Question from Dianna Fry, Germany:
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"I’m trying to get to grips with a conundrum that has been puzzling me deeply for quite some time. I’d so appreciate other people’s views on this.

Back in October 2011, I heard a radio interview about breast screening and how confusing it all is for the women involved as they don’t know what to do for the best. Should they have mammographies done or not? I couldn’t help thinking ‘at least they have the choice about whether to go for screening!’

I was diagnosed with ovarian cancer in 2007, whereupon I had a hysterectomy and chemotherapy. I also took part in the ICON7 clinical trial for which I am truly grateful as it means that I still get my CA125 marker monitored every six months and the oncologist checks my belly. I also get a CT scan occasionally, which I gather would no longer be the case if I wasn’t in the trial.

I am currently spending some time in Germany and, as the only time I have actually seen a gynaecologist in the UK since my treatment in 2007 was for a quick check-up a few weeks after the operation, I decided to make an appointment with the gynaecologist here in Bavaria. Besides a smear she carried out an ultrasound of my lower end internally and said that it was a standard measure for women who have had ovarian cancer to come for this screening every six months. Apparently, this ulstrasound examination is absolutely harmless and picks up abnormalities even before a CT scan.

Now, I know that breast cancer is far more common than ovarian cancer, but I can’t help thinking that it might reassure ovarian cancer survivors in the UK to know they were getting a little more screening rather than waiting for the cancer to rear its ugly head again, by which time it will often be too late.

I am really puzzled why in one country ovarian cancer survivors undergo prophylactic screening every six months as a matter of course, while in the UK one is lucky if one ever sees a gynaecologist again after treatment.

When I put this question to my oncologist in the UK he replied that I was actually being monitored fairly closely because of taking part in the ICON7 trial, and that there was no evidence currently that more intensive follow-ups lead to a better outlook. And indeed the most recent evidence suggests that picking up a cancer recurrence early with a CA125 marker does not improve overall prognosis.

What makes this even more mystifying is that my German gynaecologist and GP actually agreed with this statement. So what to do for the best? How is it possible to make sure that any recurrence is detected as early as possible, without becoming completely paranoid about every abdominal pain? Come to think of it I am not even sure I know what to look out for in the event of a recurrence.”
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Reply from Professor Sean Kehoe:

“Doctors manage situations differently in different countries. The statement that ultrasound detects cancer earlier than CT is not based on evidence at all. The earliest way to detect recurrent disease is by CA125 – as it will rise months before any scan can detect the disease.

It seems logical that doing a CA125 and then treating on a rising level – even before symptoms and anything appears on a scan – would give best results. But a large randomised trial has shown that treating on a rising CA125 result has no better outcome than treating symptoms when they present or a tumour is detected. Indeed the quality of life was better in the latter group. Many argue about this study – as it seems wrong. It goes against logic, but there you are it’s the best evidence.

In the UK, we do follow up patients with examinations every three to four months for the first two years and then every six months to five years – with some having a regular CA125. Adding an ultrasound scan would be interesting and requires a proper study so that it’s justifiable and cost effective.”

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Professor Sean Kehoe, Institute of Cancer and Genomic Sciences, Lawson Tait Profesessor of Gynaecological Cancer

First published in the Ovacome spring newsletter 2012