Cancer Screening

Allison Brown Dr. Bird STATS 2000 27 April, 2020 Homework #3: Cancer Screening For this homework assignment I chose to focus on ovarian cancer for my focused research; 1.) According to the Cancer Statistics Center in 2020, the “incidence rates” for 2012 2016 were 11.1 for every 100,000 women (age adjusted to the 2010 Census population) in the United States would contract ovarian cancer. For death rates from 2013 - 2017 the average rate of death is 6.2 for every 100,000 women (age adjusted to the 2010 Census population) in the United States. Additionally to the rates, the Cancer Statistics Center estimates 21,750 new cases in 2020 and 13,940 deaths due to ovarian cancer in 2020. This source broke down the incidence and death rates by women’s ethnicity as follows; (group) (incidence) (deaths) Non-Hispanic White 11.6 7.3 American Indian and Alaskan Native 10.3 6.3 Hispanic 10.1 6.1 Non-Hispanic Black 9.1 5.1 Asian and Pacific Islander 9.1 4.4 What this data shows is that the incidence rates for the different populations are marginally close with some larger differences, i.e. the 2.5 difference between Non-Hispanic 1 White and Asian and Pacific Islander populations for incidence and 2.9 for death rates per 100,000 women of each ethnic population. This source also projects the probability of developing and potentially dying from ovarian cancer depending on different age groups. As shown below, it is obvious that the older a population is the more likely a woman would develop ovarian cancer and the more the potential for the disease to be fatal increases; (age group) (incidence) (deaths) 0 - 49 0.2% <0.1% 50 - 59 0.2% 0.1% 60 - 69 0.3% 0.2% 70 + 0.7% 0.7% (Out of 100,000 women in each age group) 2.) So according to the American Cancer Society, screening by medical professionals is not recommended to women unless they complain or mention common ovarian cancer symptoms. Ovarian cancer has no clear test, like a mammogram or a single test, and is composed of two parts: a trans-vaginal ultrasound to attempt and find a tumour and a CA-125 blood test. Both are required to diagnose the disease certainly because the CA-125 test is prone to false positives and confirmation is required to be confident in the diagnosis. That being said, early screening (defined by ages 55 and under) has been found to be useless in a way. According to the US Preventive Services Task Force in 2018; “The USPSTF found adequate evidence that screening for ovarian cancer does not reduce ovarian cancer mortality. The USPSTF found adequate evidence that the harms from screening for ovarian cancer are at least moderate and may be substantial in some cases, and include 2 unnecessary surgery for women who do not have cancer. Given the lack of mortality benefit of screening, and the moderate to substantial harms that could result from false-positive screening test results and subsequent surgery, the USPSTF concludes with moderate certainty that the harms of screening for ovarian cancer outweigh the benefit, and the net balance of the benefit and harms of screening is negative” This conclusion from the Preventive Services Task Force is confirmed by other sources include a peer-reviewed medical observational experiment in the United Kingdom in 2017; “ … around 200,000 women aged 50-74 were enrolled and randomly assigned to three groups: 50% to receive no screening, 25% to annual transvaginal ultrasound screening (USS) and 25% to annual multimodal screening (MMS) with CA-125 testing using the 'risk of ovarian cancer algorithm' followed by transvaginal ultrasound. PLCO and UKCTOCS were powered to detect mortality differences of 30-35%, but the UKCTOCS data demonstrate that a 15-20% reduction may be more realistic ” The case with ovarian cancer shows the preventative screening is not effective and that ultimately the most effective and crucial time for a woman to be screened is if she is over the age of fifty and already displaying multiple symptoms of the cancer. 3.) Chemotherapy treatment, as is the case with most cancers, is found to be the most effective form non-invasive of treatment for ovarian cancer (Yallapu/ Maher 2010). With chemotherapy, two different methods are used to administer the treatment. One method is to give the drugs through a vein via an I.V. Chemotherapy is administered to women in cycles of treatment days and rest, typically you get the chemotherapy drugs bi-weely and then have the time between to recover but the number of treatment days varies with the drug given. Women with ovarian cancer typically get six cycles of chemotherapy with rest periods built in. I was unable to find a direct percentage of the effectiveness of chemotherapy or a correlation with the 3 success of the treatment to the development of the cancer and the percentages regarding the age groups that the treatment is used on. Radiotherapy is an additional treatment that is available to women with ovarian cancer. According to Target Ovarian Cancer in 2019, “Radiotherapy is not generally used to treat ovarian cancer but is sometimes recommended for early stage cancer after surgery to help kill off any cancer cells left behind”. Women receiving this treatment is an extra insurance to destroy and prevent any cancerous cells from returning. The most effective form of treatment if the disease is caught in stages I or II or the cancer is a total abdominal hysterectomy to remove any area where the cancer could have already spread and prevent it from developing outside of the uterus and ovaries. This treatment is typical for women who are older (the majority of women affected by ovarian cancer) but for younger women with the disease is often avoided with hopes for children in their future and a less permanent treatment of chemotherapy is chosen. 4.) As with any cancer or serious disease, the mortality rate differs with which stage the disease is in and in the case of ovarian cancer the spread of the cells from rupture ovaries to the peritoneal cavity (where most major organs are) is a crucial stage in terms of mortality. “For all types of ovarian cancer taken together, about 3 in 4 women with ovarian cancer live for at least 1 year after diagnosis. Almost half (46.2%) of women with ovarian cancer are still alive at least 5 years after diagnosis” (National Cancer Institute 2020). In stage II of the cancer, in which the cancer is found in one or both ovaries and has spread into other areas of the pelvis, the relative “5 Year Survival Rate” ranges from 56% - 70% depending on the sub-stage. For stage III, defined 4 as the cancer is found in one or both ovaries and has spread outside the pelvis to other parts of the abdomen, the 5-year survival rate ranges from 39% - 59%. For stage IV, the cancer has spread beyond the abdomen to other parts of the body, such as the lungs or tissue inside the liver, the 5-year survival rate is only 17%. Ovarian cancer is more prone than other types of cancer with recurrent tissues (without a complete hysterectomy) and some women go on and off of chemotherapy for years on end. After the cancerous fluid/cells spread into the peritoneal cavity for most women the quality of life is greatly reduced as all major organs start to develop the cancerous cells and discomfort during normal body functions grows until the disease is fatal. Sources: American Cancer Society: Cancer Facts & Statistics. (2020). Retrieved from https://cancerstatisticscenter.cancer.org/?_ga=2.33744289.1209035461.1588008823-183 663117.1588008823#!/cancer-site/Ovary Document: United States Preventive Services Taskforce. (2018, February 13). Retrieved from https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationState 5 entFinal/ovarian-cancer-screening National Cancer Institute, Learn About Stages for Ovarian Cancer. (2020). Retrieved from https://ocrahope.org/patients/about-ovarian-cancer/staging/?gclid=EAIaIQobChMI_KSk ZGJ6QIVh7LICh1HqAH3EAAYASAAEgJglPD_BwE Treatment: surgery, chemotherapy, other drugs. (2019). Retrieved from https://www.targetovariancancer.org.uk/information-and-support/i-have-just-been-diagn sed-ovarian-cancer/treatment/treatment-surgery Wentzensen, N. (2016). Large ovarian cancer screening trial shows modest mortality reduction, but does not justify population-based ovarian cancer screening. (2017) Evidence - Based Medicine, 21(4), 159. doi: http://dx.doi.org.libproxy.uwyo.edu/10.1136/ebmed-2016-110411 Yallapu, M. M., Maher, D. M., Sundram, V., Bell, M. C., Jaggi, M., & Chauhan, S. C. (2010). Curcumin induces chemo/radio-sensitization in ovarian cancer cells and curcumin nanoparticles inhibit ovarian cancer cell growth. Journal of Ovarian Research, 3 doi:http://dx.doi.org.libproxy.uwyo.edu/10.1186/1757-2215-3-11 6