Professor Adam Rosenthal

Ovarian cancer surveillance for BRCA1 and BRCA2 gene alteration carriers

Thanks to Victoria Macdonald and the superb Channel 4 News team for running a story about the introduction of ovarian cancer surveillance for BRCA-carriers at UCLH. This service marks the culmination of over 2 decades of efforts by an extra-ordinary team. It took a clinical trial of over 5000 volunteers at 42 UK hospitals (UKFOCSS), a NHS implementation program of over 800 BRCA-carriers at 12 UK centres (ALDO), a NICE guideline, funding from CRUK, The EveAppeal, NHS and North Central London CancerAlliance, but finally we are here. To be clear, risk-reducing bilateral salpingo-oophorectomy remains the recommended option for women at high risk of ovarian cancer. But many choose to defer the surgery to have children or avoid premature surgical menopause. For these women, 4-monthly Risk of Ovarian Cancer Algorithm (ROCA) blood tests provide the only method consistently shown (across 3 separate trials) to diagnose pre-symptomatic ovarian cancer, approximately halving the risk of diagnosis with stage 3 and 4 disease, compared to women no longer on surveillance. Over 9 in 10 women diagnosed via ROCA testing had no visible disease remaining after up-front surgery (a key prognostic indicator) and given the earlier stages diagnosed, the surgical complexity required to achieve this was relatively modest, reducing patient morbidity. Of course, surveillance can’t prevent ovarian cancer, so should not be used as a reason to put off having potentially life-saving risk-reducing surgery. However, until patients feel ready to take that major step, we can now offer them the chance of earlier diagnosis. I’m happy to report that another major NHS Trust is currently in the set-up phase for offering surveillance, and we hope others follow soon, so we can avoid a post-code lottery.