Grant: Operating Grant

Ovarian cancer is the 5th most common cause of death from cancer in Canadian women. The high death rate is largely due to late diagnosis. Studies have shown that the majority of women with ovarian cancer experience symptoms before diagnosis, but these symptoms are vague. Several influential organizations have recommend testing of women experiencing these symptoms, in the hope of increasing the proportion of women diagnosed in Stage I, when the tumor is still confined to the ovary. However, there was no evidence that testing symptomatic women would achieve early stage diagnosis. The DOvE (Diagnosing Ovarian Cancer Early) project was started with the primary aim of evaluating whether providing fast-track evaluation to symptomatic women 50 years or older would result in a higher proportion diagnosed in Stage I. In the pilot phase, we evaluated 1455 symptomatic Montreal women with a blood test and transvaginal ultrasound. We found 10 times more invasive cancers in symptomatic women than expected. The tumor-volume was smaller and more amenable to complete removal, which substantially improves survival. Our results also showed that high-grade serous cancer (HGSC), the type responsible for 90% of deaths from ovarian cancer, often does not start in the ovary, but in the fallopian tube and spreads to the pelvis and abdomen even before it gets on the ovary. So, it would appear that until now we have been concentrating on the wrong place - the ovary. In the next phase of the study we intend to offer the DOvE service in 12 satellite clinics in Montreal sited in areas with a dense proportion of older women, who are more at risk of HGSC. This strategy will allow us to evaluate about 14000 symptomatic women in the highest risk-group and diagnose approximately 100 cancers early enough for the women to benefit from complete surgery. We will also develop predictive models to identify the women at the highest risk so that such a service can be offered all over Canada and the world.