Algorithm predicts ovarian cancer in BRCA1/2 carriers within NHS

A screening tool for women with BRCA1 or 2 gene variants identifies ovarian cancers at an earlier stage, and reduces the need for expensive cancer therapies.

For women with BRCA1 or 2 variants the risk of ovarian, breast and fallopian tube cancer is significantly elevated. It is thought up to 18 percent of women with ovarian cancer carry a BRCA 1 or 2 variant. The only recommended risk-reduction method is removal of both the ovaries and fallopian tubes by 35 or 40 respectively. However, a new surveillance tool for women who chose to not undergo this surgery, called the Risk of Ovarian Cancer Algorithm (ROCA) test, has been shown to help detect ovarian cancer at an earlier stage in a cohort of NHS patients by researchers at University College London (UCL) and London School of Economics.

Dr Adam Rosenthal, lead author of the study from UCL's EGA Institute for Women's Health said: 'Whilst we continue to recommend that all BRCA-carriers should undergo risk-reducing surgery when they feel able to do so, these encouraging results indicate that surveillance is a better option than waiting for symptoms to prompt diagnosis in those women who choose to defer surgery.'

Blood tests for a tumour biomarker were carried out every four months in the cohort of 767 women in this study, aged between 35-85 years old. The ROCA test analysed this alongside age, menopausal status and familial risk to triage the women into four categories. Depending on the category the women then either continued screening every four months, had their test repeated, were moved to screening every six months, which might also include an ultrasound, or for those deemed most at risk they were given an urgent gynaecology referral as well as an ultrasound.

ROCA screening identified 19 patients who then underwent surgery, 11 of whom had their ovaries or fallopian tubes removed and six who had developed ovarian or fallopian tube cancer. Two of the cancers were identified very early (stage 1a), while another three were identified as stage 3a. Of these six cancers identified, five were completely reduced by surgery to remove visible tumours.

Screening with the ROCA tool was found to increase the quality-adjusted life years of patients by just over two months. Analysis carried out by researchers from the London School of Economics and published in the paper in the journal Cancer Genetics showed the NHS could save money by adopting the surveillance tool, as earlier detection of cancers resulted in treatment cost savings of over £100,000 for each woman diagnosed with ovarian cancer compared to those who are not monitored. The ROCA test is not currently available on the NHS and costs £150.