 21.3 deaths per 100,000, and the death rate from cervical cancer dropped by more than half during that same period, from 5.6 deaths per 100,000 women to 2.3 deaths per 100,000.

Among women who were diagnosed with ovarian cancer between 1975 and 1977, only 36 percent lived 5 years or more, while nearly half (46 percent) of women diagnosed with ovarian cancer between 2005 and 2007 lived at least 5 years beyond their diagnosis (Howlader et al., 2015). However, that improvement in survival rates was driven primarily by improvements in survival among white women; survival rates decreased (from 42 to 36 percent) over the same period for black women (ACS, 2015; also see section Race and Ethnicity later in this chapter).

Stage Distribution

Ovarian cancer’s high mortality and low survival rates can be attributed in part to the fact that it is rarely diagnosed at an early stage. Indeed, 60 percent of women are diagnosed with advanced disease, when the cancer has already spread beyond the ovary to distant organs or lymph nodes (Howlader et al., 2015). In comparison, as seen in Figure 1-4 , other female cancers are more commonly diagnosed during the localized or regional stages.

The relatively late stage of diagnosis for ovarian cancer is particularly important because survival is highly correlated with the stage at diagnosis (see Figure 1-5 ). While the 5-year survival rate is 45.6 percent overall, it is substantially higher for women diagnosed while the cancer is still at the localized stage (92.1 percent) or the regional stage (73.2 percent), and it is substantially lower for women diagnosed at the distant stage (28.3 percent) (ACS, 2015; Howlader et al., 2015). Survival is lowest among women who receive an unstaged ovarian cancer diagnosis (22.9 percent).

White and black women show similar patterns of stage distribution (see Figure 1-6 ). However, there is a difference in stage of diagnosis in women

FIGURE 1-4 Distribution (percentage) of stage of diagnosis for cancers of the breast, endometrium, cervix, and ovary among U.S. women, 2005–2011. SOURCE: Howlader et al., 2015.

FIGURE 1-5 Five-year relative survival (percentage) from ovarian cancer by stage at diagnosis among U.S. women, 2005–2011. SOURCE: Howlader et al., 2015.

FIGURE 1-6 Stage distribution (percentage of cases) at diagnosis among white and black U.S. women diagnosed with ovarian cancer, 2003–2009. SOURCE: Howlader et al., 2015.

of different ages, with women younger than age 65 tending to be diagnosed at earlier stages than women older than age 65 (see Figure 1-7 ).

Ovarian cancer incidence increases with age, with a sharp increase in the rate beginning in the mid-40s (see Figure 1-8 ). From 2008 to 2012, nearly 88 percent of all new cases of ovarian cancer occurred among women ages 45 and older, with 69 percent of cases among women ages 55 and older, and the average age at diagnosis was 63 years. A half-century ago, most cases occurred among women between the ages of 35 and 63, and the average age at diagnosis was 48.5 years (Munnell, 1952).While the age-adjusted incidence rate for ovarian cancer among all women is nearly 12 cases per 100,000 women, the rate varies sharply with age, with women younger than age 65 having an incidence rate of 7.5 cases per 100,000 women while women 65 years old and older have an incidence rate of more than 42 cases per 100,000 women (Howlader et al., 2015).

FIGURE 1-7 Stage distribution (percentage of cases) at diagnosis among women diagnosed with ovarian cancer by age, 2003–2009. SOURCE: Howlader et al., 2015.

FIGURE 1-8 Age-adjusted incidence of ovarian cancer per 100,000 women in the United States by age group. SOURCE: SEER Program, 2015.

FIGURE 1-9 Trends in age-adjusted death rates from ovarian cancer per 100,000 women in the United States by age group, 1975–2012. SOURCE: Howlader et al., 2015.

clined overall in the past 40 years, most of this decline is attributable to decreases in mortality among women diagnosed with ovarian cancer less than age 65 (ACS, 2015; Howlader et al., 2015).

Race and Ethnicity

The patterns of ovarian cancer incidence and mortality differ substantially among women of different races and ethnic backgrounds (see Figure 1-10 ). Whites have the highest incidence of ovarian cancer, followed by Hispanics, American Indian/Alaska Natives, blacks, and Asian/Pacific Islanders (ACS, 2015; Howlader et al., 2015; Singh et al., 2014). The 5-year survival rate is highest among Asian/Pacific Islanders, followed by Hispanics, whites, American Indian/Alaska Natives, and blacks, while mortality rates are highest among whites, followed by blacks, Hispanics, American Indian/Alaska Natives, and Asian/Pacific Islanders. A particularly dramatic contrast can be seen between black and Asian/Pacific Islander women. While the two groups are similar in having low incidence rates, black women have the second-highest mortality rates and the lowest survival rates, while Asian/Pacific Islanders have the lowest mortality and the highest survival rates. The incidence of ovarian cancer, particularly HGSC, is higher than average in women of Ashkenazi Jewish ancestry, in part because of the higher prevalence of deleterious mutations in cancer-predisposition genes such as BRCA1 and BRCA2 among these women (ACS, 2015; Moslehi et al., 2000).

FIGURE 1-10 Age-adjusted ovarian cancer incidence and mortality per 100,000 U.S. women by race and ethnicity, 2008–2012. SOURCE: Howlader et al., 2015.

Furthermore, the variations in the incidence rates of ovarian cancer by race and ethnicity change as women age (see Figure 1-11 ). For example, whites and Asian/Pacific Islanders have similar incidence rates until around age 50, when their incidence rates begin to diverge. White women aged 45–49 have an age-specific incidence rate of 15.1 cases per 100,000, and Asian/Pacific Islanders of the same age group have a very similar rate of 15.5 cases per 100,000. By contrast, white women aged 80–84 have an incidence rate of 50.8 cases per 100,000, while Asian/Pacific Islanders of the same age group have a dramatically lower rate of 30.1 cases per 100,000.

FIGURE 1-11 Age-specific incidence rates of ovarian cancer per 100,000 women in the United States by race/ethnicity and age at diagnosis, 2008–2012. NOTE: Rates for American Indian/Alaska Natives are only displayed for ages 50 through age 69, because the number of cases in other age groups were less than 16 per age group. SOURCE: SEER Program, 2015.

ers, and American Indian/Alaskan Natives were not statistically significant (Howlader et al., 2015). Moreover, while survival rates have increased among women overall and among white women since the mid-1970s, survival rates have declined slightly among black women (see Figure 1-12 ). Furthermore, although black women had higher rates of survival compared to white women and to women overall in 1975, by the mid-1980s survival rates had begun to reverse, such that black women now have lower survival rates than white women and women of all races overall even despite gains in survival among blacks in the 1990s (ACS, 2015).

FIGURE 1-12 Trends in 5-year relative survival rates (percentage) for ovarian cancer among U.S. women by race, 1975–2011. SOURCE: Howlader et al., 2015.

across the states, only Alabama, Oregon, Pennsylvania, and Washington have significantly higher rates, statistically speaking, than the United States as a whole, while only Florida, Hawaii, and Texas have significantly lower rates than the national average.

Ovarian cancer incidence and mortality also vary internationally, with incidence and mortality rates being higher in more developed regions than in less developed regions (Ferlay et al., 2015).

Aside from genetics (e.g., the higher proportion of mutations in cancer-predisposition genes among Ashkenazi Jewish women), the reasons behind the racial and ethnic differences in outcomes are unknown, but they might be explained in part by other variables such as differences in access to health care or the quality of that care (Baicker et al., 2005; IOM, 2003, 2012). Similarly, the reasons behind geographic variation in the demographics of ovarian cancer are unknown, and might be explained by other variables such as race and ethnicity (e.g., the higher proportion of Asian and Pacific Islanders in Hawaii) or differences in access to health care or the quality of that care in different geographic regions (Baicker et al., 2005; IOM, 2003, 2012). (See Chapter 4 for more on access and standards of care for women with ovarian cancer.) Overall, as noted previously, reporting on the demographics and epidemiology of ovarian cancer is challenging because of the fact that most of the data sources aggregate the various subtypes, and even when the data are reported by subtype, differences in the grading, classification, and nomenclature of the subtypes create challenges in summarizing and comparing data.

THE LANDSCAPE OF STAKEHOLDERS IN OVARIAN CANCER RESEARCH

Many public and private organizations are involved in funding, supporting, and carrying out ovarian cancer research, and they are involved in a variety of ways. The research is sometimes focused on ovarian cancers exclusively, but it sometimes looks at broader populations (e.g., women with gynecologic cancers). A complete cataloguing of every stakeholder in ovarian cancer research and of their individual efforts is beyond the scope of this report. Instead, this section offers an overview of the wide range of stakeholders and highlights the areas of ovarian cancer research that are getting the most attention and the methods used by stakeholders to communicate about new findings in ovarian cancer research.

Federal Stakeholders

While there are a number of different federal stakeholders in ovarian cancer research, the CDC, the U.S. Department of Defense (DoD), and the NIH (and the NCI in particular) are collectively responsible for the majority of the funding for ovarian cancer research at the federal level. The sections below give an overview of the funding levels and focus areas for these agencies. Where possible, the areas of focus are presented in alignment with the Common Scientific Outline (CSO), an international classification system used by cancer researchers to compare research portfolios. The CSO consists of seven broad areas of interest:

Etiology (causes of cancer);
Prevention;
Early detection, diagnosis, and prognosis;
Cancer control, survivorship, and outcomes research; and
Scientific model systems (DoD, 2015b).

Centers for Disease Control and Prevention

The CDC conducts and supports studies, often in collaboration with partners, to “develop, implement, evaluate, and promote effective cancer prevention and control practices” (CDC, 2015). In general, the CDC approaches cancer by monitoring cancer demographics (surveillance), by conducting research and evaluation, by partnering with other stakeholders to help translate evidence, and by developing educational materials (CDC, 2015). Most of the CDC’s work in ovarian cancer is performed through its Division of Cancer Prevention and Control. 6 Since fiscal year (FY) 2000, the CDC has received about $5 million annually in congressional appropriations to support its Ovarian Cancer Control Initiative. In addition, in 2008 the CDC started receiving funds under Johanna’s Law to improve communication with women regarding gynecologic cancers. The CDC’s Inside Knowledge 7 campaign works to raise awareness about cervical, ovarian, uterine, vaginal, and vulvar cancers. Between 2010 and 2014, ads produced for the Inside Knowledge campaign were seen or heard around 3.5 million times and were worth a total of $136 million in donated ad value (CDC, 2014).

6 For more information, see http://www.cdc.gov/cancer/dcpc/about (accessed July 21, 2015).

7 For more information, see http://www.cdc.gov/cancer/knowledge (accessed September 1, 2015).

U.S. Department of Defense

The DoD’s Ovarian Cancer Research Program (OCRP) 8 received congressional appropriations from FY 1997 to FY 2014 totaling $236.45 million and received another $20 million in appropriations for FY 2015 (DoD, 2015a). Since the inception of the DoD OCRP, more than 130 ovarian cancer survivors have taken part in efforts to establish the OCRP’s priorities and research award mechanisms, and they have helped choose the research to be funded. From FY 1997 through FY 2013, the OCRP funded 313 awards in a variety of areas (see Figure 1-13 ). These awards show a focus on biology, treatment, and early detection, diagnosis, and prognosis. OCRP’s research priorities include understanding the precursor lesions, microenvironment, and pathogenesis of all types of ovarian cancer; developing and improving the performance and reliability of screening, diagnostic approaches, and treatment; developing or validating models to study initiation and progression; investigating tumor response to therapy; and enhancing the pool of ovarian cancer scientists (DoD, 2015a).

National Institutes of Health

The NCI of the NIH has initiated several activities to advance ovarian cancer research with intramural and extramural funding. In the past, five ovarian cancer–specific specialized programs of research excellence (SPOREs) in the United States conducted ovarian cancer research in early detection, imaging technologies, risk assessment, immunosuppression, and novel therapeutic approaches (NCI, 2015e). The NCI currently lists four active SPOREs for ovarian cancer.

The NCI is involved in ovarian cancer research in a variety of other ways. For example, the Clinical Proteomic Tumor Analysis Consortium (CPTAC) is trying to understand the molecular basis of cancer in order to help improve the diagnosis, treatment, and prevention of cancer (NCI, 2015b). To accomplish these goals, CPTAC is using the data collected by The Cancer Genome Atlas (TCGA) analysis of ovarian tumors. The NCI has also supported a follow-up of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial to analyze the biological material and risk factor information in order to better understand the risks and identify early biomarkers, including biomarkers for ovarian cancers. (See Chapter 3 for more on the PLCO Cancer Screening Trial.)

8 For more information, see http://cdmrp.army.mil/ocrp (accessed July 21, 2015).

FIGURE 1-13 Areas of ovarian cancer research funded by OCRP, FY 1997–2011. SOURCE: DoD, 2015b.

9 The NCI notes that “the estimated NCI investment is based on funding associated with a broad range of peer-reviewed scientific activities” (NCI, 2015g). The NCI research portfolio for ovarian cancer may be found at http://fundedresearch.cancer.gov/nciportfolio/search/get?site=Ovarian+Cancer&fy=PUB2013 (accessed December 2, 2015).

thermore, data collected by the DoD 10 through the International Cancer Research Partnership indicates that the funded amount is significantly less when considering only new grants awarded by the NCI each year. Only 52 projects involving ovarian cancer research totaling $33.4 million were started in 2010, 58 new projects totaling $20.4 million in 2011, and 52 new projects totaling $16.3 million in 2012 (ICRP, 2015). Figure 1-14 shows that, like the DoD, the NCI portfolio for ovarian cancer research focuses primarily on treatment, biology, and early detection, diagnosis, and prognosis.

The Office of Cancer Survivorship (OCS), 11 part of the Division of Cancer Control and Population Sciences at the NCI, “works to enhance the quality and length of survival of all persons diagnosed with cancer and to minimize or stabilize adverse effects experienced during cancer survivorship. The office supports research that both examines and addresses the long- and short-term physical, psychological, social, and economic effects of cancer and its treatment among pediatric and adult survivors of cancer and their families” (NCI, 2014).

Figure 1-15 shows the areas of cancer survivorship research expertise at the NCI. As of October 2015, the Division of Cancer Control and Population Sciences had two open funding opportunities for general cancer survivorship research: one focused on the efficacy and impact of care planning, and the other examined the effects of physical activity and weight control interventions on cancer prognosis and survival (NCI, 2015a). Neither of these grant opportunities specified a focus on ovarian cancer survivorship.

Private Stakeholders

A wide variety of private stakeholders are engaged in ovarian cancer research, including professional societies, advocacy organizations, women’s health groups, and disease-specific foundations. In some cases, the organization specifically focuses on ovarian cancer and ovarian cancer research. However, many others focus on cancer or women’s health broadly (e.g., the American Cancer Society and the American Congress of Obstetricians and Gynecologists). Overall, private funders of ovarian cancer research tend to focus funding on biology and treatment, with very little funding directed toward the etiology of ovarian cancer or survivorship issues.

Private stakeholders can support young researchers with grant funding; provide training and educational opportunities; encourage collabora-

10 Personal communication, Patricia Modrow, data assembled by the U.S. Department of Defense Ovarian Cancer Research Program, January 16, 2015.

11 For more information about the OCS, see http://cancercontrol.cancer.gov/ocs (accessed May 15, 2015).

FIGURE 1-14 Areas of ovarian cancer research funded by the NCI. SOURCE: NCI, 2013.

tive, transdisciplinary efforts; and engage consumers, survivors, and their families. Examples of previous and current efforts by individual private stakeholders include

The Health, Empowerment, Research, and Awareness Women’s Cancer Foundation awarded the Sean Patrick Multidisciplinary Collaborative Grant for cross-disciplinary projects to allow scientists to come together and test ideas that may not be fundable by other agencies (HERA, 2015).
The Marsha Rivkin Center for Ovarian Cancer Research awards Bridge Funding Awards to researchers who are close to fundable grant scores for the DoD or the NIH but require additional data to ensure a successful resubmission (Rivkin Center, 2015).
The Ovarian Cancer Research Fund (OCRF) provides funding to researchers at all stages of their careers; OCRF awards include funding for recent graduates, newly independent researchers who are building laboratories, and senior researchers working on collaborative projects (OCRF, 2015).

FIGURE 1-15 Expertise areas for cancer survivorship research at the NCI. SOURCE: NCI, 2015c.

The Society of Gynecologic Oncology (SGO) released Pathways to Progress in Women’s Cancer in 2011, a research agenda based on discussions of working groups at a 2010 research summit. One working group focused on ovarian cancers, and the report provides short-term, intermediate, and long-term research priorities (SGO, 2011).
The Honorable Tina Brozman Foundation for Ovarian Cancer Research (also known as Tina’s Wish) funds research specifically in the early detection and prevention of ovarian cancer and also supports a consortium to advance such research (Tina’s Wish, 2015).

The Role of Advocacy in Ovarian Cancer Research

Advocacy has positively affected ovarian cancer research, public knowledge, and awareness. Many different types of people play the role of

advocate—women with ovarian cancer, partners, family members, health care professionals, and activists—and their advocacy efforts range from the individual, patient level to the societal level, but all of these different efforts have had effects on funding efforts, policy change, and the direction of research.

Patients self-advocate by taking active roles in their own care. Researchers have recognized this concept of self-advocacy as an important part of patient-centered care, and it has been described as “a distinct type of advocacy in which an individual or group supports and defends their interests either in the face of a threat or proactively to meet their needs” (Hagan and Donovan, 2013, p. 3). However, despite claims that self-advocacy may improve quality of life, health care use, and symptom management, these potential effects have not been adequately studied.

Nurses can serve as advocates for patients by protecting patients’ rights, incorporating patients’ beliefs and values into their care plans, and respecting the autonomy of the patient to ensure access to quality care (Temple, 2002). Advocacy groups provide education, information, and personal support to patients, family caregivers, and the general public. Many advocacy groups also use lobbying efforts to influence policy, including the direction of research and funding.

Large-scale advocacy efforts have arguably had a great impact on cancer research and funding. In the late 1990s, survivors advocated for wider recognition of early-stage ovarian cancer symptoms. Until that time, physicians and medical textbooks had claimed that women did not experience symptoms until advanced stages of disease (Twombly, 2007). Johanna’s Law is considered a victory of advocacy groups’ lobbying efforts. Furthermore, Congress has appropriated funds for ovarian cancer research and education programs since FY 1997. The establishment and unified efforts of national advocacy organizations are partially responsible for the significant funding increases in the intervening years (Temple, 2002).

Advocacy groups have also been integral to the advancement of ovarian cancer research through their participation in the design and administration of studies (Armstrong et al., 2014; Holman et al., 2014). The scientific literature emphasizes the importance of patient advocates in patient-centered research, citing examples of the collaboration between researchers and patient advocates in research studies (Armstrong et al., 2014; Holman et al., 2014; Staton et al., 2008).

students about the early signs and symptoms of ovarian cancer. Recently, OCNA spearheaded the formation of the first congressional Ovarian Cancer Caucus with the support of Rosa DeLauro (D-CT) and Sean Duffy (R-WI). The first meeting was held on September 29, 2015, in Washington, DC. The National Ovarian Cancer Coalition (NOCC), another national advocacy organization, funds the Teal Initiative to improve education and awareness. NOCC also supports specific research in ovarian cancer and provides survivor support, primarily through its Faces of Hope program, which is “dedicated to improving the quality of life for women affected by ovarian cancer, as well as providing support for their loved ones and caregivers” (NOCC, 2014). At the international level, the charity Ovarian Cancer Action encourages collaboration among ovarian cancer researchers around the world. Half of its funds go to the Ovarian Cancer Action Research Centre in the United Kingdom, which exclusively supports “research that can be translated into meaningful outcomes for real women in real life” (Ovarian Cancer Action, 2015). In addition, every few years Ovarian Cancer Action hosts an international forum to bring researchers together to share information, inspire collaboration, and develop white papers. In 2011 the forum developed the paper Rethinking Ovarian Cancer: Recommendations for Improving Outcomes, which outlined recommendations for improving outcomes for women with ovarian cancer (Vaughan et al., 2011). A number of other advocacy groups work at the local and national levels to support research in ovarian cancer.

The Role of Consortia and Collaboration in Ovarian Cancer Research

Because of the relative rarity of ovarian cancers, especially when subdivided according to subtypes, collaborative research efforts are necessary in order to collect sufficient data for statistically significant results. Many consortia and multisite studies have evolved to promote the sharing of biospecimens, clinical data, and epidemiologic data in order to ensure sufficient sample sizes in studies. These consortia and collaborations operate at both the national and international levels. Common uses of consortia include carrying out research on the genetic and nongenetic risk factors of developing ovarian cancers, studying mechanisms of disease relapse and resistance, and identifying newer therapies (AOCS, 2015; COGS, 2009; NRG Oncology, 2015; OCAC, 2015; OCTIPS, 2015). Furthermore, groups will often team together in coalitions to promote transdisciplinary research and also to promote the translation and dissemination of information. For example, in 2015, OCNA, NOCC, and OCRF provided funding for the Stand Up To Cancer (SU2C) Dream Team for ovarian cancer. This team will bring together experts in DNA repair, translational investigators, and

clinicians “to create new programs in discovery, translation, and clinical application, while cross-fertilizing and educating researchers at all levels to enhance collaboration and catalyze translational science” (SU2C, 2015).

Consortia and coalitions have had clear, measureable impacts on the research base for ovarian cancers. For example, as a result of the Collaborative Oncological Gene-environment Study (COGS), 14 new markers for risk of ovarian cancer were identified (only 8 had been known before COGS) (COGS, 2014). Based on the work of this coalition, TCGA researchers completed a detailed analysis of ovarian cancer, which confirmed that mutations in the TP53 gene (which encodes a protein that normally suppresses tumor development) are present in nearly all HGSCs (Bell et al., 2011). The analysis also examined gene expression patterns and identified signatures that correlate with survival outcomes, affirmed four subtypes of HGSCs, and identified dozens of genes that might be targeted by gene therapy (NIH, 2011, 2015b).

NCI’s National Clinical Trials Network

In 1955 the NCI established the Clinical Trials Cooperative Group Program. As the science of cancer treatment was evolving, researchers realized that collaborative efforts were necessary to accrue sufficient numbers for clinical trials in order to more rapidly compare the value of new therapies to existing standards of care, particularly for the use of chemotherapy in the treatment of solid tumors (DiSaia et al., 2006; IOM, 2010b). The work of the cooperative groups led to advances in the treatment of women with ovarian cancer specifically, including a demonstration of the value of adding paclitaxel to cisplatin, confirmation of the value of cytoreductive surgery, and a demonstration of the value of carboplatin for late-stage ovarian cancers (IOM, 2010b). The groups have also studied issues related to the quality of life and the prevention of ovarian cancer. Between 1970 and 2005, clinical trials of the Gynecologic Oncology Group (GOG) alone included approximately 35,000 women with ovarian cancer (DiSaia et al., 2006).

In 2014, based in part on the IOM report A National Cancer Clinical Trials System for the 21st Century , the NCI transformed the cooperative group program into the new National Clinical Trials Network (IOM, 2010b, 2011, 2013b; NCI, 2015f). This reorganization consolidated nine cooperative groups into five new groups:

The Alliance for Clinical Trials in Oncology;
The ECOG-ACRIN Cancer Research Group (a merger of two cooperative groups: the Eastern Cooperative Oncology Group and the American College of Radiology Imaging Network);
NRG Oncology (a merger of three cooperative groups: the National Surgical Adjuvant Breast and Bowel Project, the Radiation Therapy Oncology Group, and the GOG);
The Southwest Oncology Group; and
The Children’s Oncology Group (NCI, 2015f).

PREVIOUS WORK AT THE INSTITUTE OF MEDICINE

The IOM has a long history of producing reports related to various aspects of cancer care, and many of them are directly relevant to this current study. This section describes some examples of previous IOM work that is related to the work of this committee.

Prevention and Early Detection

In 2005 the IOM report Saving Women’s Lives: Strategies for Improving Breast Cancer Detection and Diagnosis (IOM, 2005) recommended the development of tools to identify the women who would benefit most from breast cancer screening based on “individually tailored risk prediction techniques that integrate biologic and other risk factors.” The report also called for the development of tools that “facilitate communication regarding breast cancer risk to the public and to health care providers.” In addition, the report called for more research on breast cancer screening and detection technologies, including research on various aspects of technology adoption (e.g., monitoring the use of technology in clinical practice).

A 2007 IOM report, Cancer Biomarkers , offered recommendations on the methods, tools, and resources needed to discover and develop biomarkers for cancer; guidelines, standards, oversight, and incentives needed for biomarker development; and the methods and processes needed for clinical evaluation and adoption of such biomarkers (IOM, 2007a). Specific recommendations from the report included establishing international consortia to generate and share data, supporting high-quality biorepositories of prospectively collected samples, and developing criteria for conditional coverage of new biomarker tests. Subsequently, in 2010, an IOM report, Evaluation of Biomarkers and Surrogate Endpoints in Chronic Disease , outlined a framework for the evaluation of biomarkers (IOM, 2010a).

tion about new biomarkers (including genetic information) with standard care in motivating behavior change and improving clinical outcomes” and “Compare the effectiveness of genetic and biomarker testing and usual care in preventing and treating breast, colorectal, prostate, lung, and ovarian cancer, and possibly other clinical conditions for which promising biomarkers exist” (IOM, 2009, p. 4).

In 2007, the IOM’s National Cancer Policy Forum hosted a workshop on cancer-related genetic testing and counseling. According to the published summary of that workshop, participants observed that “genetic testing and counseling are becoming more complex and important for informing patients and families of risks and benefits of certain courses of action, and yet organized expert programs are in short supply. The subject matter involves not only the scientific and clinical aspects but also workforce and reimbursement issues, among others” (IOM, 2007b)

Clinical Trials

The 2005 IOM report on breast cancer detection called for public health campaigns and for improved information and communication about the value of participation in clinical trials (including the participation of healthy individuals).

A 2010 report, A National Cancer Clinical Trials System for the 21st Century: Reinvigorating the NCI Cooperative Group Program (IOM, 2010b), called for the restructuring of the NCI Cooperative Group Program and set four goals:

Improve the speed and efficiency of the design, launch, and conduct of clinical trials (e.g., improve collaboration among stakeholders);
Incorporate innovative science and trial design into cancer clinical trials (e.g., support standardized central biorepositories, develop and evaluate novel trial designs);
Improve the means of prioritization, selection, support, and completion of cancer clinical trials (e.g., develop national unified standards); and
Incentivize the participation of patients and physicians in clinical trials (e.g., develop electronic tools to alert clinicians to available trials for specific patients, encourage eligibility criteria to allow broad participation, cover cost of patient care in trials).

Palliative and End-of-Life Care

Improving Palliative Care for Cancer (IOM, 2001) called for incorporating palliative care into clinical trials. The report also noted that infor-

mation on palliative and end-of-life care is largely absent from materials developed for the public about cancer treatment, and the committee recommended strategies for disseminating information and improving education about end-of-life care. The report recommended that the NCI require comprehensive cancer centers to carry out research in palliative care and symptom control and that the Health Care Finance Administration (now the Centers for Medicare & Medicaid Services) fund demonstration projects for service delivery and reimbursement that integrate palliative care throughout the course of the disease.

Dying in America (IOM, 2015) noted that palliative care can begin early in the course of treatment, in conjunction with treatment, and can continue throughout the continuum of care. The report further observed that “a palliative approach can offer patients near the end of life and their families the best chance of maintaining the highest possible quality of life for the longest possible time” (IOM, 2015, p. 1).

Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis (IOM, 2013a) addressed the delivery of cancer care, including palliative and end-of-life care. The study called for providing patients and their families with understandable information about palliative (and other) care and recommended that “the cancer care team should provide patients with end-of-life care consistent with their needs, values, and preferences” (IOM, 2013a, p. 9).

Communication and Survivorship

From Cancer Patient to Cancer Survivor (IOM, 2006) called for actions to raise awareness about the needs of cancer survivors, including the establishment of cancer survivorship as a distinct phase of cancer care. In 2008, the IOM report Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs (IOM, 2008) recommended that facilitating effective communication between patients and care providers, identifying psychosocial health needs, and engaging and supporting patients in managing their illnesses should all be considered as part of the standard of care. The report emphasized the importance of educating patients and their families and of enabling patients to actively participate in their own care by providing tools and training in how to obtain information, make decisions, solve problems, and communicate more effectively with their health care providers. The report further called for the government to invest in a large-scale demonstration and evaluation of various approaches to the efficient provision of psychosocial health care.

Women’s Health Research (IOM, 2010c) found that there are many barriers to the translation of research findings in general and that some have aspects that are “peculiar to women.” The committee recommended

specific research on how to translate research findings on women’s health into clinical practice and public health policies.

Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis (IOM, 2013a) called for providing patients and their families with “understandable information on cancer prognosis, treatment benefits and harms, palliative care, psychosocial support, and estimates of the total and out-of-pocket costs of cancer care.” The report further called for the development of decision aids to be made available through print, electronic, and social media; for the formal training of cancer care team members in communication; for the communication of relevant and personalized information at key decision points along the continuum of cancer care; and for consideration of patients’ individual needs, values, and preferences when developing a care plan, including end-of-life care. The report also called for the identification and public dissemination of evidence-based information about cancer care practices that are unnecessary or for which the harm may outweigh the benefits.

OVERVIEW OF THE REPORT

This chapter has provided an overview of the study charge and the committee’s approach to its work. It has also provided an introduction to the challenges in ovarian cancer research, to defining and classifying ovarian cancers, to the patterns and demographics of the disease, and to the landscape of stakeholders in ovarian cancer research. The remaining chapters follow the research framework outlined in Figure 1-1 .

Chapter 2 describes the current state of the science in the biology of ovarian cancers, thus providing a foundation for the descriptions of most of the other ovarian cancer research covered in this report. This background includes information about the characteristics of specific ovarian carcinomas, the role of the tumor microenvironment, and experimental model systems.

Chapter 3 builds on this to discuss research on the prevention and early detection of ovarian cancers. On the topic of risk assessment, the chapter includes discussions of a wide range of genetic and nongenetic risk factors for the development of an ovarian cancer, risk-prediction models, and genetic testing. Concerning prevention, both surgical and nonsurgical prevention strategies are discussed. And on the topic of early detection, the chapter has descriptions of various approaches to identifying ovarian cancers earlier, including biomarkers and imaging techniques, and a discussion of the challenges in performing screening in both general and high-risk populations.

Chapter 4 describes the research base for the diagnosis and treatment of women newly diagnosed with ovarian cancer as well as for women with

relapsed ovarian cancer. The chapter outlines research on current standards of care and also explores the development of novel therapeutics such as anti-angiogenics, poly ADP ribose polymerase (PARP) inhibitors, and immunotherapy. Later, the chapter discusses issues of clinical trial development and use as they relate specifically to research in ovarian cancer.

Chapter 5 discusses research on survivorship and management issues along the entire care continuum from diagnosis to end of life. Furthermore, women who are at a high risk for developing cancer (sometimes referred to as “previvors”) may have psychosocial needs of their own that should be studied. Overall, research that focuses specifically on survivorship and management issues in ovarian cancer is scarce; it may thus be necessary to apply research from broader studies of survivorship to women with ovarian cancer. The chapter discusses the research base for the unique issues of survivorship and management for women with ovarian cancer and their families, including managing the physical side effects of treatment, addressing unique psychosocial impacts, engaging women in their own self-care, and addressing end-of-life concerns.

Chapter 6 summarizes the findings and conclusions of the previous chapters in order to provide a cohesive set of recommendations for prioritizing research on ovarian cancers in such a way as to have the greatest impact on reducing morbidity and mortality from the disease.

Chapter 7 gives an overview of research on the translation and dissemination of new information to the general public, providers, researchers, policy makers, and others. The chapter reflects on the messages within the previous chapters that are ready to be communicated and identifies potential avenues for communicating these messages.

Finally, the report contains five appendixes. Appendix A contains a list of key acronyms used throughout the report. Appendix B contains a glossary of key terms. Appendix C includes a listing of currently active studies on epithelial ovarian cancer (based on information available through www.ClinicalTrials.gov ) in order to give a sense of where emphasis is being placed in future research. Appendix D lists the agendas of the committee’s workshops. Appendix E contains the biographical sketches of the committee members and project staff.

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In an era of promising advances in cancer research, there are considerable and even alarming gaps in the fundamental knowledge and understanding of ovarian cancer. Researchers now know that ovarian cancer is not a single disease—several distinct subtypes exist with different origins, risk factors, genetic mutations, biological behaviors, and prognoses. However, persistent questions have impeded progress toward improving the prevention, early detection, treatment, and management of ovarian cancers. Failure to significantly improve morbidity and mortality during the past several decades is likely due to several factors, including the lack of research being performed by specific disease subtype, lack of definitive knowledge of the cell of origin and disease progression, and incomplete understanding of genetic and non-genetic risk factors.

Ovarian Cancers examines the state of the science in ovarian cancer research, identifies key gaps in the evidence base and the challenges to addressing those gaps, considers opportunities for advancing ovarian cancer research, and examines avenues for translation and dissemination of new findings and communication of new information to patients and others. This study makes recommendations for public- and private-sector efforts that could facilitate progress in reducing the incidence of morbidity and mortality from ovarian cancers.

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Ovarian cancer is an abnormal cell growth (tumour) arising in the ovary. The majority of ovarian cancers are epithelial and develop in women over 50. Screening is highly recommended in women with a family history of ovarian cancer.

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Targeting branched N -glycans and fucosylation sensitizes ovarian tumors to immune checkpoint blockade

Cancer cells can employ aberrant glycosylation patterns to evade the host immune response. Here the authors report that inhibition of branched N-glycans sensitizes homologous recombination (HR)-proficient, but not HR-deficient, epithelial ovarian cancer to immune checkpoint inhibitors.

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A biomarker-driven therapy for ovarian cancer

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Beating the odds: molecular characteristics of long-term survivors of ovarian cancer

High-grade serous ovarian cancer, the most common form of the disease, is often fatal. This study investigated the genomic and immune characteristics of tumors from women who survived more than 10 years after their initial diagnosis, and compared them with short-term and moderate-term survivors.

Cytoreductive surgery effective after relapse

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High-grade serous ovarian cancer is the most frequent histotype of ovar- ian cancer, often diagnosed at late-stage in postmenopausal women. Un- derstanding the role of tumor microenviroment in the progression and drug resistance of this disease is crucial, and cell-cell communication tools based on single-cell RNA sequencing data are an emerging tech- nology to face this challenge. This thesis provides a general overview about the different classes of tools and their biological assumptions, followed by a case study. In particular, the CellChat R package is em- ployed to infer cell-cell communication of four high-grade serous ovarian cancer samples, the first of which derives from the primary tumor site at the time of diagnostic laparoscopic surgery, while the others refer to three metastatic peritoneal sites after the neoadjuvant chemotherapy. By comparing each metastatic sample to the primary one, the major signaling changes of cancer cells were identified. Regarding the primary site, cell-cell communication reveals MIF, the macrophage migration inhibitory factor, being differentially overexpressed in cancer cells and determining a strong autocrine signaling. On the other hand, two of the metastatic sites exhibit strong interactions between collagen and CD44 receptor on cancer cells, which also resulted to be highly expressed by fibroblasts.

A plethora of bioinformatics tools have emerged to decipher cell-cell communications by exploiting the potential of single-cell transcriptomics. In the present thesis project, CellChat is employed to analyze ligand-receptor interactions in 4 single-cell RNA datasets of ovarian cancer.

In silico analysis of cell-cell communication in ovarian cancer single-cell expression data

Musumarra, carmelo vittorio, scheda scheda dc.

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Cancer Terminology and Characteristics Carcinomas arise from epithelial tissue, lymphomas are cancers of lymphatic tissue, leukemias are cancers of blood-forming cells, and sarcomas come from connective tissue.
Children With Cancer and Schooling Challenges The rationale for the study was to identify what society has done to meet the social needs of children with cancer.
Smoking and Cancer in the United States In this research study, data on tobacco smoking and cancer prevalence in the United States was used to determine whether cancer in the United States is related to tobacco smoking tobacco.
Enhancing Cancer Screening Access and Treatment Equity Increasing the accessibility and equity in cancer screening solutions is extremely important. The existing screening criteria should be expanded through changes in guidelines, and increased funding.
Progress in Cancer Control: Rhetorical Analysis According to their study, these behaviors are more likely to lead to cancer, and the authors’ goal is to convince the audience that they should take responsibility for their health and strive to minimize the […]
Breast Cancer and Its Population Burden The other objectives that are central to this paper are highlighted below: To determine which group is at a high risk of breast cancer To elucidate the impact of breast cancer on elderly women and […]
Pap Smear and Cervical Cancer: Oncology Nursing The piece of legislation I believe has most significantly affected women’s healthcare in the past century is the regulation for women to take Pap smear regularly to prevent cervical cancer development.
Colorectal Cancer Screening Methodology CRC affects the colon, the large intestine, and the rectum a passageway between the colon and the anus. In 2019, the average incidence rate for CRC in the United States was 41.
Screening Colonoscopy for Colorectal Cancer Prevention Colonoscopy allows visualization of the entire mucosa of the distal terminal ileum and the large intestine. Before the screening, the natural history of the disease is essential for the practitioner to identify the prevention levels.
Prostate Cancer: Urinary Frequency and Incontinence In terms of the back and spine pain that the patient reported, it is notable that the x-ray revealed some mild degenerative changes in the form of a cystic mass near the spine.
Discussion: Understanding of Cancer Annually, the IARC estimates the number of new cancer cases and fatalities worldwide and in the United States and gathers the most up-to-date data on the prevalence of cancer in populations.
Ovarian Cancer: Risk Factors, Health Disparities, and Preventive Measures The most common signs and symptoms of ovarian cancer include weight loss, pain in the pelvic region, swelling and bloating in the abdomen, low appetite, and increased urination.
Mindfulness Practice During Adjuvant Chemotherapy for Breast Cancer She discusses the significance of the study to the nursing field and how nurses can use the findings to help their patients cope with stress.
The Role of hnRNPs in Acute Myeloid Leukemia Blood and lymph are tissues of mesenchymal origin, which consist of plasma and corpuscles suspended in it and form the internal environment of the body.
Benefits of Good Nutrition During Cancer Treatment Eating various foods is an important part of a healthy diet to get the nutrients the patient needs to fight cancer.
Community-Based Health Education on Cervical Cancer Through awareness, women will be able to understand the life of the diseases and the control measures that should be put in place to eradicate the infection.
Antioxidants: The Role in Preventing Cancer and Heart Disease Some of antioxidants are more widely known as vitamins E, C, and carotenoids, and have a reputation of preventing cardiovascular diseases and cancer.
The Lung Cancer Incidence Research The attributed risk is calculated by dividing the newly diagnosed incidence of cancer attributed to smoking by the total number of newly diagnosed cases of lung cancer.
Breast Cancer: The Effective Care Domain Information about how the patient is seen, how often the patient is seen, and whether she will return for mammograms can be collected and analyzed to verify the successful intervention to extend consistency with mammograms.
Colorectal Cancer Screening and Its Effect on Disease Incidence The purpose of this quantitative quasi-experimental quality improvement project was to determine if or to what degree the implementation of the Agency for Healthcare Research and Quality’s System Approach to Tracking and Increasing Screening for […]
The Burden of Cancer in the United States Both Hispanic men and women are the least affected by lung cancer in terms of incidence and mortality. Therefore, considering the DALYs measure and smoking rates in the Hispanic group, it can be concluded that […]
Statistical Analysis of Lung and Bronchus Cancer Data Using the mean obtained, the Black community has recorded the highest cases of lung and bronchus cancer, with the lowest ethnic group recording, such being the Hispanic race.
Garden Pesticide and Breast Cancer Therefore, taking into account the basic formula, the 1000 person-years case, the number of culture-positive cases of 500, and culture-negative of 10000, the incidence rate will be 20 new cases.
Breast Cancer as a Genetic Red Flag It is important to note that the genetic red flags in Figure 1 depicted above include heart disease, hypertension, and breast cancer.
Breast Cancer Surveillance Consortium Analysis Simultaneously, the resource is beneficial because it aims to “improve the delivery and quality of breast cancer screening and related outcomes in the United States”.
Drinking Green Tea: Breast Cancer Patients Therefore, drinking green tea regularly is just a necessity- it will contribute to good health and physical vigor throughout the day and prevent severe diseases.
Pathophysiology of Chronic Obstructive Pulmonary Disease and Lung Cancer It is also evident that the illness acts fast due to the continuous multiplication of the cancer cells leading to breathing disruptions and eventual death. This sustained weight loss is primarily essential to the advancement […]
Breast Cancer Prevention: Ethical and Scientific Issues Such information can potentially impact the patient and decide in favor of sharing the information about the current condition and risks correlating with the family history.
Prostate Cancer Statistics for a Term Paper Prostate cancer is also known as ‘Carcinoma of the Prostate’ and it starts when cells in the prostate glands develop an abnormality that allows them to grow out of control.
Colorectal Cancer: Promoting a Healthy Diet The aims and goals were to analyze the goals, techniques of solution, and outcomes of particular research and enhance knowledge about the topic area based on a review of freshly released data. I would also […]
Colorectal Cancer Development Due to Dietary Habits A fundamental research interest of the present dissertation was to run a pilot test on a small sample to assess the possibility of using questionnaires as a tool to assess Saudis’ perception of dietary habits […]
Cancer Patients’ Late Admission to a Hospice Mulville et al.set out to evaluate and identify the reasons that prevent timely admission to the hospice of cancer patients at the end of life.
Breast Cancer: Epidemiology, Risks, and Prevention In that way, the authors discuss the topics of breast cancer and obesity and the existing methods of prevention while addressing the ethnic disparities persistent in the issue.
Breast Cancer Development in Black Women With consideration of the mentioned variables and target population, the research question can be formulated: what is the effect of nutrition and lifestyle maintained on breast cancer development in black women?
Dietary Habits as a Risk Factor of Colorectal Cancer The risks, however, reduce with the adoption of healthy dietary habits, such as the intake of fresh fruits and vegetables. The author advised conducting more qualitative studies on factors affecting the Saudis population to adhere […]
Traditional and Complementary Medicine Among Indigenous Cancer Patients Therefore, it is necessary to increase the overall understanding of the role of CAM among breast cancer patients alongside identifying the key motivating factors, where the prime manifestations of the phenomenon are faith and prayer.
Mechanisms Behind Cancer Development This shows that epigenetics can be employed to determine the type of cancer an individual is expected to develop and make it easier to detect the disease at its early stages. Thus, the combination of […]
Education for Parents of Children With Cancer The hospital was selected because I am have been working there for a long time, and the personnel is willing to help me with the implementation of the process.
Health Inequities in Cancer Patients Despite a recent slowdown in overall spending, the United States spends more on health care than other high-income nations and still has some of the worst health results.
177Lu-PSMA Radioligand Therapy for Prostate Cancer The therapy is proved to be safer and more effective than its alternatives, with a great deal of success in reducing PSMA.
Lung Cancer: Diagnostics and Treatment Thus, it is essential to invest in research about lung cancer and be aware of the factors that contribute to its emergence to protect themselves.
Khalaf’s Burden of Pancreatic Cancer Study Analysis The outcome factors in this study are that regular-dose and low-dose Aspirin were observed to decrease the risk of pancreatic cancer.
Cancer Blood Tests Saving Lives It is important to note that the article explores novel ways of cancer diagnostics and screening methods using blood tests for various signs of the condition.
Breast Cancer in Miami Florida The situation with the diagnosis of breast cancer is directly related to the availability of medicine in the state and the general awareness of the non-population.
177LU-PSMA Radiological Therapy of Prostate Cancer More clinical trials are necessary to define the efficacy of PSMA treatment and develop more concomitant medication. Also, Gafia et al.found that PSMA is a long-term clinical condition whose changes in management are observed after […]
Cancer Among Aboriginal and Torres Strait Islander People When compared to non-Indigenous Australians, Aboriginal and Torres Strait Islander people, also known as Indigenous Australians, are disadvantaged across a number of health and socioeconomic indices.
The Ethical Problem in the Case of the Cancer Patient On the other hand, urgently inducing the patient’s death may have been an administrative problem for the patient, and it is not sure that it was caused by the wife’s deliberate decision.
Cancer Treatment Strategies and Challenges Inspired by the merits of the natural nanovesicles and the state of the art of the advanced engineering versatility of synthetic nanomaterials, we previously presented the synthetic and biological hybrid exosomes for targeted synergistic chemo […]
Urinary Tract Infections and Pancreatic Cancer The laboratory technician is supposed to culture the urine and use Gram’s staining method to detect the microbes in the sample. The practitioners used a combination of mecillinam and cefotaxime to manage the condition.
Patient HealthCare: Early Diagnosis of Cancer The NCQA describes the three patients’ interventions and explains how the Nurse Practitioner explicitly measures the listed interventions’ effects. While the patient is in the clinic for routine care, problems with preventive tests and their […]
Machine Learning Algorithms in Cancer Detection One of the most fundamental tools for machine learning in cancer detection is the use of imaging, with the premise that prognostic data is embedded in pathology images and digital pathology can provide big data […]
Acute Lymphoblastic Leukemia and Nutritional Influences A complete blood count is used to determine the precise number of each blood cell type in an individual, whereas a peripheral blood smear is used to determine alteration in the appearance and mobility of […]
Breast Cancer: Genetics and Malignancy In the presence of such conditions, the formation of atypical cells is possible in the mammary gland. In the described case, this aspect is the most significant since it includes various details of the patient’s […]
Video Consultations Between Patients and Clinicians in Diabetes, Cancer, and Heart Failure Services For example, during one of my interactions with the patient, I was asked whether the hospital had the policy to avoid face-to-face interaction during the pandemic with the help of video examinations.
Diets to Prevent Heart Disease, Cancer, and Diabetes In order to prevent heart disease, cancer, and diabetes, people are required to adhere to strict routines, including in terms of diet. Additionally, people wanting to prevent heart disease, cancer, and diabetes also need to […]
Smoking as a Risk Factor for Lung Cancer Lung cancer is one of the most frequent types of the condition, and with the low recovery rates. If the problem is detected early and the malignant cells are contained to a small region, surgery […]
Skin Cancer: Description, Causes, and Treatment Skin cancer is one of the most common types of cancer; the three most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma, and melanoma.
Acute Lymphoblastic Leukemia, Its Prevalence and Incidence The purpose of this paper is to present the first part of the case study by describing the disease’s pathophysiology, treatment options, prevalence, and incidence.
Colon Cancer: Symptoms, Genes, and Immunosuppression Colon cancer is the type of cancer that starts in the large intestine, which is the last section of the digestive tract.
Acute Lymphoblastic Leukemia: Causes, Origin, and Gene Mutation Apart from analyzing chromosome abnormalities present in patients with ALL, the purpose of this paper is to investigate the disorder’s origin, including primary causes and the process of gene mutations.
Researching the Colon Cancer and Nursing It is critical for the nurse to have trusted information about cancer tumors because many studies have indicated that patients appreciate and rely on the competence of nurses.
Nebraska State Department of Health Registries for Cancer and Immunization There is a need to report the progress of breast cancer in Nebraska to help do more research on preventing and introducing improved chemotherapy plans. Nebraska state has immunization and cancer registries which are helpful […]
The Cancer Cell Development: Causes and Sources Loss of function of suppressor genes resulting from mutations becomes the cause of cancer development: the cell divides abnormally, increasing the cell mass of the tissue.
Chronic Myelogenous Leukemia and Granulocytosis: Causes and Treatment The accumulation of the underdeveloped stem cells impairs the functioning of the blood cells resulting in such diseases as cancer. This is because white blood cells are part of the immune system and help fight […]
Epidemiology: Lung Cancer Risk The continued exploration of the factors, as well as agents, leading to the spread of pandemics led to a quantitative and qualitative examination and the development of immunization to reduce infections.
Case Study for a Patient With Cancer Because Julia refused to continue chemotherapy and radiation treatment, her adenocarcinoma should be expected to get worse, which means she may need further services of a nurse, who would create plans for supportive care; as […]
Financing of Public Health Initiative on Prostate Cancer Additionally, they need to demonstrate to the public that the resources bestowed on them are adding value to the facilities they are in charge of.
Genetic Testing: Screening for Colon Cancer This disorder is characterized by the development of hundreds of thousands of adenomatous polyps in the colon and rectum early in life.
Cancer: Causes, Diagnostic and Treatment This article recommends that the new dietary patterns can be used to reduce the risk of cancer and other diseases. Vegetables can be used to reduce the occurrence of stomach cancer and colorectal cancer.
Prostate Cancer Among Blacks in Maryland: Public Health Initiative This paper evaluates the economic principles underlying community health needs assessment of the initiative and the health economics relevant to the utilization of the service.
New Gene Discovered That Stops Spread of Cancer At this point, it is crucial to mention that the discovery by the Salk institute is just a beginning of a long scientific journey that is anticipated to culminate in a comprehensive and conclusive study […]
Genes Cause Breast Cancer Evidence suggests the role of BRCA1 in DNA repair is more expansive than that of BRCA2 and involves many pathways. Therefore, it is suggested that BRCT ambit containing proteins are involved in DNA repair and […]
Do Cellphones Cause Brain Cancer? The reason for the worries is that cellphones emit RF energy that contains both electric and magnetic energy, and exposure to it may be unhealthy for a human being.
Cancer Survivorship and Reproductive Health Outcomes This life includes the social, emotional, psychological, and financial effects that start at the beginning of diagnosis and commences up to the final stage of the disease.
Patients With Cancer: The Importance of Early Referrals to Hospitals The purpose of this study was to prove the connection between early referrals to hospitals for patients with cancer and the possibility of a positive outcome of treatment for them.
Aspects of Testicular Cancer The cancer is narrowed to the testicles and the epididymis as the tumor markers level reads normal at the first stage and has not grown into the blood.
New Venture: Cancer Risks of Firefighters In my opinion, being a firefighter is not just a profession, it is the ability to come to the rescue, to have compassion, to feel pain, and to empathize with people who are in a […]
Acute Myeloid Leukemia: Genetic Features of Black Patients According to the researcher, the differences in the biological impact of disease and the socioeconomic factors play a crucial role in the disparity between the Blacks and the Whites in the recovery process.
Cancer Alley and Environmental Racism One of the sources under study is valuable, as it examines the current situation of the coronavirus and the impact of pollution on human health.
Descriptive Data Statistics: National Cancer Institute The definitions for the measures presented are as follows: Mean = sum of all data points / number of data points; Median = the value that’s exactly in the middle when it is ordered from […]
Cancer: Risk, Treatment and Prevention Cancer is a condition characterized by abnormal cells that do not function usefully in the body, thereby destroying normal body tissues.
Colon Cancer: Treatment Options, Medication Research Colon cancer typically begins in the large intestine, which is at the end of the digestive tract and is called a colon.
Managing Patient With Pancreatic Cancer Overall, pancreatic cancer affects the cellular functioning of the pancreas and disrupts the operation of the digestive system. PanIN is the most common antecedent of pancreatic cancer and occurs in the small pancreatic ducts.
Cancer Medication and Treatment Alternatives: Project Proposal Indeed, despite the advances made in the management of cancer, particularly, the surgical removal of the tumor and the following therapy allowing to reduce health risks, cancer remains one of the major causes of death […]
Dr. Paul Demers Presentations: Asbestos and Occupational Cancers and Carcinogens With the cases of asbestos-related cancer rising and the vast amounts of asbestos existing in buildings, water pipes, and workplaces, there is a dire need for stringent policies to remove all asbestos from the environment.Dr.
Does the Sun Radiation Cause Skin Cancer? Moreover, from the article written by American Cancer Society, it is evident that Ultraviolet A and Ultraviolet B from the sun lead to skin cancer.
Light Use in Cancer Treatment The notable strength of this article is that it goes further to identify ZnPc-Q1 as a possible candidate for using light therapy in the treatment of cancer. In this work, the authors examine and describe […]
The Virus That Causes Throat Cancers The research article used after the insight of the summary in the New York Times was from the journal of American medical association.
Esophageal Cancer: Credible Internet Information Esophageal cancer has become one of the main forms of cancers which usually causes a lot of suffering to patients due to immense pain, difficulty in swallowing or dysphagia.
Breast Cancer. Service Management The trial specifically looks at the effect on breast-cancer mortality of inviting women to screening from age 40 years compared with invitation from age 50 years as in the current NHS breast-screening programme.
Fibrocystic Breast Condition or Breast Cancer? The presence of the fibrocystic breast condition means that the tissue of the breast is fibrous, and cysts are filled with the liquid or fluid. The main characteristic feature of this cancer is that it […]
Cervical Cancer: Causes and Treatment Cervical cancer develops in the cervix – the lower part of the uterus. It starts in a particular part of the cervix, where its squamous and glandular cells connect.
Analysis in Epidemiology: “Epithelial Ovarian Cancer and Oral Contraceptives” Therefore, in the current case, since the use of combination oral contraceptives reduces the occurrence of epithelial ovarian cancer, then the factors that affect the OCs MUST ALWAYS precede the factors affecting the occurrence of […]
Coping With Stress in Breast Cancer Patients Therefore, it is important for research experts to ensure and guarantee adherence to methodologies and guidelines that define scientific inquiry. However, various discrepancies manifest with regard to the initiation and propagation of research studies.
Breast Self-Examination and Breast Cancer Mortality Though it is harsh to dismiss self-exams entirely due to studies that indicate little in deaths of women who performed self-exams and those who did not, the self-exams should not be relied on exclusively as […]
Breast Self-Exams Curbing Breast Cancer Mortality The results of the study were consistent with the findings of other studies of the same nature on the effectiveness of breast self-examination in detecting and curbing breast cancer.
Prostate Cancer: Pathophysiology and Diagnostics The disease is normally multimodal in the prostate gland and just about 70% of the illness exists in the or the Peripheral zone.
Cancer: Factors of Prevention and Treatment The paper focuses on studying polyploidy/multinucleated giant cancer cells, calcium, BXL Protein, Acetylsalicylic Acid, and their specific roles in the prevention and treatment of cancer.
Herbal Therapy for Cancer Herbal therapy is a theoretical and practical medicine based on the scientific study and use of medicinal plants or drugs obtained from them for therapeutic or prophylactic purposes.
An Approach to Care of Cancer Overview Suspecting the presence of ovarian cancer is primarily based on a number of symptoms, especially abnormal physical examination, CT and NRI scans of the abdomen as well as the pelvis region.
Taxol Effectiveness in Inhibiting Breast Cancer Cells The following were the objectives of this experiment: To determine the effectiveness of Taxol in inhibiting breast cancer cells and ovarian cancer cells using culture method.
Control Breast Cancer: Nursing Phenomenon, Ontology and Epistemology of Health Management Then, the evidence received is presented in an expert way leading to implementation of the decision on the management of the disease.
Leukemia: Causes, Pathogenesis, Morphological Changes, Basic Management Studies are ongoing to establish the exact cause of the disease, which is still unknown according to the Leukemia and Lymphoma Society.
MD Anderson Cancer Center: Community Health Assessment The focus of the assessment is the city of Houston, Texas, and the MD Anderson Cancer Center. Most health issues are related to income disparities, immigration status, and the insurance status of Houston residents.
Researching the Ovarian Cancer In the European continent, for every 100,000 females, 12 to 17 will have ovarian cancer, depending on the nation of origin; this is the age-standardized rate. BRCA1 and BRCA2 profoundly account for the prevalence of […]
Local Inflammation and Human Papillomavirus Status of Head and Neck Cancers The objective of the study was to assess whether periodontitis is related to the human papillomavirus status of the head and neck squamous cell carcinoma.
Throat Cancer With Diagnosis of Human Papillomavirus The infection by the HPVs often appears in the epithelium, particularly in the areas with tissue lesions. In this respect, by means of the RNA scope, it is possible to transcribe the HPV genome and […]
Breast Cancer: Effects of Breast Health Education The design of the research focused on research variables like skills, performance, self-efficacy, and knowledge as the researchers aimed at examining the effectiveness of these variables among young women who underwent training in breast cancer […]
Community Nursing Role in Breast Cancer Prevention However, early detection still remains important in the prevention and treatment of breast cancer. The community has thus undertaken activities aimed at funding the awareness, treatment and research in order to reduce the number of […]
Radiotherapy: The Efficient Cancer Treatment Method The main purpose for the proposal of this policy is to increase the safety levels and promote efficiency in the delivery of radiotherapy services to patients.
Measuring the Uncertainty in Children With Cancer The Limitations of using Mishel Uncertainty Illness Scale and Children Uncertainty Illness Scale led to the development of Uncertainty scale for kids.
Self-Examination and Knowledge of Breast Cancer Among Female Students Shin, Park & Mijung found that a quarter of the participants practiced breast self-examination and a half had knowledge regarding breast cancer.
Prognosis in Ulcerative Colitis for Risk of Cancer After that the attempt was to extract the information about incidence of colon cancer in populations previously diagnosed with ulcerative colitis, to check whether the cancer risk increased with the duration of disease and finally […]
“Tracking Breast Cancer Cells on the Move” by Gomis The article serves the purpose of examining the role of NOG, a gene that is essential in bone development and its role in breast cancer.
Nutritional Assessment for Cancer Patients The consumption of fatty fish and a reduction in the consumption of unhealthy fats can reduce the risk of colon cancer that is brought about by the consumption of animal fat.
Cancer Treatment Measures in the Sydney Cancer Center Overall, the study enhanced the proper understanding of the effectiveness through the analysis of the number of health specialists working in the Sydney Cancer Centre and the number of cancer patients attended per day.
Association Between Pre-Diagnostic Circulating 25-(OH) D and Cancer This was what made the authors to undertake an investigation on correlation between pre-diagnostic of circulating 25- D concentration in the body and dietary intakes of vitamin D and calcium with colon and rectum cancer […]
Sonodynamic Therapy for Cancer Treatment Sonodynamic therapy also known as ultrasound therapy is a hopeful innovative cancer treatment method that focuses on synergistic effect on tumor cell killing of a photosensitizer and ultrasound. Cavitation refers to the growth, oscillation and […]
The Relationship Between Cancer and Lifestyle In addition, other lifestyle aspects, such as cigarette smoking, sun exposure and stress need to be addressed to reduce the risks of cancer.
Cancer: Angiogenesis, Recent Research, Ethical Concerns Zayed et al.’s research reveals that the CIB1 protein controlling the endothelial cell functions is the same as the one causing red blood cell formation in cancer tumors.
Breast Cancer Survivorship: Are African American Women Considered? The finding of the analysis is that the issue of cancer survivorship is exclusive, developing, and at the same time it depends on what individuals perceive to be cancer diagnosis as well as personal experiences […]
Gaining Ground on Breast Cancer: Advances in Treatment The article by Esteva and Hortobagyi discusses breast cancer from the aspect of increased survival rates, the novel treatments that have necessitated this and the promise in even more enhanced management of breast cancer.
Pain Management in Hillman Cancer Center’s Patients Medical and surgical approaches are considered to be the main ways for pain treatment in cancer patients. Advanced stages of cancer result into a multidimensional pain and are where the clinical psychologists step in.
Ovarian Cancer: Description and Treatment In applying various treatment options, it is important for doctors to ensure that they understand all options, means of navigating through the process, as well as the development stage of the cancer.
Effects of Hypoxia, Surrounding Fibroblasts, and p16 Expression on Breast Cancer The study was conducted to determine whether migration and invasion of breast cancer cells were stimulated by hypoxia, as well as determining whether the expression of p16 ectopically had the potential to modulate the cell […]
Breast Cancer: Preventing, Diagnosing, Addressing the Issue In contrast to the MRI, which presupposes that the image of the tissue should be retrieved with the help of magnetic fields, the mammography tool involves the use of x-rays.
Smoking and Lung Cancer Among African Americans Primarily, the research paper provides insight on the significance of the issue to the African Americans and the community health nurses.
Acute Lymphocytic Leukemia in Adult Patients Acute lymphocytic leukemia is the cancer of the blood and the bone marrow. The final type of lymph cells is natural killer cells whose role in the body is to nullify the effect of cancerous […]
Dietary Fat Intake and Development of Breast Cancer This study aimed to determine the relationship between dietary fat intake and the development of breast cancer in women. The outcome of the study strongly suggests that there is a close relationship between a high […]
The Detection and Diagnosis of Breast Cancer The severity of cancer depends on the movement of the cancerous cells in the body and the division and growth or cancerous cells.
Prostate Cancer: Preventive Approaches and Treatment However, the case of prostate cancer seems to oppose this ideology; hence, the purpose of this paper is to understand preventive approaches and therapies used to manage prostate cancer.
Skin Cancer: Comparison of Samples The aim of this experiment is to examine and thereafter represent low and high power illustrations of a normal skin specimen and of skin specimens that have been affected by various forms types of skin […]
The Female Reproductive System and Ovarian Cancer The ovary is the one of the central organs of the female reproductive system. The zona granulosa is the exterior layer of cells enclosing the follicles.
Property Rights to the Cancer Genes The easiest way to understand the protection of patents and the rationale behind them is by appreciating the fact that patents are part of human rights.
Dietary Approach to Colon Cancer Prevention These research findings appear to support the hypothesis that the presence of folate in the diet is linked to the risk factor for colon cancer.
Treatment of Ovarian Cancer Factors that predispose women to ovarian cancer include infertility, use of certain medication, hormone replacement therapy, use of oral contraceptives, and party.
The Pennsylvania Cancer Registry (PCR) This data is essential in that, doctors or clinical experts are able to identify the form of treatment to be provided to each cancer patient, to follow up on the patients’ progress, give any necessary […]
Breast Cancer: WMI Research and the Current Approaches Although the conclusions provided by the WHI in the study conducted to research the effects of estrogen and progesterone cessation on the chance of developing a breast cancer do not comply with the results of […]
Oesophageal Cancer as a Global Health Concern The incidence of oesophageal cancer is high in various parts of the world, but for the purposes of this paper, China will be the region of focus.
Using Genetically-Modified Bacteria to Fight Cancer at Johns Hopkins To do so, a concise summary of the article will be provided, followed by a review of its relevance to the course.
Skin Cancer and Sunlight: Case Control, Cohort, and Clinical Trial Design The main component in sunlight that is said to be responsible for the development of skin cancer is the Ultraviolet emission.
Battle Against Cancer in New York State On the other hand, the cancer goals for New York target to reduce the new forms of the disease as well as the various disabilities and body deformations resulting from cancer.
Various Proteins Targets for Lung, Breast and Colorectal Cancers This protein has been identified in recent research as the one playing the biggest role in causing the growth and the spread of cancer in the lungs.
Global Health Organization – World-Cancer Campaign The organization can collaborate with other organizations such as the World Economic Forum and the International Council of Nurses to tackle the cancer crisis.
Healthcare: Colon Cancer The colon refers to the longest section of the large gut and the most low-down section of the digestive arrangement in the human body.
Dosage & Regimen for MEK Inhibitor: Cancer Clinical Trial The study is a treatment trial aimed at designing the correct dose of GSK1120212. The trial is aimed at determining the dosage and regimen for MEK inhibitor that should be mixed with everolimus in order […]
Breast Cancer Susceptibility Gene (BRCA2) The mechanisms underlying the genetic predisposition to a particular disease are manifold and this concept is the challenging one to the investigators since the advent of Molecular Biology and database resources.
Prostate Cancer Pathophysiology and Management At the moment, the use of tumour markers such as kallikrein is the most widespread method of differentiating these two disorders.
Terminal Cancer Patients: Community Nursing The sole purpose of any nursing activity during any given kind of illness and end-of-life stage is to maximize the quality of life and functioning for individuals, families, and the community at large.
Esophageal Cancer Overview and Analysis Esophageal Cancer mainly refers to the growths that forms within the tissues that line the walls of the esophagus; the tube composed of muscles that aid the passage of the food from the exterior opening […]
Ovarian Cancer Overview and Analysis However, several factors have been deemed to contribute to the risk of developing ovarian cancer, for instance, the lesser children a woman has and the later in life she bears children, the higher the chances […]
Prediction of Breast Cancer Prognosis It has been proposed that the fundamental pathways are alike and that the expression of gene sets, instead of that of individual genes, may give more information in predicting and understanding the basic biological processes.
The Genetic Basis of Human Cancer This is one of the most difficult in curing, as it may affect any part of the body, and seriously damage the body tissues.
Breast Cancer Survivors: Effects of a Psychoeducational Intervention While the conceptual framework is justified in analysis of the quality of life, there is the likelihood of influence of the context with quality of life adopting different meanings to patients in different areas and […]
Cancer and Oxygenation: Oxygen as a Remedy for Cancer Cancer is simply the decrease of oxygen in body cells to levels low enough to allow for a change in the nature of the cells.
Cancer: Gene Mutation’s Influence, Treatments
The Effective Pain Assessment in Patients With Lung Cancer
Providers’ Role in Quality Assurance in Breast Cancer Screening
Framing Qualitative Research on Lung Cancer
Oncology: Colorectal Cancer
Prostate Cancer: Symptoms and Treatment
Clinical Laboratory Science of Breast Cancer
Induced and Spontaneous Abortion and Breast Cancer Incidence Among Young Women
Quality of Life in Chronic Leukemia Patients
Dyspnea in Cancer Patients
Ovarian Cancer: Medical Review
Lung Cancer Cells Migrating to Other Parts of the Body
Prostate Cancer: The Ion Channels
To Live Until You Die: Palliative Care in Cancer Experience
Care Needs of Children Whose Parents Have Incurable Cancer
New Screening Guidelines for Breast Cancer
Breast Cancer in Afro- and Euro-Americans
Cancer Treatment and Life Quality in Adult Patients
Breast Cancer Assessment in London
Oral Cancer Reconstruction
Skin Cancer Awareness Overview
Angiostatic Approaches to Cancer Therapy
Genetics of Prostate Cancer and Physical Features
Epithelial Ovarian Cancer Investigation
Creativity in People With Cancer
Cancer: Alternative and Complementary Therapies
Promotion of Cardiovascular Health and Cancer Prevention
Breast Cancer: Crucial Issues
Cancer Longitudinal Exploration
Breast Cancer: At-Risk Population, Barriers, and Improvement
Effective Solutions to the Prevention of Cervical Cancer
Breast Cancer: Moral and Medical Aspects
Breast Cancer and AIDS: Significant Issues in the United States in the Late 20th Century
Breast Cancer Risk Factors: Genetic and Nutritional Influences
Breast Cancer Genetics & Chromosomal Analysis
The Role Genetics Information Plays in Treating Cancer
Breast Cancer: The Case of Anne H.
Leukemia Types: Characteristics, Genetics, and Symptoms
CRISPR and Cas-9 Technology as the Solution to Cancer
Colon Cancer: Risk Factors
World Health Organization Cancer Website Tool
Long Distance Cancer Treatment Ethics
A Community Capacity-Enhancement Approach to Breast and Cervical Cancer Screening
The Role of Inflammation in Cancer
Cognitive Behavioral Therapy: Plan for Cancer Pain
Psychosocial Factors & Immune Mechanisms in Cancer Regulation
Fundraising Methods for the Canadian Cancer Society
Nutrition and Cancer Rates
Breast Cancer Diagnosis Procedure in Saudi Arabia
Language and Stigmatization: Cancer, HIV, and AIDS
The Three Most Common Types of Cancer in America
Breast Cancer and the Effects of Diet
J. Overcash on Older Adults With Cancer
Postmenopause Hormone Therapy and Endometrial Cancer
Risk Factors for Cervical Cancer
When the Smoke Clears: The Story About the Lung Cancer
Motivational Interviewing as a Smoking Cessation Intervention for Patients With Cancer
Genetic Predisposition to Breast Cancer: Genetic Testing
Cancer Pathophysiology and Nursing Management
Breast Cancer: Causes and Treatment
Integumentary System Diseases. Skin Cancer and Eczema
Digestive Cancer. Complementary & Alternative Treatment
The History of Cervical Cancer: Treatment and Care
Ethics of Leukemia Treatment With Disabled HIV Cells
Human Papillomavirus Infection and Cervical Cancer
Colorectal Cancer Care Coordination
Penectomy Challenges in Cancer Patients
Monoclonal Antibodies in Treating Breast Cancer
The American Cancer Society’s Website Evaluation
Acute Lymphocytic and Myelogenous Leukemia in Children
Cancer and Chemotherapy Effects on Patients
Chronic Diseases: Heart Failure and Cancer
Pain Reduction Metods for Cancer Patients
Lung Cancer Stages, Complications, and Support
Breast Cancer: Women’s Health Initiative & Practices
Hormone Receptor-Positive Breast Cancer Pathophysiology
Cervical Cancer and Women’s Health
Complex Fibroadenoma and Breast Cancer Risk
Cannabis and Cancer Pain Management
Breast Cancer: Health Psychology Plan
Colorectal Cancer Patient’s Discharge Planning
Cancer Epidemic Research and Expectations
Best Practices in Breast Cancer Care
Carcinoma in Situ Management Options
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Key insights from statistical modeling of cancer patient life expectancy

by Karolinska Institutet

With the progress in treatment for most cancer types, there is a growing interest to understand the overall impact of a cancer diagnosis throughout the remaining lifespan. In addition to conventional survival probabilities, estimating life expectancy following cancer diagnosis and loss in life expectancy for cancer patients in comparison to if they did not have cancer provides valuable insights into the societal burden of cancer.

This also leads to insights into the progress in cancer control efforts, resource allocation , and disparities in cancer survival among different groups.

In a new thesis from Karolinska Institutet, Ph.D. student Yuliya Leontyeva at the Department of Medical Epidemiology and Biostatistics, addressed methodological challenges in estimating the number of years remaining after a cancer diagnosis (LEC) and the corresponding loss in life years due to cancer (LLE) within the Relative Survival framework. The research aimed to make these estimations more widely applicable and accessible to both epidemiological and clinical research in cancer survival.

What are the most important results in your thesis?

"My research project employed statistical methods for population-based cancer survival studies. We used Flexible Parametric Relative Survival models to estimate LEC and LLE. While confirming the validity of the existing approach to estimate LEC and LLE, we propose novel methodology to address limitations in certain situations.

"In addition, we estimated LEC and LLE for individuals with Myeloproliferative neoplasms, a previously unexplored area due to complexity. It has been illustrated that individuals with MPN have a reduced life expectancy compared to the general population for all MPN subtypes across ages at diagnosis. Furthermore, the estimation of LEC and LLE was extended to small geographical areas, with the publication of accessible code to facilitate wider usage."

Why did you become interested in this topic?

"At first, I got interested in methodological challenges of estimating LEC and LLE. However, working on the research project and accumulating more knowledge and understanding about the cancer survival area, I realized the value of LEC and LLE as complimentary measures to survival probabilities. By addressing methodological challenges and expanding the application of LEC and LLE, this thesis contributes to a more comprehensive understanding of cancer survival."

What do you think should be done in future research?

"There is a need for further studies to tackle remaining challenges and continue refining our understanding of cancer survival. For example, we have only subtly touched upon an area of extrapolation, which is required to estimate LEC and LLE. It is necessary to explore this area more thoroughly for individuals diagnosed with cancer before the age of 50. Another fascinating area to explore is estimating LEC and LLE for cancer types with indolent courses or other diseases beside cancer. So, there is a lot to do for those who would like to indulge in the statistical world."

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Ovarian cancer

Ovarian cancer is a type of cancer that begins in the ovaries. The ovaries — each about the size of an almond — produce eggs (ova) as well as the hormones estrogen and progesterone.

Ovarian cancer is a growth of cells that forms in the ovaries. The cells multiply quickly and can invade and destroy healthy body tissue.

The female reproductive system contains two ovaries, one on each side of the uterus. The ovaries — each about the size of an almond — produce eggs (ova) as well as the hormones estrogen and progesterone.

Ovarian cancer treatment usually involves surgery and chemotherapy.

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The ovaries, fallopian tubes, uterus, cervix and vagina (vaginal canal) make up the female reproductive system.

When ovarian cancer first develops, it might not cause any noticeable symptoms. When ovarian cancer symptoms happen, they're usually attributed to other, more common conditions.

Signs and symptoms of ovarian cancer may include:

Abdominal bloating or swelling
Quickly feeling full when eating
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Discomfort in the pelvic area
Changes in bowel habits, such as constipation
A frequent need to urinate

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It's not clear what causes ovarian cancer, though doctors have identified things that can increase the risk of the disease.

Doctors know that ovarian cancer begins when cells in or near the ovaries develop changes (mutations) in their DNA. A cell's DNA contains the instructions that tell the cell what to do. The changes tell the cells to grow and multiply quickly, creating a mass (tumor) of cancer cells. The cancer cells continue living when healthy cells would die. They can invade nearby tissues and break off from an initial tumor to spread (metastasize) to other parts of the body.

Types of ovarian cancer

The type of cell where the cancer begins determines the type of ovarian cancer you have and helps your doctor determine which treatments are best for you. Ovarian cancer types include:

Epithelial ovarian cancer. This type is the most common. It includes several subtypes, including serous carcinoma and mucinous carcinoma.
Stromal tumors. These rare tumors are usually diagnosed at an earlier stage than other ovarian cancers.
Germ cell tumors. These rare ovarian cancers tend to occur at a younger age.

Risk factors

Factors that can increase your risk of ovarian cancer include:

Older age. The risk of ovarian cancer increases as you age. It's most often diagnosed in older adults.

Inherited gene changes. A small percentage of ovarian cancers are caused by genes changes you inherit from your parents. The genes that increase the risk of ovarian cancer include BRCA1 and BRCA2 . These genes also increase the risk of breast cancer.

Several other gene changes are known to increase the risk of ovarian cancer, including gene changes associated with Lynch syndrome and the genes BRIP1 , RAD51C and RAD51D .

Family history of ovarian cancer. If you have blood relatives who have been diagnosed with ovarian cancer, you may have an increased risk of the disease.
Being overweight or obese. Being overweight or obese increases the risk of ovarian cancer.
Postmenopausal hormone replacement therapy. Taking hormone replacement therapy to control menopause signs and symptoms may increase the risk of ovarian cancer.
Endometriosis. Endometriosis is an often painful disorder in which tissue similar to the tissue that lines the inside of your uterus grows outside your uterus.
Age when menstruation started and ended. Beginning menstruation at an early age or starting menopause at a later age, or both, may increase the risk of ovarian cancer.
Never having been pregnant. If you've never been pregnant, you may have an increased risk of ovarian cancer.

There's no sure way to prevent ovarian cancer. But there may be ways to reduce your risk:

Consider taking birth control pills. Ask your doctor whether birth control pills (oral contraceptives) may be right for you. Taking birth control pills reduces the risk of ovarian cancer. But these medications do have risks, so discuss whether the benefits outweigh those risks based on your situation.
Discuss your risk factors with your doctor. If you have a family history of breast and ovarian cancers, bring this up with your doctor. Your doctor can determine what this may mean for your own risk of cancer. You may be referred to a genetic counselor who can help you decide whether genetic testing may be right for you. If you're found to have a gene change that increases your risk of ovarian cancer, you may consider surgery to remove your ovaries to prevent cancer.

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Hoffman BL, et al. Epithelial ovarian cancer. In: Williams Gynecology. 4th ed. McGraw Hill; 2020. https://accessmedicine.mhmedical.com. Accessed May 5, 2021.
Niederhuber JE, et al., eds. Carcinoma of the ovaries and fallopian tubes. In: Abeloff's Clinical Oncology. 6th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed May 5, 2021.
Ovarian cancer including fallopian tube cancer and primary peritoneal cancer. National Comprehensive Cancer Network. https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1453. Accessed May 5, 2021.
Ovarian, fallopian tube and primary peritoneal cancer prevention (PDQ) — Patient version. National Cancer Institute. https://www.cancer.gov/types/ovarian/patient/ovarian-prevention-pdq. Accessed May 5, 2021.
Van Stein RM, et al. Hyperthermic intraperitoneal chemotherapy for ovarian and colorectal cancer. JAMA Oncology. 2021; doi:10.1001/jamaoncol.2021.0580.
Palliative care. National Comprehensive Cancer Network. https://www.nccn.org/guidelines/guidelines-detail?category=3&id=1454. Accessed May 5, 2021.
Ovarian SPOREs. National Cancer Institute. https://trp.cancer.gov/spores/ovarian.htm. Accessed May 5, 2021.
Warner KJ. Allscripts EPSi. Mayo Clinic. Feb. 26, 2021.
Member institutions. Alliance for Clinical Trials in Oncology. https://www.allianceforclinicaltrialsinoncology.org/main/public/standard.xhtml?path=%2FPublic%2FInstitutions. Accessed May 5, 2021.
Genetic/familial high-risk assessment: Breast, ovarian and pancreatic. National Comprehensive Cancer Network. https://www.nccn.org/guidelines/guidelines-detail?category=2&id=1503. Accessed June 24, 2021.
Gershenson DM, et al. Management of low-grade, serous carcinoma of the ovary. https://www.uptodate.com/contents/search. Accessed June 25, 2021.
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Committee on the State of the Science in Ovarian Cancer Research; Board on Health Care Services; Institute of Medicine; National Academies of Sciences, Engineering, and Medicine. Ovarian Cancers: Evolving Paradigms in Research and Care. Washington (DC): National Academies Press (US); 2016 Apr 25.

Ovarian Cancers: Evolving Paradigms in Research and Care.

Hardcopy Version at National Academies Press

1 Introduction and Background

A lack of research focusing on specific disease subtypes;
An incomplete understanding of genetic and nongenetic risk factors;
An inability to develop and validate effective screening and early detection tools;
Inconsistency in the delivery of the standard of care;
Limited evidence-based personalized medicine approaches tailored to the disease subtypes and other tumor characteristics; and
Limited attention paid to research on survivorship issues, including supportive care with long-term management of active disease.

The symptoms of ovarian cancers can be nonspecific and are often not seen as indicating a serious illness by women or their health care providers until the symptoms worsen, at which point the cancer may be widespread and difficult to cure. The fact that these cancers are not diagnosed in many women until they are at an advanced stage is a major factor contributing to the high mortality rate for ovarian cancer, especially for women with high-grade serous carcinoma (HGSC)—the most common and lethal subtype. Indeed, roughly two-thirds of women with ovarian cancer are diagnosed with an advanced-stage cancer or with a cancer that has not been definitively staged, and the 5-year survival rate for these women is less than 30 percent ( Howlader et al., 2015 ). Although many ovarian cancers respond well to initial treatment, including the surgical removal of grossly visible tumor (cytoreduction) and chemotherapy, the vast majority of the tumors recur. Recurrent ovarian cancers may again respond to further treatment, but virtually all of them will ultimately become resistant to current drug therapies.

STUDY CHARGE AND APPROACH

In spite of their high mortality rates, ovarian cancers often do not receive as much attention as other cancers. In part, this is because ovarian cancers are relatively uncommon. Furthermore, ovarian cancer has been called a “silent killer” because researchers once believed that there were no perceptible symptoms in the earlier stages of the disease ( Goff, 2012 ). However, more recent research has shown that most women diagnosed with ovarian cancer report symptoms such as bloating, pelvic or abdominal pain, and urinary symptoms, and many women recall having these symptoms for an extended period of time before diagnosis ( Goff et al., 2000 , 2004 ). Often, due to the nonspecific nature of ovarian cancer symptoms, patients and physicians do not recognize these early symptoms as indicative of ovarian cancer ( Gajjar et al., 2012 ; Jones et al., 2010 ; Lockwood-Rayermann et al., 2009 ).

In this context, in 2006 the U.S. Congress passed the Gynecologic Cancer Education and Awareness Act of 2005, 1 which amended the Public Health Service Act (42 U.S.C. 247b-17) to direct the secretary of the U.S. Department of Health and Human Services to launch a campaign to “increase the awareness and knowledge of health care providers and women with respect to gynecologic cancers.” The law is commonly known as Johanna's Law in memory of Johanna Silver Gordon, a public school teacher from Michigan who died from late-stage ovarian cancer ( Twombly, 2007 ). The law was reauthorized in 2010, 2 and, as part of the Consolidated Appropriations Act of 2014, Congress directed the Centers for Disease Control and Prevention (CDC) to use funds from Johanna's Law to perform a review of the state of the science in ovarian cancer. 3

Study Charge

Statement of Task.

Finally, the committee focused as much as possible on the research gaps and the challenges to addressing those gaps that are unique to ovarian cancer. However, those research gaps and challenges that are common to all types of cancer research, or even to all health care research, are described as appropriate. For example, while the clinical trials system is extremely important to the ovarian cancer research enterprise, many of the outstanding questions and concerns related to the clinical trials system are shared with all types of cancer research and could not be explored or discussed in detail. Therefore, the committee turned to previous IOM reports specific to the clinical trials system in general for guidance, and then considered aspects of the system that are particularly relevant for ovarian cancer research.

Study Approach

A variety of sources informed the committee's work. The committee met in person four times, and during two of those meetings it held public sessions to obtain input from a broad range of relevant stakeholders. In addition, the committee conducted extensive literature reviews, reached out to a variety of public and private stakeholders, and commissioned one paper.

Framework for research in ovarian cancer. NOTE: Colored figures represent phases of the ovarian cancer care continuum where research can be focused. Black boxes indicate critical areas of ongoing cross-cutting research that span these phases.

DEFINITIONS OF KEY TERMS

This section provides definitions of several key terms that are relevant to this report, and also provides an explanation of how the committee selected terms for consistency throughout the report. A glossary including more terms is provided in Appendix B , and a list of key acronyms is included in Appendix A .

Target Population

Basic Cancer Terminology

The terms “cancer,” “carcinoma,” and “tumor” can be confused or interchanged at times. Cancer is “a term for diseases in which abnormal cells divide without control and can invade nearby tissues,” while a tumor (which can be cancerous or noncancerous) is “an abnormal mass of tissue that results when cells divide more than they should or do not die when they should” ( NCI, 2015d ). Carcinomas are cancers that “begin in the skin or in tissues that line or cover internal organs” (i.e., arising from epithelial cells) ( NCI, 2015d ). As was noted previously, this report focuses on ovarian carcinomas, because they are the most common and most lethal of the ovarian cancer subtypes.

When ovarian cancer reappears in a woman, it is usually referred to as “relapsed” or “recurrent” disease. The National Cancer Institute (NCI) defines cancer recurrence as “cancer that has recurred (come back), usually after a period of time during which the cancer could not be detected. The cancer may come back to the same place as the original (primary) tumor or to another place in the body” ( NCI, 2015d ). Noting that a cancer that has recurred is also called “relapsed cancer,” the NCI defines relapse as “the return of a disease or the signs and symptoms of a disease after a period of improvement.” In this report, for consistency the committee uses only the terms “recurrent” or “recurrence”—and not “relapsed” or “relapse”—but it recognizes that there may be subtle differences, preferences, or interpretations in the use of the two terms.

DEFINING AND CLASSIFYING OVARIAN CANCERS

“Ovarian cancer” is a generic term that can be used for any cancer involving the ovaries. The ovaries are composed of several different cell types, including the germ cells, specialized gonadal stromal cells (e.g., granulosa cells, theca cells, Leydig cells, and fibroblasts), and epithelial cells; ovarian cancers can arise from any of these cell types. Ovarian cancers with epithelial differentiation (carcinomas) account for more than 85 percent of ovarian cancers and are responsible for most ovarian cancer–related deaths ( Berek and Bast, 2003 ; Braicu et al., 2011 ; SEER Program, 2015 ; Seidman et al., 2004 ). Consequently, this report will focus on the biology of ovarian carcinomas, while recognizing that although other, less common types of ovarian malignancies do exist, they are responsible for a smaller fraction of ovarian cancer–related deaths.

As with ovarian cancers in general, ovarian carcinomas are quite heterogeneous and come in a variety of different tumor types (see Figure 1-2 ). The major ovarian carcinoma subtypes are named according to how closely the tumor cells resemble normal cells lining different organs in the female genitourinary tract. Specifically, serous, endometrioid, and a subset of mucinous carcinomas exhibit morphological features that are similar to normal epithelial cells in the fallopian tube, endometrium, and endocervix, respectively. Furthermore, clear cell carcinomas resemble cells seen in the gestational endometrium ( Scully et al., 1999 ).

Percentage of cases by major ovarian carcinoma subtype. NOTE: Other* refers to mixed or transitional carcinomas where it is not possible to categorize to a single subtype. SOURCES: Gilks et al., 2008; Seidman et al., 2003, 2004.

Over the past several years, researchers have developed a streamlined classification scheme in which the majority of ovarian carcinomas can be divided into five types:

Endometrioid carcinoma (EC),

Clear cell carcinoma (CCC),

Low-grade serous carcinoma (LGSC), and

Mucinous carcinoma (MC) ( Gurung et al., 2013 ; Kalloger et al., 2011 ).

Some researchers have offered an even simpler classification with a scheme in which ovarian carcinomas are divided into Type I and Type II tumors based on shared features ( Shih and Kurman, 2004 ). In this scheme, Type I carcinomas are low-grade, relatively unaggressive, and genetically stable tumors that often arise from recognizable precursor lesions such as endometriosis or benign tumors and frequently harbor somatic mutations that deregulate specific cell signaling pathways or chromatin remodeling complexes. ECs, CCCs, MCs, and LGSCs are considered Type I tumors and are often characterized by KRAS , BRAF , or PTEN mutations. Type II carcinomas are high-grade, biologically aggressive tumors from their inception, with a propensity for metastasis from small, even microscopic, primary lesions. HGSCs represent the majority of Type II tumors and are characterized by the mutation of TP53 and frequent mutations of genes (e.g., BRCA1 and BRCA2 ) that lead to homologous recombination defects ( Pennington et al., 2014 ).

After being classified by subtype, tumors are usually also assigned a grade, based on how closely the tumor cells resemble their normal counterparts. Both two-grade and three-grade systems have been applied in various situations; in both types of systems, the lower-grade tumors more closely resemble normal cells than the higher-grade tumors ( Malpica et al., 2004 ; Silverberg, 2000 ).

OVARIAN CANCER PATTERNS AND DEMOGRAPHICS 4

Although ovarian cancer is relatively rare, it is one of the deadliest cancers. It was estimated that more than 21,000 women in the United States would receive a diagnosis of an ovarian cancer in the year 2015 5 ( Howlader et al., 2015 ). This represents almost 12 new cases for every 100,000 women and 2.6 percent of all new cancer cases in women in the United States. Nearly 200,000 women in the United States are living with ovarian cancer in any given year, and approximately 1.3 percent of all American women will be diagnosed with ovarian cancer at some point in their lives, which qualifies ovarian cancer as a rare disease as defined by the National Institutes of Health (NIH) Genetic and Rare Diseases Information Center ( NIH, 2015a ). Still, according to estimates, more than 14,000 American women will have died from ovarian cancer in 2015, which corresponds to approximately 7.7 deaths per 100,000 women and 5.1 percent of all cancer deaths among American women ( ACS, 2015 ; Howlader et al., 2015 ). Despite its relatively low incidence, ovarian cancer is the fifth leading cause of cancer deaths among U.S. women and the eighth leading cause of women's cancer deaths worldwide ( Ferlay et al., 2015 ; Howlader et al., 2015 ). By comparison, breast cancer is more common—among American women the estimated number of new cases of breast cancer each year is 10 times the number of new cases of ovarian cancer—but ovarian cancer is more deadly, with a death-to-incidence ratio that is more than three times higher than for breast cancer ( Howlader et al., 2015 ) (see Figure 1-3 ).

The ratio between the death and incidence rates for ovarian, breast, endometrial, and cervical cancers per 100,000 women in the United States, 2008–2012. SOURCE: Howlader et al., 2015.

The incidence of ovarian cancer has declined slightly since the mid-1970s, when the incidence was approximately 16 new cases per 100,000 women ( Howlader et al., 2015 ). Mortality from ovarian cancer has also declined—from 9.8 deaths per 100,000 women in 1975 to 7.4 deaths per 100,000 women in 2012. However, the decline in mortality is relatively small when compared to reductions in death rates achieved for most other female gynecological cancers and for breast cancer in women. For example, the death rate from breast cancer fell by one-third between 1975 and 2012, from 31.4 deaths per 100,000 women to 21.3 deaths per 100,000, and the death rate from cervical cancer dropped by more than half during that same period, from 5.6 deaths per 100,000 women to 2.3 deaths per 100,000.

Among women who were diagnosed with ovarian cancer between 1975 and 1977, only 36 percent lived 5 years or more, while nearly half (46 percent) of women diagnosed with ovarian cancer between 2005 and 2007 lived at least 5 years beyond their diagnosis ( Howlader et al., 2015 ). However, that improvement in survival rates was driven primarily by improvements in survival among white women; survival rates decreased (from 42 to 36 percent) over the same period for black women ( ACS, 2015 ; also see section Race and Ethnicity later in this chapter).

Stage Distribution

Ovarian cancer's high mortality and low survival rates can be attributed in part to the fact that it is rarely diagnosed at an early stage. Indeed, 60 percent of women are diagnosed with advanced disease, when the cancer has already spread beyond the ovary to distant organs or lymph nodes ( Howlader et al., 2015 ). In comparison, as seen in Figure 1-4 , other female cancers are more commonly diagnosed during the localized or regional stages.

Distribution (percentage) of stage of diagnosis for cancers of the breast, endometrium, cervix, and ovary among U.S. women, 2005–2011. SOURCE: Howlader et al., 2015.

The relatively late stage of diagnosis for ovarian cancer is particularly important because survival is highly correlated with the stage at diagnosis (see Figure 1-5 ). While the 5-year survival rate is 45.6 percent overall, it is substantially higher for women diagnosed while the cancer is still at the localized stage (92.1 percent) or the regional stage (73.2 percent), and it is substantially lower for women diagnosed at the distant stage (28.3 percent) ( ACS, 2015 ; Howlader et al., 2015 ). Survival is lowest among women who receive an unstaged ovarian cancer diagnosis (22.9 percent).

Five-year relative survival (percentage) from ovarian cancer by stage at diagnosis among U.S. women, 2005–2011. SOURCE: Howlader et al., 2015.

White and black women show similar patterns of stage distribution (see Figure 1-6 ). However, there is a difference in stage of diagnosis in women of different ages, with women younger than age 65 tending to be diagnosed at earlier stages than women older than age 65 (see Figure 1-7 ).

Stage distribution (percentage of cases) at diagnosis among white and black U.S. women diagnosed with ovarian cancer, 2003–2009. SOURCE: Howlader et al., 2015.

Stage distribution (percentage of cases) at diagnosis among women diagnosed with ovarian cancer by age, 2003–2009. SOURCE: Howlader et al., 2015.

Ovarian cancer incidence increases with age, with a sharp increase in the rate beginning in the mid-40s (see Figure 1-8 ). From 2008 to 2012, nearly 88 percent of all new cases of ovarian cancer occurred among women ages 45 and older, with 69 percent of cases among women ages 55 and older, and the average age at diagnosis was 63 years. A half-century ago, most cases occurred among women between the ages of 35 and 63, and the average age at diagnosis was 48.5 years ( Munnell, 1952 ).While the age-adjusted incidence rate for ovarian cancer among all women is nearly 12 cases per 100,000 women, the rate varies sharply with age, with women younger than age 65 having an incidence rate of 7.5 cases per 100,000 women while women 65 years old and older have an incidence rate of more than 42 cases per 100,000 women ( Howlader et al., 2015 ).

Age-adjusted incidence of ovarian cancer per 100,000 women in the United States by age group. SOURCE: SEER Program, 2015.

Mortality rates also increase sharply with age. The death rate for women aged 65 and older is approximately 13 times that of women less than age 65 (see Figure 1-9 ). Furthermore, while mortality rates have declined overall in the past 40 years, most of this decline is attributable to decreases in mortality among women diagnosed with ovarian cancer less than age 65 ( ACS, 2015 ; Howlader et al., 2015 ).

Trends in age-adjusted death rates from ovarian cancer per 100,000 women in the United States by age group, 1975–2012. SOURCE: Howlader et al., 2015.

Race and Ethnicity

The patterns of ovarian cancer incidence and mortality differ substantially among women of different races and ethnic backgrounds (see Figure 1-10 ). Whites have the highest incidence of ovarian cancer, followed by Hispanics, American Indian/Alaska Natives, blacks, and Asian/ Pacific Islanders ( ACS, 2015 ; Howlader et al., 2015 ; Singh et al., 2014 ). The 5-year survival rate is highest among Asian/Pacific Islanders, followed by Hispanics, whites, American Indian/Alaska Natives, and blacks, while mortality rates are highest among whites, followed by blacks, Hispanics, American Indian/Alaska Natives, and Asian/Pacific Islanders. A particularly dramatic contrast can be seen between black and Asian/Pacific Islander women. While the two groups are similar in having low incidence rates, black women have the second-highest mortality rates and the lowest survival rates, while Asian/Pacific Islanders have the lowest mortality and the highest survival rates. The incidence of ovarian cancer, particularly HGSC, is higher than average in women of Ashkenazi Jewish ancestry, in part because of the higher prevalence of deleterious mutations in cancer-predisposition genes such as BRCA1 and BRCA2 among these women ( ACS, 2015 ; Moslehi et al., 2000 ).

FIGURE 1-10

Age-adjusted ovarian cancer incidence and mortality per 100,000 U.S. women by race and ethnicity, 2008–2012. SOURCE: Howlader et al., 2015.

FIGURE 1-11

Age-specific incidence rates of ovarian cancer per 100,000 women in the United States by race/ethnicity and age at diagnosis, 2008–2012. NOTE: Rates for American Indian/Alaska Natives are only displayed for ages 50 through age 69, because the (more...)

Historical trends also show considerable variations by race. Between 2003 and 2012, mortality rates decreased significantly among whites and Hispanics, while declines in mortality among blacks, Asian/Pacific Islanders, and American Indian/Alaskan Natives were not statistically significant ( Howlader et al., 2015 ). Moreover, while survival rates have increased among women overall and among white women since the mid-1970s, survival rates have declined slightly among black women (see Figure 1-12 ). Furthermore, although black women had higher rates of survival compared to white women and to women overall in 1975, by the mid-1980s survival rates had begun to reverse, such that black women now have lower survival rates than white women and women of all races overall even despite gains in survival among blacks in the 1990s ( ACS, 2015 ).

FIGURE 1-12

Trends in 5-year relative survival rates (percentage) for ovarian cancer among U.S. women by race, 1975–2011. SOURCE: Howlader et al., 2015.

In the United States, there are slight geographic variations in ovarian cancer incidence, but these variations are not significant ( Howlader et al., 2015 ; Ries et al., 2007 ). However, the differences in mortality from state to state are significant. In the United States, from 2008 to 2012 the death rate for ovarian cancer was 7.7 deaths per 100,000 women. During that same period, the age-adjusted death rates by state ranged from a low of 5.3 deaths per 100,000 women in Hawaii to a high of 9.0 deaths per 100,000 women in Oregon ( Howlader et al., 2015 ). Despite the wide variation across the states, only Alabama, Oregon, Pennsylvania, and Washington have significantly higher rates, statistically speaking, than the United States as a whole, while only Florida, Hawaii, and Texas have significantly lower rates than the national average.

Ovarian cancer incidence and mortality also vary internationally, with incidence and mortality rates being higher in more developed regions than in less developed regions ( Ferlay et al., 2015 ).

Aside from genetics (e.g., the higher proportion of mutations in cancer-predisposition genes among Ashkenazi Jewish women), the reasons behind the racial and ethnic differences in outcomes are unknown, but they might be explained in part by other variables such as differences in access to health care or the quality of that care ( Baicker et al., 2005 ; IOM, 2003 , 2012 ). Similarly, the reasons behind geographic variation in the demographics of ovarian cancer are unknown, and might be explained by other variables such as race and ethnicity (e.g., the higher proportion of Asian and Pacific Islanders in Hawaii) or differences in access to health care or the quality of that care in different geographic regions ( Baicker et al., 2005 ; IOM, 2003 , 2012 ). (See Chapter 4 for more on access and standards of care for women with ovarian cancer.) Overall, as noted previously, reporting on the demographics and epidemiology of ovarian cancer is challenging because of the fact that most of the data sources aggregate the various subtypes, and even when the data are reported by subtype, differences in the grading, classification, and nomenclature of the subtypes create challenges in summarizing and comparing data.

THE LANDSCAPE OF STAKEHOLDERS IN OVARIAN CANCER RESEARCH

Federal Stakeholders

Etiology (causes of cancer);

Prevention;

Early detection, diagnosis, and prognosis;

Cancer control, survivorship, and outcomes research; and

Scientific model systems ( DoD, 2015b ).

Centers for Disease Control and Prevention

The CDC conducts and supports studies, often in collaboration with partners, to “develop, implement, evaluate, and promote effective cancer prevention and control practices” ( CDC, 2015 ). In general, the CDC approaches cancer by monitoring cancer demographics (surveillance), by conducting research and evaluation, by partnering with other stakeholders to help translate evidence, and by developing educational materials ( CDC, 2015 ). Most of the CDC's work in ovarian cancer is performed through its Division of Cancer Prevention and Control. 6 Since fiscal year (FY) 2000, the CDC has received about $5 million annually in congressional appropriations to support its Ovarian Cancer Control Initiative. In addition, in 2008 the CDC started receiving funds under Johanna's Law to improve communication with women regarding gynecologic cancers. The CDC's Inside Knowledge 7 campaign works to raise awareness about cervical, ovarian, uterine, vaginal, and vulvar cancers. Between 2010 and 2014, ads produced for the Inside Knowledge campaign were seen or heard around 3.5 million times and were worth a total of $136 million in donated ad value ( CDC, 2014 ).

U.S. Department of Defense

The DoD's Ovarian Cancer Research Program (OCRP) 8 received congressional appropriations from FY 1997 to FY 2014 totaling $236.45 million and received another $20 million in appropriations for FY 2015 ( DoD, 2015a ). Since the inception of the DoD OCRP, more than 130 ovarian cancer survivors have taken part in efforts to establish the OCRP's priorities and research award mechanisms, and they have helped choose the research to be funded. From FY 1997 through FY 2013, the OCRP funded 313 awards in a variety of areas (see Figure 1-13 ). These awards show a focus on biology, treatment, and early detection, diagnosis, and prognosis. OCRP's research priorities include understanding the precursor lesions, microenvironment, and pathogenesis of all types of ovarian cancer; developing and improving the performance and reliability of screening, diagnostic approaches, and treatment; developing or validating models to study initiation and progression; investigating tumor response to therapy; and enhancing the pool of ovarian cancer scientists ( DoD, 2015a ).

FIGURE 1-13

Areas of ovarian cancer research funded by OCRP, FY 1997–2011. SOURCE: DoD, 2015b.

National Institutes of Health

The NCI of the NIH has initiated several activities to advance ovarian cancer research with intramural and extramural funding. In the past, five ovarian cancer–specific specialized programs of research excellence (SPOREs) in the United States conducted ovarian cancer research in early detection, imaging technologies, risk assessment, immunosuppression, and novel therapeutic approaches ( NCI, 2015e ). The NCI currently lists four active SPOREs for ovarian cancer.

The NCI is involved in ovarian cancer research in a variety of other ways. For example, the Clinical Proteomic Tumor Analysis Consortium (CPTAC) is trying to understand the molecular basis of cancer in order to help improve the diagnosis, treatment, and prevention of cancer ( NCI, 2015b ). To accomplish these goals, CPTAC is using the data collected by The Cancer Genome Atlas (TCGA) analysis of ovarian tumors. The NCI has also supported a follow-up of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial to analyze the biological material and risk factor information in order to better understand the risks and identify early biomarkers, including biomarkers for ovarian cancers. (See Chapter 3 for more on the PLCO Cancer Screening Trial.)

Overall, the NCI supported $100.6 million in research 9 related to ovarian cancer in FY 2013 while providing $559.2 million for breast cancer research, $63.4 million for cervical cancer research, and $17.8 million for endometrial cancer research ( NCI, 2015g ). However, the research projects listed as being related to ovarian cancer are not necessarily limited to ovarian cancer, and they include studies of multiple cancers (including ovarian cancer) or areas of cross-cutting research related to ovarian cancer. Furthermore, data collected by the DoD 10 through the International Cancer Research Partnership indicates that the funded amount is significantly less when considering only new grants awarded by the NCI each year. Only 52 projects involving ovarian cancer research totaling $33.4 million were started in 2010, 58 new projects totaling $20.4 million in 2011, and 52 new projects totaling $16.3 million in 2012 ( ICRP, 2015 ). Figure 1-14 shows that, like the DoD, the NCI portfolio for ovarian cancer research focuses primarily on treatment, biology, and early detection, diagnosis, and prognosis.

FIGURE 1-14

Areas of ovarian cancer research funded by the NCI. SOURCE: NCI, 2013.

Figure 1-15 shows the areas of cancer survivorship research expertise at the NCI. As of October 2015, the Division of Cancer Control and Population Sciences had two open funding opportunities for general cancer survivorship research: one focused on the efficacy and impact of care planning, and the other examined the effects of physical activity and weight control interventions on cancer prognosis and survival ( NCI, 2015a ). Neither of these grant opportunities specified a focus on ovarian cancer survivorship.

FIGURE 1-15

Expertise areas for cancer survivorship research at the NCI. SOURCE: NCI, 2015c.

Private Stakeholders

A wide variety of private stakeholders are engaged in ovarian cancer research, including professional societies, advocacy organizations, women's health groups, and disease-specific foundations. In some cases, the organization specifically focuses on ovarian cancer and ovarian cancer research. However, many others focus on cancer or women's health broadly (e.g., the American Cancer Society and the American Congress of Obstetricians and Gynecologists). Overall, private funders of ovarian cancer research tend to focus funding on biology and treatment, with very little funding directed toward the etiology of ovarian cancer or survivorship issues.

Private stakeholders can support young researchers with grant funding; provide training and educational opportunities; encourage collaborative, transdisciplinary efforts; and engage consumers, survivors, and their families. Examples of previous and current efforts by individual private stakeholders include

The Health, Empowerment, Research, and Awareness Women's Cancer Foundation awarded the Sean Patrick Multidisciplinary Collaborative Grant for cross-disciplinary projects to allow scientists to come together and test ideas that may not be fundable by other agencies ( HERA, 2015 ).
The Marsha Rivkin Center for Ovarian Cancer Research awards Bridge Funding Awards to researchers who are close to fundable grant scores for the DoD or the NIH but require additional data to ensure a successful resubmission ( Rivkin Center, 2015 ).
The Ovarian Cancer Research Fund (OCRF) provides funding to researchers at all stages of their careers; OCRF awards include funding for recent graduates, newly independent researchers who are building laboratories, and senior researchers working on collaborative projects ( OCRF, 2015 ).
The Society of Gynecologic Oncology (SGO) released Pathways to Progress in Women's Cancer in 2011, a research agenda based on discussions of working groups at a 2010 research summit. One working group focused on ovarian cancers, and the report provides short-term, intermediate, and long-term research priorities ( SGO, 2011 ).
The Honorable Tina Brozman Foundation for Ovarian Cancer Research (also known as Tina's Wish) funds research specifically in the early detection and prevention of ovarian cancer and also supports a consortium to advance such research ( Tina's Wish, 2015 ).

The Role of Advocacy in Ovarian Cancer Research

Advocacy has positively affected ovarian cancer research, public knowledge, and awareness. Many different types of people play the role of advocate—women with ovarian cancer, partners, family members, health care professionals, and activists—and their advocacy efforts range from the individual, patient level to the societal level, but all of these different efforts have had effects on funding efforts, policy change, and the direction of research.

Patients self-advocate by taking active roles in their own care. Researchers have recognized this concept of self-advocacy as an important part of patient-centered care, and it has been described as “a distinct type of advocacy in which an individual or group supports and defends their interests either in the face of a threat or proactively to meet their needs” ( Hagan and Donovan, 2013 , p. 3). However, despite claims that self-advocacy may improve quality of life, health care use, and symptom management, these potential effects have not been adequately studied.

Nurses can serve as advocates for patients by protecting patients' rights, incorporating patients' beliefs and values into their care plans, and respecting the autonomy of the patient to ensure access to quality care ( Temple, 2002 ). Advocacy groups provide education, information, and personal support to patients, family caregivers, and the general public. Many advocacy groups also use lobbying efforts to influence policy, including the direction of research and funding.

Large-scale advocacy efforts have arguably had a great impact on cancer research and funding. In the late 1990s, survivors advocated for wider recognition of early-stage ovarian cancer symptoms. Until that time, physicians and medical textbooks had claimed that women did not experience symptoms until advanced stages of disease ( Twombly, 2007 ). Johanna's Law is considered a victory of advocacy groups' lobbying efforts. Furthermore, Congress has appropriated funds for ovarian cancer research and education programs since FY 1997. The establishment and unified efforts of national advocacy organizations are partially responsible for the significant funding increases in the intervening years ( Temple, 2002 ).

Advocacy groups have also been integral to the advancement of ovarian cancer research through their participation in the design and administration of studies ( Armstrong et al., 2014 ; Holman et al., 2014 ). The scientific literature emphasizes the importance of patient advocates in patient-centered research, citing examples of the collaboration between researchers and patient advocates in research studies ( Armstrong et al., 2014 ; Holman et al., 2014 ; Staton et al., 2008 ).

Several large advocacy groups at the national and international levels focus on ovarian cancer. For example, the Ovarian Cancer National Alliance (OCNA), a national advocacy organization, has among its activities the Survivors Teaching Students: Saving Women's Lives ® program, which is aimed at educating caregivers and medical, nursing, and other professional students about the early signs and symptoms of ovarian cancer. Recently, OCNA spearheaded the formation of the first congressional Ovarian Cancer Caucus with the support of Rosa DeLauro (D-CT) and Sean Duffy (R-WI). The first meeting was held on September 29, 2015, in Washington, DC. The National Ovarian Cancer Coalition (NOCC), another national advocacy organization, funds the Teal Initiative to improve education and awareness. NOCC also supports specific research in ovarian cancer and provides survivor support, primarily through its Faces of Hope program, which is “dedicated to improving the quality of life for women affected by ovarian cancer, as well as providing support for their loved ones and caregivers” ( NOCC, 2014 ). At the international level, the charity Ovarian Cancer Action encourages collaboration among ovarian cancer researchers around the world. Half of its funds go to the Ovarian Cancer Action Research Centre in the United Kingdom, which exclusively supports “research that can be translated into meaningful outcomes for real women in real life” ( Ovarian Cancer Action, 2015 ). In addition, every few years Ovarian Cancer Action hosts an international forum to bring researchers together to share information, inspire collaboration, and develop white papers. In 2011 the forum developed the paper Rethinking Ovarian Cancer: Recommendations for Improving Outcomes , which outlined recommendations for improving outcomes for women with ovarian cancer ( Vaughan et al., 2011 ). A number of other advocacy groups work at the local and national levels to support research in ovarian cancer.

The Role of Consortia and Collaboration in Ovarian Cancer Research

Because of the relative rarity of ovarian cancers, especially when subdivided according to subtypes, collaborative research efforts are necessary in order to collect sufficient data for statistically significant results. Many consortia and multisite studies have evolved to promote the sharing of biospecimens, clinical data, and epidemiologic data in order to ensure sufficient sample sizes in studies. These consortia and collaborations operate at both the national and international levels. Common uses of consortia include carrying out research on the genetic and nongenetic risk factors of developing ovarian cancers, studying mechanisms of disease relapse and resistance, and identifying newer therapies ( AOCS, 2015 ; COGS, 2009 ; NRG Oncology, 2015 ; OCAC, 2015 ; OCTIPS, 2015 ). Furthermore, groups will often team together in coalitions to promote transdisciplinary research and also to promote the translation and dissemination of information. For example, in 2015, OCNA, NOCC, and OCRF provided funding for the Stand Up To Cancer (SU2C) Dream Team for ovarian cancer. This team will bring together experts in DNA repair, translational investigators, and clinicians “to create new programs in discovery, translation, and clinical application, while cross-fertilizing and educating researchers at all levels to enhance collaboration and catalyze translational science” (SU2C, 2015).

Consortia and coalitions have had clear, measureable impacts on the research base for ovarian cancers. For example, as a result of the Collaborative Oncological Gene-environment Study (COGS), 14 new markers for risk of ovarian cancer were identified (only 8 had been known before COGS) ( COGS, 2014 ). Based on the work of this coalition, TCGA researchers completed a detailed analysis of ovarian cancer, which confirmed that mutations in the TP53 gene (which encodes a protein that normally suppresses tumor development) are present in nearly all HGSCs ( Bell et al., 2011 ). The analysis also examined gene expression patterns and identified signatures that correlate with survival outcomes, affirmed four subtypes of HGSCs, and identified dozens of genes that might be targeted by gene therapy ( NIH, 2011 , 2015b ).

NCI's National Clinical Trials Network

In 1955 the NCI established the Clinical Trials Cooperative Group Program. As the science of cancer treatment was evolving, researchers realized that collaborative efforts were necessary to accrue sufficient numbers for clinical trials in order to more rapidly compare the value of new therapies to existing standards of care, particularly for the use of chemotherapy in the treatment of solid tumors ( DiSaia et al., 2006 ; IOM, 2010b ). The work of the cooperative groups led to advances in the treatment of women with ovarian cancer specifically, including a demonstration of the value of adding paclitaxel to cisplatin, confirmation of the value of cytoreductive surgery, and a demonstration of the value of carboplatin for late-stage ovarian cancers ( IOM, 2010b ). The groups have also studied issues related to the quality of life and the prevention of ovarian cancer. Between 1970 and 2005, clinical trials of the Gynecologic Oncology Group (GOG) alone included approximately 35,000 women with ovarian cancer ( DiSaia et al., 2006 ).

In 2014, based in part on the IOM report A National Cancer Clinical Trials System for the 21st Century , the NCI transformed the cooperative group program into the new National Clinical Trials Network ( IOM, 2010b , 2011 , 2013b ; NCI, 2015f ). This reorganization consolidated nine cooperative groups into five new groups:

The Alliance for Clinical Trials in Oncology;
The ECOG-ACRIN Cancer Research Group (a merger of two cooperative groups: the Eastern Cooperative Oncology Group and the American College of Radiology Imaging Network);
NRG Oncology (a merger of three cooperative groups: the National Surgical Adjuvant Breast and Bowel Project, the Radiation Therapy Oncology Group, and the GOG);
The Southwest Oncology Group; and
The Children's Oncology Group ( NCI, 2015f ).
PREVIOUS WORK AT THE INSTITUTE OF MEDICINE

Prevention and Early Detection

In 2005 the IOM report Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis ( IOM, 2005 ) recommended the development of tools to identify the women who would benefit most from breast cancer screening based on “individually tailored risk prediction techniques that integrate biologic and other risk factors.” The report also called for the development of tools that “facilitate communication regarding breast cancer risk to the public and to health care providers.” In addition, the report called for more research on breast cancer screening and detection technologies, including research on various aspects of technology adoption (e.g., monitoring the use of technology in clinical practice).

A 2007 IOM report, Cancer Biomarkers , offered recommendations on the methods, tools, and resources needed to discover and develop biomarkers for cancer; guidelines, standards, oversight, and incentives needed for biomarker development; and the methods and processes needed for clinical evaluation and adoption of such biomarkers ( IOM, 2007a ). Specific recommendations from the report included establishing international consortia to generate and share data, supporting high-quality biorepositories of prospectively collected samples, and developing criteria for conditional coverage of new biomarker tests. Subsequently, in 2010, an IOM report, Evaluation of Biomarkers and Surrogate Endpoints in Chronic Disease , outlined a framework for the evaluation of biomarkers ( IOM, 2010a ).

In Initial National Priorities for Comparative Effectiveness Research ( IOM, 2009 ), the committee offered two priorities that are relevant to ovarian cancer genetics: “Compare the effectiveness of adding information about new biomarkers (including genetic information) with standard care in motivating behavior change and improving clinical outcomes” and “Compare the effectiveness of genetic and biomarker testing and usual care in preventing and treating breast, colorectal, prostate, lung, and ovarian cancer, and possibly other clinical conditions for which promising biomarkers exist” ( IOM, 2009 , p. 4).

In 2007, the IOM's National Cancer Policy Forum hosted a workshop on cancer-related genetic testing and counseling. According to the published summary of that workshop, participants observed that “genetic testing and counseling are becoming more complex and important for informing patients and families of risks and benefits of certain courses of action, and yet organized expert programs are in short supply. The subject matter involves not only the scientific and clinical aspects but also workforce and reimbursement issues, among others” ( IOM, 2007b )

Clinical Trials

A 2010 report, A National Cancer Clinical Trials System for the 21st Century: Reinvigorating the NCI Cooperative Group Program ( IOM, 2010b ), called for the restructuring of the NCI Cooperative Group Program and set four goals:

Improve the speed and efficiency of the design, launch, and conduct of clinical trials (e.g., improve collaboration among stakeholders);

Incorporate innovative science and trial design into cancer clinical trials (e.g., support standardized central biorepositories, develop and evaluate novel trial designs);

Improve the means of prioritization, selection, support, and completion of cancer clinical trials (e.g., develop national unified standards); and

Incentivize the participation of patients and physicians in clinical trials (e.g., develop electronic tools to alert clinicians to available trials for specific patients, encourage eligibility criteria to allow broad participation, cover cost of patient care in trials).

Palliative and End-of-Life Care

Improving Palliative Care for Cancer ( IOM, 2001 ) called for incorporating palliative care into clinical trials. The report also noted that information on palliative and end-of-life care is largely absent from materials developed for the public about cancer treatment, and the committee recommended strategies for disseminating information and improving education about end-of-life care. The report recommended that the NCI require comprehensive cancer centers to carry out research in palliative care and symptom control and that the Health Care Finance Administration (now the Centers for Medicare & Medicaid Services) fund demonstration projects for service delivery and reimbursement that integrate palliative care throughout the course of the disease.

Dying in America ( IOM, 2015 ) noted that palliative care can begin early in the course of treatment, in conjunction with treatment, and can continue throughout the continuum of care. The report further observed that “a palliative approach can offer patients near the end of life and their families the best chance of maintaining the highest possible quality of life for the longest possible time” ( IOM, 2015 , p. 1).

Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis ( IOM, 2013a ) addressed the delivery of cancer care, including palliative and end-of-life care. The study called for providing patients and their families with understandable information about palliative (and other) care and recommended that “the cancer care team should provide patients with end-of-life care consistent with their needs, values, and preferences” ( IOM, 2013a , p. 9).

Communication and Survivorship

From Cancer Patient to Cancer Survivor ( IOM, 2006 ) called for actions to raise awareness about the needs of cancer survivors, including the establishment of cancer survivorship as a distinct phase of cancer care. In 2008, the IOM report Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs ( IOM, 2008 ) recommended that facilitating effective communication between patients and care providers, identifying psychosocial health needs, and engaging and supporting patients in managing their illnesses should all be considered as part of the standard of care. The report emphasized the importance of educating patients and their families and of enabling patients to actively participate in their own care by providing tools and training in how to obtain information, make decisions, solve problems, and communicate more effectively with their health care providers. The report further called for the government to invest in a large-scale demonstration and evaluation of various approaches to the efficient provision of psychosocial health care.

Women's Health Research ( IOM, 2010c ) found that there are many barriers to the translation of research findings in general and that some have aspects that are “peculiar to women.” The committee recommended specific research on how to translate research findings on women's health into clinical practice and public health policies.

Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis ( IOM, 2013a ) called for providing patients and their families with “understandable information on cancer prognosis, treatment benefits and harms, palliative care, psychosocial support, and estimates of the total and out-of-pocket costs of cancer care.” The report further called for the development of decision aids to be made available through print, electronic, and social media; for the formal training of cancer care team members in communication; for the communication of relevant and personalized information at key decision points along the continuum of cancer care; and for consideration of patients' individual needs, values, and preferences when developing a care plan, including end-of-life care. The report also called for the identification and public dissemination of evidence-based information about cancer care practices that are unnecessary or for which the harm may outweigh the benefits.

OVERVIEW OF THE REPORT

This chapter has provided an overview of the study charge and the committee's approach to its work. It has also provided an introduction to the challenges in ovarian cancer research, to defining and classifying ovarian cancers, to the patterns and demographics of the disease, and to the landscape of stakeholders in ovarian cancer research. The remaining chapters follow the research framework outlined in Figure 1-1 .

Chapter 4 describes the research base for the diagnosis and treatment of women newly diagnosed with ovarian cancer as well as for women with relapsed ovarian cancer. The chapter outlines research on current standards of care and also explores the development of novel therapeutics such as anti-angiogenics, poly ADP ribose polymerase (PARP) inhibitors, and immunotherapy. Later, the chapter discusses issues of clinical trial development and use as they relate specifically to research in ovarian cancer.

Finally, the report contains five appendixes. Appendix A contains a list of key acronyms used throughout the report. Appendix B contains a glossary of key terms. Appendix C includes a listing of currently active studies on epithelial ovarian cancer (based on information available through www.ClinicalTrials.gov ) in order to give a sense of where emphasis is being placed in future research. Appendix D lists the agendas of the committee's workshops. Appendix E contains the biographical sketches of the committee members and project staff.

Gynecologic Cancer Education and Awareness Act of 2005, Public Law 475, 109th Cong., 2nd sess. (January 12, 2007).

To reauthorize and enhance Johanna's Law to increase public awareness and knowledge with respect to gynecologic cancers, Public Law 324, 111th Cong., 2nd sess. (December 22, 2010).

Explanatory statement submitted by Mr. Rogers of Kentucky, Chairman of the House Committee on Appropriations regarding the House amendment to the Senate amendment on H.R. 3547, consolidated… , 113th Cong., 2nd sess., Congressional Record 160, no. 9, daily ed. (January 15, 2014):H 1035.

Terminology to describe race and ethnicity reflects the terminology used in the original sources.

Because historical epidemiologic data typically combine the multiple types of ovarian cancer, they are discussed as a single disease in this discussion of epidemiology.

For more information, see http://www .cdc.gov/cancer/dcpc/about (accessed July 21, 2015).

For more information, see http://www .cdc.gov/cancer/knowledge (accessed September 1, 2015).

For more information, see http://cdmrp .army.mil/ocrp (accessed July 21, 2015).

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Personal communication, Patricia Modrow, data assembled by the U.S. Department of Defense Ovarian Cancer Research Program, January 16, 2015.

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Cite this Page Committee on the State of the Science in Ovarian Cancer Research; Board on Health Care Services; Institute of Medicine; National Academies of Sciences, Engineering, and Medicine. Ovarian Cancers: Evolving Paradigms in Research and Care. Washington (DC): National Academies Press (US); 2016 Apr 25. 1, Introduction and Background.
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Topic: ovarian cancer

Ovarian cancer.

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Ovarian cancer is a type of cancer that begins in the ovaries, which are female reproductive organs responsible for producing eggs and hormones. It is often referred to as the "silent killer" because symptoms are often vague and can easily be mistaken for other conditions. Ovarian cancer is the seventh most common cancer among women and accounts for more deaths than any other cancer of the female reproductive system. Research in the area of ovarian cancer focuses on improving early detection methods, understanding the genetic and environmental factors that contribute to the development of the disease, and developing more effective treatments. This includes studying the role of certain genes, hormones, and lifestyle factors in ovarian cancer risk, as well as investigating new drugs and therapies to target and treat the disease. Additionally, researchers are working to identify biomarkers that can help diagnose ovarian cancer at its earliest stages, when treatment is most effective.

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'Exhausted' immune cells in healthy women could be target for breast cancer prevention

People carrying BRCA1 and BRCA2 gene mutations are at high risk of developing breast and ovarian cancer. Researchers have found that changes occur in the immune cells of breast tissue in carriers of BRCA1 and BRCA2 mutations long before breast cancer develops. This raises the possibility of early intervention to prevent the disease, as an alternative to risk-reduction surgery. Drugs already approved for late-stage breast cancer treatment could reactivate the faulty immune cells and keep the breast cells healthy. If successful in mouse models, this preventative therapeutic approach could pave the way for clinical trials in human carriers of BRCA1 and BRCA2 mutations.

Researchers at the University of Cambridge have created the world's largest catalogue of human breast cells, which has revealed early cell changes in healthy carriers of BRCA1 and BRCA2 gene mutations.

Everyone has BRCA1 and BRCA2 genes, but mutations in these genes -- which can be inherited -- increase the risk of breast and ovarian cancer.

The study found that the immune cells in breast tissue of healthy women carrying BRCA1 or BRCA2 gene mutations show signs of malfunction known as 'exhaustion'. This suggests that the immune cells can't clear out damaged breast cells, which can eventually develop into breast cancer.

This is the first time that 'exhausted' immune cells have been reported in non-cancerous breast tissues at such scale -- normally these cells are only found in late-stage tumours.

The results raise the possibility of using existing immunotherapy drugs as early intervention to prevent breast cancer developing, in carriers of BRCA1 and BRCA2 gene mutations.

The researchers have received a 'Biology to Prevention Award' from Cancer Research UK to trial this preventative approach in mice. Existing drugs have serious side effects, so testing in mice is necessary to find the right safe dosage. If effective, this will pave the way to a pilot clinical trial in women carrying BRCA gene mutations.

"Our results suggest that in carriers of BRCA mutations, the immune system is failing to kill off damaged breast cells -- which in turn seem to be working to keep these immune cells at bay," said Professor Walid Khaled in the University of Cambridge's Department of Pharmacology and Wellcome-MRC Cambridge Stem Cell Institute, senior author of the report.

He added: "We're very excited about this discovery, because it opens up potential for a preventative treatment other than surgery for carriers of BRCA breast cancer gene mutations.

"Drugs already exist that can overcome this block in immune cell function, but so far, they've only been approved for late-stage disease. No-one has really considered using them in a preventative way before."

The results are published today in the journal Nature Genetics .

Risk-reducing surgery, in which the breasts are removed, is offered to those at increased risk of breast cancer. This can be a difficult decision for young women to make and can have a significant effect on body image and sexual relationships.

"The best way to prevent breast cancer is to really understand how it develops in the first place. Then we can identify these early changes and intervene," said Khaled.

He added: "Late-stage breast cancer tends to be very unpredictable and hard to manage. As we make better and better drugs, the tumours just seem to find a way around it."

Using samples of healthy breast tissue collected from 55 women across a range of ages, the researchers catalogued over 800,000 cells -- including all the different types of breast cell.

The resulting Human Breast Cell Atlas is now available as a resource for other researchers to use and add to. It contains huge amounts of information on other risk factors for breast cancer including Body Mass Index (BMI), menopausal status, contraceptive use and alcohol consumption.

"We've found that there are multiple breast cell types that change with pregnancy, and with age, and it's the combination of these effects -- and others -- that drives the overall risk of breast cancer," said Austin Reed, a PhD student in the University of Cambridge's Department of Pharmacology and joint first author of the report.

He added: "As we collect more of this type of information from samples around the world, we can learn more about how breast cancer develops and the impact of different risk factors -- with the aim of improving treatment."

One of the biggest challenges in treating breast cancer is that it is not just one disease, but many. Many different genetic variations can lead to breast cancer, and genetic risk interacts with other risk factors in complicated ways.

For example, it is known that the likelihood of breast cancer increases with age, but this risk is greatly reduced by pregnancy early in life. And age-associated risk is greatly increased in carriers of the breast cancer genes BRCA1 and BRCA2.

The new study aimed to understand how some of these risk factors interact, by characterising the different cell types in the human breast under many different physiological states.

The researchers used a technique called 'single cell RNA-sequencing' to characterise the many different breast cell types and states. Almost all cells in the body have the same set of genes, but only a subset of these are switched on in each cell -- and these determine the cell's identity and function. Single cell RNA-sequencing reveals which genes are switched on in individual cells.

"Breast cancer occurs around the world, but social inequalities mean not everyone has access to treatment. Prevention is the most cost-effective approach. It not only tackles inequality, which mostly affects low-income countries, but also improves disease outcome in high-income countries," said Dr Sara Pensa, Senior Research Associate in the University of Cambridge's Department of Pharmacology and joint first author of the study.

Breast Cancer
Women's Health
Colon Cancer
Diseases and Conditions
Lung Cancer
Breastfeeding
Breast cancer
Mammography
Breast reconstruction
Breast implant
Chemotherapy
Monoclonal antibody therapy

Story Source:

Materials provided by University of Cambridge . The original text of this story is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License . Note: Content may be edited for style and length.

Journal Reference :

Austin D. Reed, Sara Pensa, Adi Steif, Jack Stenning, Daniel J. Kunz, Linsey J. Porter, Kui Hua, Peng He, Alecia-Jane Twigger, Abigail J. Q. Siu, Katarzyna Kania, Rachel Barrow-McGee, Iain Goulding, Jennifer J. Gomm, Valerie Speirs, J Louise Jones, John C. Marioni, Walid T. Khaled. A single-cell atlas enables mapping of homeostatic cellular shifts in the adult human breast . Nature Genetics , 2024; DOI: 10.1038/s41588-024-01688-9

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Ovarian Cancer Part
THESIS RMUTT 2023 ARCHITECTURE : Cancer Specialized Hospital
March is Ovarian Cancer Awareness Month! Here is a short version of my story. #ovariancancer #fyp
Ovarian cancer: causes, symptoms, diagnosis and treatment #ovariancancer
Ovarian Cancer Symptoms I Dr. Pakhee Aggarwal
"Understanding Ovarian Cancer: Signs, Symptoms, and Treatment

COMMENTS

Theses & Dissertations: Cancer Research
Phos-Tag-Based Screens Identify Novel Therapeutic Targets in Ovarian Cancer and Pancreatic Cancer, Renya Zeng. Theses/Dissertations from 2021 PDF. Functional Characterization of Cancer-Associated DNA Polymerase ε Variants, Stephanie R. Barbari. PDF. Pancreatic Cancer: Novel Therapy, Research Tools, and Educational Outreach, Ayrianne J ...
Dissertation or Thesis
Ovarian cancer is the most fatal gynecologic malignancy and the fifth leading cause of cancer-related deaths among women in the U.S (USCS 2015). The majority (>80%) of women is diagnosed at late stages (III or IV), often when the prognosis is poor and the 5-year survival rate is 37-45% (Howlader et al. 2015; USCS 2015).
Ovarian Cancer: An Integrated Review
Objective: To provide an overview of the risk factors, modifiable and non-modifiable, for ovarian cancer as well as prevention, diagnostic, treatment, and long-term survivorship concerns. This article will also examine current and future clinical trials surrounding ovarian cancer. Data sources: A review of articles dated 2006-2018 from CINAHL, UpToDate, and National Comprehensive Cancer ...
PDF Evaluating Novel Biomarkers for Ovarian Cancer Diagnosis
guidance in planning and execution of the study, assistance in thesis preparation Dr. Joanne Kotsopoulos (Program Advisory Committee member) - assistance in thesis planning, preparation and execution ... Ovarian cancer (OC) remains a significant health concern worldwide, accounting for 6% of all cancer deaths (Siegel et al., 2012). It is the ...
Pathways to ovarian cancer diagnosis: a qualitative study
The median combined appraisal and help-seeking interval was 2.5 months (range: 7 days to 4.5 years), while the median time from first healthcare consult to ovarian cancer diagnosis (diagnostic) was 18 days (range: 0 days to 3.75 years), and the median time from ovarian cancer diagnosis to start of treatment was 8 days (range: 1 day to 1 month).
Ovarian Cancers: Evolving Paradigms in Research and Care
Chapter 3 builds on this to discuss research on the prevention and early detection of ovarian cancers. On the topic of risk assessment, the chapter includes discussions of a wide range of genetic and nongenetic risk factors for the development of an ovarian cancer, risk-prediction models, and genetic testing. ... SU2C-ovarian cancer research ...
Heterogeneity and treatment landscape of ovarian carcinoma
Subjects. Ovarian carcinoma is characterized by heterogeneity at the molecular, cellular and anatomical levels, both spatially and temporally. This heterogeneity affects response to surgery and/or ...
New insights into ovarian cancer pathology
Malignant epithelial tumors (carcinomas) are the most common ovarian cancers and also the most lethal gynecological malignancies. Based on histopathology and molecular genetic alterations, ovarian carcinomas are divided into five main types [high-grade serous (70%), endometrioid (10%), clear-cell (10%), mucinous (3%), and low-grade serous carcinomas (<5%)] that account for over 95% of cases ...
PDF LSHTM Research Online
Factors influencing ovarian cancer survival worldwide Lisa Melissa Matz Thesis submitted in accordance with the requirements for the degree of Doctor of Philosophy University of London January 2017 ... TABLE 2.1 KEY TOPICS AND SEARCH TERMS FOR LITERATURE REVIEW ...
PDF Recent Advances in Ovarian Cancer: Therapeutic Strategies, Potential
Keywords: ovarian cancer; angiogenesis; technology advances; molecular insight; therapeutic strategies and targets 1. Introduction Ovarian cancer (OC) is the presence of abnormal cells that initially grow in the ovary and then reproduce out of control, which can form a tumor malignancy when they spread into the surrounding tissues [1,2].
Ovarian cancer
Ovarian cancer is an abnormal cell growth (tumour) arising in the ovary. The majority of ovarian cancers are epithelial and develop in women over 50. Screening is highly recommended in women with ...
Major clinical research advances in gynecologic cancer in 2021
PREVENTION OF GYNECOLOGIC CANCER. The major research results related to the prevention of gynecological cancer reported in 2021 can be summarized into two categories as follows: 1) Long-term follow-up results of the UKCTOCS study that evaluated the effectiveness of early ovarian cancer detection [ 51 ].
Assessment of Adult Women With Ovarian Masses and Treatment of
PURPOSE To provide expert guidance to clinicians and policymakers in three resource-constrained settings on diagnosis and staging of adult women with ovarian masses and treatment of patients with epithelial ovarian (including fallopian tube and primary peritoneal) cancer. METHODS A multidisciplinary, multinational ASCO Expert Panel reviewed existing guidelines, conducted a modified ADAPTE ...
Ovarian Cancer Research Highlights
The ACS funds scientists who conduct research about ovarian cancer at medical schools, universities, research institutes, and hospitals throughout the United States. We use a rigorous and independent peer review process to select the most innovative research projects proposals to fund. These grant statistics are as of August 1, 2023.
In silico analysis of cell-cell communication in ovarian cancer single
In the present thesis project, CellChat is employed to analyze ligand-receptor interactions in 4 single-cell RNA datasets of ovarian cancer. High-grade serous ovarian cancer is the most frequent histotype of ovar- ian cancer, often diagnosed at late-stage in postmenopausal women. Un- derstanding the role of tumor microenviroment in the ...
The Emotional Impact of Sensitive Topics: An Autoethnographic Account
The Emotional Impact of Sensitive Topics: An Autoethnographic Account of an Ovarian Cancer Research. Dinah A. Tetteh. Arkansas State University - Main Campus, [email protected]. Follow this and additional works at: https://nsuworks.nova.edu/tqr. Part of the Health Communication Commons.
PDF MD/MS Obstetrics & Gynecology thesis topics
List of thesis topics Obstetrics & Gynecology Observational design (descriptive): ... Comparison of quality of life among women treated for advanced ovarian cancer through neoadjuvant chemotherapy versus upfront surgery 44. Co relation of programmed death ligand 1 (PDL1) expression / serum PDL1 levels in endometrial ...
Ovarian Cancer Essays: Examples, Topics, & Outlines
This thesis delves into the multitude of benefits breastfeeding offers to both mothers and their infants, highlighting the positive impact it can have on health, development, and emotional.... View our collection of ovarian cancer essays. Find inspiration for topics, titles, outlines, & craft impactful ovarian cancer papers.
353 Cancer Essay Topic Ideas & Examples
Urinary Tract Infections and Pancreatic Cancer. The laboratory technician is supposed to culture the urine and use Gram's staining method to detect the microbes in the sample. The practitioners used a combination of mecillinam and cefotaxime to manage the condition. Patient HealthCare: Early Diagnosis of Cancer.
Key insights from statistical modeling of cancer patient life expectancy
This also leads to insights into the progress in cancer control efforts, resource allocation, and disparities in cancer survival among different groups. In a new thesis from Karolinska Institutet ...
Ovulation induction drug and ovarian cancer: an updated systematic
Further, the risk of ovarian cancer, ... Most of our findings were generally consistent with previous studies on this topic [71, 72, 107, 108]. A new study was included in this latest update of the systematic review and meta-analysis compared to previous studies in this area. This study provides new data on the risk of BOT and IOC to CC exposure.
Ovarian cancer
When ovarian cancer first develops, it might not cause any noticeable symptoms. When ovarian cancer symptoms happen, they're usually attributed to other, more common conditions. Signs and symptoms of ovarian cancer may include: Abdominal bloating or swelling. Quickly feeling full when eating.
Introduction and Background
Trends. The incidence of ovarian cancer has declined slightly since the mid-1970s, when the incidence was approximately 16 new cases per 100,000 women ( Howlader et al., 2015 ). Mortality from ovarian cancer has also declined—from 9.8 deaths per 100,000 women in 1975 to 7.4 deaths per 100,000 women in 2012. However, the decline in mortality ...
Dissertations
Clinico-Pathological Features of Ovarian tumours- A Prospective Observational study 2013-2015: 81: Dr. Satwik Metgud: Dr. M.C.Metgud: Nil Comparison of efficacy & safety of intravenous ferric carboxymaltose v/s iron sucrose in the treatment of antepartum iron deficiency anemia- A randomized controlled trial 2012-2014: 82: Dr. Trupti Ruge: Dr ...
ovarian cancer
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'Exhausted' immune cells in healthy women could be ...
People carrying BRCA1 and BRCA2 gene mutations are at high risk of developing breast and ovarian cancer. Researchers have found that changes occur in the immune cells of breast tissue in carriers ...
VIRTUAL Thesis Defense: Alyssa Oplt (Molecular Genetics and Genomics
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