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The trouble with ovarian cancer
Editorial
Science Photo Library
The trouble with ovarian cancer
See Comment page 1303 See Articles page 1331 See Seminar page 1371 See Editorial Lancet 2007; 369: 2051
Ovarian cancer remains one of the most difficult cancers to diagnose early and therefore increase the chances of disease-free survival. As Bryan Hennessy and colleagues point out in a Seminar in The Lancet today, 75% of patients present with advanced disease (stage III or IV) and almost all have tumour recurrence despite treatment. In patients with advanced disease, the challenge is to achieve extended survival by carefully balancing aggressive treatment with a tolerable toxicity and sideeffect profile. In a research paper, Noriyuki Katsumata and colleagues show an extension of progression-free survival by a median of 10·8 months in women with a dose-dense weekly regimen of chemotherapy. Extending life, even by a few months, is important. The real challenge, however, remains with screening and early diagnosis. When diagnosed in stage I, more than 90% of patients have longer than 10 years of disease-free survival. Symptoms are non-specific, such as abdominal bloating, loss of appetite, and dysuria. Screening with a combination of serum cancer antigen 125 and transvaginal ultrasonography is recommended in women at high risk, such as carriers of the BRCA1
mutation. General screening in postmenopausal women is currently being assessed in the UK Collaborative Trial of Ovarian Cancer Screening due to end in 2011. Early diagnosis also depends on women with continuing non-specific symptoms seeking medical advice. However, the findings of a survey, presented at the National Cancer Conference in Birmingham, UK, on Oct 7, suggest that UK patients with cancer-related symptoms are particularly reticent in visiting their doctors. 37% of about 2200 people surveyed said that they would put off seeing their general practitioner because they do not want to bother the doctor, are worried what they might learn, or are too busy. This behaviour might explain the persistent gap of 5–8% in 5-year survival from ovarian cancer between the UK and the European average. In 2007, the American Cancer Society and other US organisations released a consensus statement on the symptoms of ovarian cancer and encouraged women to seek medical attention. The UK urgently needs to address the real and perceived barriers for women to seek medical advice. Major progress in ovarian cancer will only be made when the disease is diagnosed early. ■ The Lancet
Photolibrary
New ideas in organ donation
See World Report page 1315 For The Organ Donation Taskforce implementation programme’s Annual Report, 2008/09 see http://www. dh.gov.uk/prod_consum_dh/ groups/dh_digitalassets/ documents/digitalasset/dh_ 106618.pdf For more on Organ Donation in China see Editorial Lancet 2009; 374: 758
1302
“Transplants can transform the quality of people’s lives, but are currently limited by the availability of organs” proclaims a report published last week by the UK Government about the first year of the country’s Organ Donation Taskforce implementation programme. Over 16 million people have demonstrated their agreement by signing the NHS Organ Donor Register. But nearly 10 000 people in the UK are still waiting for a life-saving organ transplant—a queue that is lengthening by about 8% a year—and 1000 people die every year waiting for organs. The increasing incidence of kidney failure, particularly in people aged over 50 years and ethnic minorities, is a key underlying factor. One argument is that paying donors, as in the USA, could eliminate organ trafficking. Yet over 100 000 people in the USA are waiting for an organ, about 80 000 of whom need a kidney. Indeed, payment for organs has had mixed results in Europe. Spain has the highest organ donation rate in Europe, and last year implementation of
the Spanish model, which includes presumed consent for posthumous organ donation, led to an immediate rise in organ donation in Italy, although Sweden saw hardly any increase. The UK has decided not to introduce presumed consent for prospective organ donors, and plans to focus instead on recruiting additional donor transplant coordinators and 24 h organ retrieval teams—factors that might explain Spain’s success. Living organ donors now provide for nearly 1000 transplant recipients a year, with both donors and transplants up by 12% on 2007–08. The UK Government hopes that 1400 additional lives can be saved every year through organ donation, and aims for 20 million people on the organ donor register in 2010, and 25 million by 2013. £16·5 million has been invested to implement the taskforce’s recommendations, with a further £26·5 million promised in 2009–10. Careful scrutiny is needed to ensure that these welcome investments lead to fewer deaths of people waiting for transplants. ■ The Lancet www.thelancet.com Vol 374 October 17, 2009
Science Photo Library
The trouble with ovarian cancer
See Comment page 1303 See Articles page 1331 See Seminar page 1371 See Editorial Lancet 2007; 369: 2051
Ovarian cancer remains one of the most difficult cancers to diagnose early and therefore increase the chances of disease-free survival. As Bryan Hennessy and colleagues point out in a Seminar in The Lancet today, 75% of patients present with advanced disease (stage III or IV) and almost all have tumour recurrence despite treatment. In patients with advanced disease, the challenge is to achieve extended survival by carefully balancing aggressive treatment with a tolerable toxicity and sideeffect profile. In a research paper, Noriyuki Katsumata and colleagues show an extension of progression-free survival by a median of 10·8 months in women with a dose-dense weekly regimen of chemotherapy. Extending life, even by a few months, is important. The real challenge, however, remains with screening and early diagnosis. When diagnosed in stage I, more than 90% of patients have longer than 10 years of disease-free survival. Symptoms are non-specific, such as abdominal bloating, loss of appetite, and dysuria. Screening with a combination of serum cancer antigen 125 and transvaginal ultrasonography is recommended in women at high risk, such as carriers of the BRCA1
mutation. General screening in postmenopausal women is currently being assessed in the UK Collaborative Trial of Ovarian Cancer Screening due to end in 2011. Early diagnosis also depends on women with continuing non-specific symptoms seeking medical advice. However, the findings of a survey, presented at the National Cancer Conference in Birmingham, UK, on Oct 7, suggest that UK patients with cancer-related symptoms are particularly reticent in visiting their doctors. 37% of about 2200 people surveyed said that they would put off seeing their general practitioner because they do not want to bother the doctor, are worried what they might learn, or are too busy. This behaviour might explain the persistent gap of 5–8% in 5-year survival from ovarian cancer between the UK and the European average. In 2007, the American Cancer Society and other US organisations released a consensus statement on the symptoms of ovarian cancer and encouraged women to seek medical attention. The UK urgently needs to address the real and perceived barriers for women to seek medical advice. Major progress in ovarian cancer will only be made when the disease is diagnosed early. ■ The Lancet
Photolibrary
New ideas in organ donation
See World Report page 1315 For The Organ Donation Taskforce implementation programme’s Annual Report, 2008/09 see http://www. dh.gov.uk/prod_consum_dh/ groups/dh_digitalassets/ documents/digitalasset/dh_ 106618.pdf For more on Organ Donation in China see Editorial Lancet 2009; 374: 758
1302
“Transplants can transform the quality of people’s lives, but are currently limited by the availability of organs” proclaims a report published last week by the UK Government about the first year of the country’s Organ Donation Taskforce implementation programme. Over 16 million people have demonstrated their agreement by signing the NHS Organ Donor Register. But nearly 10 000 people in the UK are still waiting for a life-saving organ transplant—a queue that is lengthening by about 8% a year—and 1000 people die every year waiting for organs. The increasing incidence of kidney failure, particularly in people aged over 50 years and ethnic minorities, is a key underlying factor. One argument is that paying donors, as in the USA, could eliminate organ trafficking. Yet over 100 000 people in the USA are waiting for an organ, about 80 000 of whom need a kidney. Indeed, payment for organs has had mixed results in Europe. Spain has the highest organ donation rate in Europe, and last year implementation of
the Spanish model, which includes presumed consent for posthumous organ donation, led to an immediate rise in organ donation in Italy, although Sweden saw hardly any increase. The UK has decided not to introduce presumed consent for prospective organ donors, and plans to focus instead on recruiting additional donor transplant coordinators and 24 h organ retrieval teams—factors that might explain Spain’s success. Living organ donors now provide for nearly 1000 transplant recipients a year, with both donors and transplants up by 12% on 2007–08. The UK Government hopes that 1400 additional lives can be saved every year through organ donation, and aims for 20 million people on the organ donor register in 2010, and 25 million by 2013. £16·5 million has been invested to implement the taskforce’s recommendations, with a further £26·5 million promised in 2009–10. Careful scrutiny is needed to ensure that these welcome investments lead to fewer deaths of people waiting for transplants. ■ The Lancet www.thelancet.com Vol 374 October 17, 2009