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Utility of symptom index in women at increased risk for ovarian cancer
ABSTRACTS / Gynecologic Oncology 120 (2011) S2–S133
simple frequencies and Fisher's exact test to evaluate occurrences of BRCA testing relative to surgery and association with surgical decisions. Results: The BRCA test was performed presurgery in 39% (90/228) and postsurgery in 61% (138/228) of this cohort. The majority of women, 68% (61/90), tested presurgery had a mastectomy compared with 38% (51/138) of women tested after surgery (P = 0.0001) (see table). Of those choosing mastectomy, 57% (35/61) of the presurgery tested woman had bilateral mastectomy as compared with 28% (15/ 53) of the women tested after surgery (P = 0.0024). Institutionspecific data showed that only 5% (11/228) of the cohort had an oophorectomy. Conclusions: Conducting BRCA mutation analysis prior to breast cancer surgery is associated with a more radical surgical approach. Unfortunately, more than half of patients with breast cancer did not have BRCA mutation information available for initial surgical planning. Data regarding oophorectomy rates in our study population were disappointing and point to a need for further education regarding ovarian cancer risk in survivors. Further research is needed to assess the feasibility and impact of genetic counseling and genetic testing within the preoperative workup for patients with breast cancer with familial/genetic risk.
S61
elevated CA-125, and 108 (18%) had a mass on TVUS, which met criteria for follow-up. TVUS was suspicious for malignancy in <1%. SI positivity did not differ among women with a positive CA-125 or with a mass on TVUS. However, women with a positive SI were less likely to have a benign ovarian lesion than those with a negative SI (8% vs 15%). The SI was significantly more likely to be positive in those older than 50 not using hormones compared with those using hormones (6% vs 1%). SI positivity did not vary by race, parity or risk category. SI positivity was significantly higher among women with a self-reported history of endometriosis (19% vs 4%), noncancerous cyst (9% vs 4%), or any ovarian condition (8% vs 4%), than among women who did not have these conditions. None of the screened patients developed ovarian cancer during the follow-up period. Conclusions: In this population of women at increased risk for ovarian cancer, the rate of SI positivity was identical to that of the general population. The SI did not overlap with CA-125 or benign masses on TVUS and may identify a different subset of women who require evaluation for ovarian cancer. Our results confirm the potential utility of a SI as part of a multimodal program that includes risk stratification.
doi:10.1016/j.ygyno.2010.12.147 Breast cancer patients' surgical decision: BRCA testin before versus after surgery Surgery
BRCA before
BRCA after
Total
Mastectomy Lumpectomy Total
61 29 90
53 85 138
114 114 228
doi:10.1016/j.ygyno.2010.12.146
140 Utility of symptom index in women at increased risk for ovarian cancer D. Singh1, K. Lowe2, C. Colllins1,3, L. Cohen1,3, J. Dungan1,3, L. Shulman1,3, M. Andersen4, B. Goff4 1 Northwestern University, Chicago, IL, 2Exponent Health Sciences, Bellevue, WA, 3Prentice Women's Hospital, Chicago, IL, 4University of Washington Medical Center, Seattle, WA Objective: Developing a screening test for a low-prevalence cancer like ovarian cancer remains a challenge, and multimodal approaches that combine risk stratification, symptom index (SI), serum studies and transvaginal ultrasound (TVUS) have been proposed. In previous studies approximately 4% of average-risk and 10% of high-risk women had a positive SI. Our purpose was to evaluate the results of a multimodality screening program in women at increased risk for ovarian cancer and describe test results in both those with positive SI and those with a negative SI. Women at elevated risk for ovarian cancer based on personal or family history were followed prospectively every six months with history, physical, SI, TVUS and serum studies. The women completed a detailed baseline questionnaire and underwent comprehensive genetics evaluation at initial visit, and information was updated at follow-up visits. Results: Between April 2009 and April 2010, a total of 569 women (mean age = 51 years, range: 20–84) participated. The majority (89%) were Caucasian and 33% were nulliparous. Women were at increased risk because of inherited predisposition (12%), first-degree relative with ovarian cancer (42%) or personal history of breast cancer (27%). Of the total population, 25 (4%) had a positive SI, 25 (4%) had
Poster Area 2 Breast, Ovarian Cancer, Fallopian Tube/Peritoneal Cancer, Quality of Life and Ovarian Clinical Trials: Abstracts 141–193 Sunday, March 6 – Tuesday, March 8, 2011 Exhibit Hall - Bonnet Creek Ballroom Breast Cancer 141 EZH2 expression in triple-negative breast carcinoma Z. Al-Wahab1, A. Munkarah1,2, S. Munns1, S. Seward1, A. Sood3, R. Morris1, R. Ali-Fehmi1 1 Wayne State University, Detroit, MI, 2Henry Ford Health System, Detroit, MI, 3University of Texas M.D. Anderson Cancer Center, Houston, TX
Objective: The polycomb group protein EZH2 is a transcriptional repressor involved in cell cycle regulation. It has been linked to aggressive breast cancer and is being evaluated as a possible therapeutic target. Triple-negative (TN: ER-, PR- and Her-2- negative) breast carcinomas have aggressive clinical behavior. In this study, we investigated the expression of EZH2 in TN compared with non-TN breast carcinomas. Tissue microarrays were constructed with 261 consecutive invasive breast carcinomas diagnosed at our institution over a three-year period with a median follow-up of 42 months. Immunohistochemistry for EZH2, CK5/6, EGFR and P53 was performed using standard procedures. EZH2 nuclear staining was scored based on intensity (0–3+) and was categorized into low and high expression. The results were correlated with clinicopathologic variables and patient outcome. Data were statistically analyzed using the χ2 or Fisher's exact test, and survival was calculated with the Kaplan–Meier method. Results: Among the 261 cases, 57 (21%) were categorized as TN, and 204 (79%) as non-TN. High expression of EZH2 was detected in 87 (33%) cases, and it was strongly associated with a TN phenotype (P < 0.0001) compared with all other non-TN tumors. High EZH2 was noted in 41 of 57 (72%) TN versus 46 of 204 (22%) non-TN tumors. Increased EZH2 expression also significantly correlated with younger age (mean age = 54 years, P = 0.008), higher grade (P = 0.04), and high P53 expression (P = 0.006). However, no correlation was
simple frequencies and Fisher's exact test to evaluate occurrences of BRCA testing relative to surgery and association with surgical decisions. Results: The BRCA test was performed presurgery in 39% (90/228) and postsurgery in 61% (138/228) of this cohort. The majority of women, 68% (61/90), tested presurgery had a mastectomy compared with 38% (51/138) of women tested after surgery (P = 0.0001) (see table). Of those choosing mastectomy, 57% (35/61) of the presurgery tested woman had bilateral mastectomy as compared with 28% (15/ 53) of the women tested after surgery (P = 0.0024). Institutionspecific data showed that only 5% (11/228) of the cohort had an oophorectomy. Conclusions: Conducting BRCA mutation analysis prior to breast cancer surgery is associated with a more radical surgical approach. Unfortunately, more than half of patients with breast cancer did not have BRCA mutation information available for initial surgical planning. Data regarding oophorectomy rates in our study population were disappointing and point to a need for further education regarding ovarian cancer risk in survivors. Further research is needed to assess the feasibility and impact of genetic counseling and genetic testing within the preoperative workup for patients with breast cancer with familial/genetic risk.
S61
elevated CA-125, and 108 (18%) had a mass on TVUS, which met criteria for follow-up. TVUS was suspicious for malignancy in <1%. SI positivity did not differ among women with a positive CA-125 or with a mass on TVUS. However, women with a positive SI were less likely to have a benign ovarian lesion than those with a negative SI (8% vs 15%). The SI was significantly more likely to be positive in those older than 50 not using hormones compared with those using hormones (6% vs 1%). SI positivity did not vary by race, parity or risk category. SI positivity was significantly higher among women with a self-reported history of endometriosis (19% vs 4%), noncancerous cyst (9% vs 4%), or any ovarian condition (8% vs 4%), than among women who did not have these conditions. None of the screened patients developed ovarian cancer during the follow-up period. Conclusions: In this population of women at increased risk for ovarian cancer, the rate of SI positivity was identical to that of the general population. The SI did not overlap with CA-125 or benign masses on TVUS and may identify a different subset of women who require evaluation for ovarian cancer. Our results confirm the potential utility of a SI as part of a multimodal program that includes risk stratification.
doi:10.1016/j.ygyno.2010.12.147 Breast cancer patients' surgical decision: BRCA testin before versus after surgery Surgery
BRCA before
BRCA after
Total
Mastectomy Lumpectomy Total
61 29 90
53 85 138
114 114 228
doi:10.1016/j.ygyno.2010.12.146
140 Utility of symptom index in women at increased risk for ovarian cancer D. Singh1, K. Lowe2, C. Colllins1,3, L. Cohen1,3, J. Dungan1,3, L. Shulman1,3, M. Andersen4, B. Goff4 1 Northwestern University, Chicago, IL, 2Exponent Health Sciences, Bellevue, WA, 3Prentice Women's Hospital, Chicago, IL, 4University of Washington Medical Center, Seattle, WA Objective: Developing a screening test for a low-prevalence cancer like ovarian cancer remains a challenge, and multimodal approaches that combine risk stratification, symptom index (SI), serum studies and transvaginal ultrasound (TVUS) have been proposed. In previous studies approximately 4% of average-risk and 10% of high-risk women had a positive SI. Our purpose was to evaluate the results of a multimodality screening program in women at increased risk for ovarian cancer and describe test results in both those with positive SI and those with a negative SI. Women at elevated risk for ovarian cancer based on personal or family history were followed prospectively every six months with history, physical, SI, TVUS and serum studies. The women completed a detailed baseline questionnaire and underwent comprehensive genetics evaluation at initial visit, and information was updated at follow-up visits. Results: Between April 2009 and April 2010, a total of 569 women (mean age = 51 years, range: 20–84) participated. The majority (89%) were Caucasian and 33% were nulliparous. Women were at increased risk because of inherited predisposition (12%), first-degree relative with ovarian cancer (42%) or personal history of breast cancer (27%). Of the total population, 25 (4%) had a positive SI, 25 (4%) had
Poster Area 2 Breast, Ovarian Cancer, Fallopian Tube/Peritoneal Cancer, Quality of Life and Ovarian Clinical Trials: Abstracts 141–193 Sunday, March 6 – Tuesday, March 8, 2011 Exhibit Hall - Bonnet Creek Ballroom Breast Cancer 141 EZH2 expression in triple-negative breast carcinoma Z. Al-Wahab1, A. Munkarah1,2, S. Munns1, S. Seward1, A. Sood3, R. Morris1, R. Ali-Fehmi1 1 Wayne State University, Detroit, MI, 2Henry Ford Health System, Detroit, MI, 3University of Texas M.D. Anderson Cancer Center, Houston, TX
Objective: The polycomb group protein EZH2 is a transcriptional repressor involved in cell cycle regulation. It has been linked to aggressive breast cancer and is being evaluated as a possible therapeutic target. Triple-negative (TN: ER-, PR- and Her-2- negative) breast carcinomas have aggressive clinical behavior. In this study, we investigated the expression of EZH2 in TN compared with non-TN breast carcinomas. Tissue microarrays were constructed with 261 consecutive invasive breast carcinomas diagnosed at our institution over a three-year period with a median follow-up of 42 months. Immunohistochemistry for EZH2, CK5/6, EGFR and P53 was performed using standard procedures. EZH2 nuclear staining was scored based on intensity (0–3+) and was categorized into low and high expression. The results were correlated with clinicopathologic variables and patient outcome. Data were statistically analyzed using the χ2 or Fisher's exact test, and survival was calculated with the Kaplan–Meier method. Results: Among the 261 cases, 57 (21%) were categorized as TN, and 204 (79%) as non-TN. High expression of EZH2 was detected in 87 (33%) cases, and it was strongly associated with a TN phenotype (P < 0.0001) compared with all other non-TN tumors. High EZH2 was noted in 41 of 57 (72%) TN versus 46 of 204 (22%) non-TN tumors. Increased EZH2 expression also significantly correlated with younger age (mean age = 54 years, P = 0.008), higher grade (P = 0.04), and high P53 expression (P = 0.006). However, no correlation was