What CDC Is Doing About Ovarian Cancer

Based on workshops in 2001 and 2002, CDC developed research and public health initiatives for ovarian cancer. In 2008, CDC convened a workshop of experts to comment on CDC's work to date and to help expand the research agenda for the future. CDC enhances the growing knowledge about ovarian cancer by initiating research projects with partners, colleagues, and national organizations to help identify factors related to early detection of the disease, treatment, and survivorship.

Accomplishments

Studies

• To investigate end-of-life care, CDC completed a study of women who died of ovarian cancer within three managed care organizations. The objective of this study was to describe end-of-life care and factors that may be associated with care for these women. The study consisted of a retrospective medical record review for the 6 months before death from ovarian cancer between 1995 and 2000. Research goals included assessment of—
  • Clinical signs and symptoms during the last 6 months of life and management of these symptoms.
  • Where the women lived during this time period.
  • What type of medical care was used.
  Results from this study have contributed to the understanding of end-of-life care for women dying of ovarian cancer, including pain management, health care utilization, social support, and hospice use.
• To enhance knowledge about ovarian cancer incidence, staging, and treatment patterns and to assess the status of cancer care for ovarian cancer patients, the Ovarian Cancer Treatment Patterns and Outcomes study was funded. It was conducted with data collected through the National Program of Cancer Registries (NPCR), a cancer surveillance program administered by CDC's Division of Cancer Prevention and Control (DCPC). Three population-based NPCR registries (in Maryland, New York, and California) collected demographic, tumor, treatment, and survival information on ovarian cancer patients diagnosed between 1997 and 2000. The study attempted to determine—
  • What surgical staging and debulking (removal of tumor) was conducted.
  • The specialty of the surgeon performing the procedure.
  • The success of the debulking process.
  In addition, types of chemotherapy and radiation treatments were evaluated, and survival at 1 and 3 years post-diagnosis was assessed. The study collected information on more than 4,000 ovarian cancer patients and provided valuable information for the public health, scientific, and clinical communities on the status of ovarian cancer care.

Research Articles

CDC has published articles disseminated for the public, health professionals, and researchers. For a complete list of citations, see Cancer Research.

National Gynecologic Cancer Awareness Campaign

In collaboration with the Department of Health and Human Services' Office on Women's Health, CDC established the Inside Knowledge: Get the Facts About Gynecologic Cancer campaign to increase awareness and knowledge among women and health care providers about the five major gynecologic cancers: cervical, ovarian, uterine, vaginal, and vulvar. This national campaign is supported by the Gynecologic Cancer Education and Awareness Act of 2005, or Johanna's Law, which was unanimously passed by the U.S. House and Senate (109th Congress) in December of 2006, and signed into law by President George W. Bush on January 12, 2007.

National Program of Cancer Registries

CDC's National Program of Cancer Registries (NPCR) collects surveillance data for all cancers, including ovarian and other gynecologic cancers. Data collected through the NPCR often are used by states to create burden assessments that guide program planning, outreach, and education efforts.

Ongoing Work

CDC's ongoing studies related to ovarian cancer include—

• Risk perception, worry, and use of ovarian cancer screening among women at average, elevated, and high risk of ovarian cancer. To examine the determinants of perceived risk and the influence of these determinants on screening behaviors, CDC is conducting a study of approximately 2,500 women at average-, elevated-, and high-risk, who will be selected randomly from enrollees in a managed care organization with a racially diverse population.
• Clinical practice in the follow-up of ovarian masses. This study will investigate the symptoms and presentation of women with adnexal masses, the radiologic characteristics of these masses, and how these factors influence how women are clinically evaluated and managed to reach a diagnosis.
• General practitioners' awareness and adherence to ovarian cancer screening guidelines. This study aims to evaluate physicians' self-reported ovarian cancer screening and testing practices and determine physician awareness of the published guidelines regarding the lack of evidence for routine ovarian cancer screening among a nationally representative sample of practicing primary care physicians and gynecologists.
• Frequency of symptoms in women aged 65 years and older with ovarian cancer as compared to a matched cohort of cancer-free women. Symptoms which have been identified previously among ovarian cancer patients have been considered non-specific. This analysis will allow a comparison of the frequencies of such symptoms in ovarian cancer cases when compared to the general population of women in the same age group.
• Physician specialty and symptoms from Medicare claims data prior to ovarian cancer. This study is investigating whether women with certain symptoms prior to ovarian cancer are more likely to see particular physician specialties and whether this is related to stage at diagnosis and time to imaging and diagnosis. Because the impact of specialty training on the earlier evaluation or diagnosis of ovarian cancer symptoms is unclear, CDC is assessing whether women with specific symptoms are diagnosed earlier because they have certain symptoms, or because they are more likely to see particular specialists.
• Relationship between recorded symptoms, time to diagnosis, and ovarian cancer histology. The purpose of this analysis is to explore whether previous findings regarding the prevalence, type, and duration of symptoms among women with early-stage disease holds true for all histological types. Since five-year relative survival and stage of diagnosis vary by histological type of ovarian cancer, investigating the relationship between specific ovarian cancer histology, reported symptoms, and time to diagnosis will provide information about the potential benefits of earlier detection through better recognition and follow-up of symptoms.
• Availability of gynecologic oncologists for ovarian cancer care. This study was started in 2009 to examine geographic access to subspecialists for treating ovarian cancer. The study will assess the geographic relationship between ovarian cancer incidence, mortality, and practicing gynecologic oncologists. It also will examine referral patterns to gynecologic oncologists and determine the effect of gynecologic oncologist treatment on survival for ovarian cancer.
• Ovarian cancer treatment patterns and outcomes (OCTPO). This study is a retrospective cohort study carried out in collaboration with CDC's National Program of Cancer Registries. The study examines staging, surgery, adjuvant therapy, and survival of women diagnosed with ovarian cancer, as well as the specialty of their treating physician. Data for the study were collected from about 3,000 patients with ovarian cancer diagnosed from 1998 through 2000. Analyses probe the factors associated with receipt of standard care for ovarian cancer, with outcomes of epithelial ovarian cancer, with the extent of surgical staging of ovarian cancer patients, and with histology-specific patterns of ovarian cancer presentation and survival.
• Inside Knowledge analyses. DCPC purchased questions on two national surveys (one of the general public, the other of physicians) to help develop campaign messages and materials and to provide baseline data prior to the release of mass media materials. Topics include knowledge of gynecologic cancers, knowledge of screening tests, care-seeking for symptoms associated with gynecologic cancer, and physician beliefs regarding screening and testing for gynecologic cancers. Analyses of these data are ongoing.

Additionally, through its National Comprehensive Cancer Control Program (NCCCP), CDC funds ovarian cancer-related projects in several states. These projects are working to develop ovarian cancer health messages for the general public and for health care providers.