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2. Ovarian cancer population screening and mortality after long-term follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial

Author

Menon, Usha, Gentry-Maharaj, Aleksandra, Burnell, Matthew, Singh, Naveena, Ryan, Andy, Karpinskyj, Chloe, Carlino, Giulia, Taylor, Julie, Massingham, Susan K, Raikou, Maria, Kalsi, Jatinderpal K, Woolas, Robert, Manchanda, Ranjit, Arora, Rupali, Casey, Laura, Dawnay, Anne, Dobbs, Stephen, Leeson, Simon, Mould, Tim, Seif, Mourad W, Sharma, Aarti, Williamson, Karin, Liu, Yiling, Fallowfield, Lesley, McGuire, Alistair J, Campbell, Stuart, Skates, Steven J, Jacobs, Ian J, and Parmar, Mahesh

Published
2021
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3. The Manchester International Consensus Group recommendations for the management of gynecological cancers in Lynch syndrome

Author

Crosbie, Emma J., Ryan, Neil A.J., Arends, Mark J., Bosse, Tjalling, Burn, John, Cornes, Joanna M., Crawford, Robin, Eccles, Diana, Frayling, Ian M., Ghaem-Maghami, Sadaf, Hampel, Heather, Kauff, Noah D., Kitchener, Henry C., Kitson, Sarah J., Manchanda, Ranjit, McMahon, Raymond F.T., Monahan, Kevin J., Menon, Usha, Møller, Pål, Möslein, Gabriela, Rosenthal, Adam, Sasieni, Peter, Seif, Mourad W., Singh, Naveena, Skarrott, Pauline, Snowsill, Tristan M., Steele, Robert, Tischkowitz, Marc, Sanchez, Angel Alonso, Bolton, James, Church, David, Donnelly, Karen, Edmondson, Richard J., Evans, D. Gareth, Gollop, Paula, Goodman, Selina, Hodgson, Shirley, Lalloo, Fiona, Lowry, Anne, McVey, Rhona J., Miles, Tracie, Moeslein, Gabriela, Moller, Pal, Stormoken, Astrid, Stringfellow, Helen, Wallace, Andrew, Whyte, Luciya, Wilkinson, Nafisa, Wilson, Godfrey, Wilson, Jo, and Wood, Nick

Published
2019
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4. List of contributors

Author

Anderson, Richard A., primary, Arya, Roopen, additional, Bano, Rashda, additional, Benedetto, Chiara, additional, Bitzer, Johannes, additional, Borella, Fulvio, additional, Brito-Mutunayagam, Savita, additional, Bumbuliene, Zana, additional, Busby, Gail, additional, Cain, Joanna M., additional, Cameron, Sharon, additional, Canuto, Emilie Marion, additional, Caretto, Marta, additional, Chervenak, Frank A., additional, Chervenak, Joseph, additional, Condous, George, additional, Cooper, Michelle, additional, Critchley, Hilary O.D., additional, Czuprynska, Julia, additional, Dafopoulos, Konstantinos, additional, Damodaran, Sujeetha, additional, da Silva, Sarah Martins, additional, Doumouchtsis, Stergios K., additional, Duncan, W. Colin, additional, Gajjar, Ketankumar B., additional, Genazzani, Andrea R., additional, George, Jyothis, additional, Giannini, Andrea, additional, González-Mesa, Ernesto, additional, Hamilton, Mark, additional, Horne, Andrew W., additional, Ind, Thomas, additional, Jordan, Clare F., additional, Jurga-Karwacka, Agnieszka, additional, Kaur, Manou Manpreet, additional, Kay, Vanessa, additional, Kini, Suresh, additional, Lal, Mira, additional, Leonardi, Mathew, additional, Lim, Chu, additional, Lui, Man-wa, additional, Maheshwari, Abha, additional, Mahmood, Tahir A., additional, McCullough, Laurence B., additional, Messini, Christina I., additional, Messinis, Ioannis E., additional, Metwally, Mostafa, additional, Narice, Brenda F, additional, Okolo, Isioma, additional, Paduch, Darius A., additional, Pearson, Andrew C., additional, Pergialiotis, Vasilios, additional, Ramalingam, Mythili, additional, Reavey, Jane J., additional, Reynolds, Rebecca M., additional, Sarhadi, Abhilash H.L., additional, Seif, Mourad W., additional, Shafi, Mahmood I., additional, Simoncini, Tommaso, additional, Swaminathan, Krishnan, additional, Talaulikar, Vikram, additional, Tan, I-Ferne, additional, Tincello, Douglas G., additional, Tridenti, Gabriele, additional, Vanza, Kiran, additional, Vatopoulou, Anastasia, additional, and Vaucher, Laurent, additional

Published
2020
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6. Ovarian cancer screening and mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial

Author

Jacobs, Ian J, Menon, Usha, Ryan, Andy, Gentry-Maharaj, Aleksandra, Burnell, Matthew, Kalsi, Jatinderpal K, Amso, Nazar N, Apostolidou, Sophia, Benjamin, Elizabeth, Cruickshank, Derek, Crump, Danielle N, Davies, Susan K, Dawnay, Anne, Dobbs, Stephen, Fletcher, Gwendolen, Ford, Jeremy, Godfrey, Keith, Gunu, Richard, Habib, Mariam, Hallett, Rachel, Herod, Jonathan, Jenkins, Howard, Karpinskyj, Chloe, Leeson, Simon, Lewis, Sara J, Liston, William R, Lopes, Alberto, Mould, Tim, Murdoch, John, Oram, David, Rabideau, Dustin J, Reynolds, Karina, Scott, Ian, Seif, Mourad W, Sharma, Aarti, Singh, Naveena, Taylor, Julie, Warburton, Fiona, Widschwendter, Martin, Williamson, Karin, Woolas, Robert, Fallowfield, Lesley, McGuire, Alistair J, Campbell, Stuart, Parmar, Mahesh, and Skates, Steven J

Published
2016
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12. Recruitment to Multicentre Trials: Lessons from UKCTOCS: Descriptive Study

Author

Menon, Usha, Gentry-Maharaj, Aleksandra, Ryan, Andy, Sharma, Aarti, Burnell, Matthew, Hallett, Rachel, Lewis, Sara, Lopez, Alberto, Godfrey, Keith, Oram, David, Herod, Jonathan, Williamson, Karin, Seif, Mourad, Scott, Ian, Mould, Tim, Woolas, Robert, Murdoch, John, Dobbs, Stephen, Amso, Nazar, Leeson, Simon, Cruickshank, Derek, McGuire, Ali, Campbell, Stuart, Fallowfield, Lesley, Skates, Steve, Parmar, Mahesh, and Jacobs, Ian

Published
2008
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13. Sensitivity of transvaginal ultrasound screening for endometrial cancer in postmenopausal women: a case-control study within the UKCTOCS cohort

Author

Jacobs, Ian, Gentry-Maharaj, Aleksandra, Burnell, Matthew, Manchanda, Ranjit, Singh, Naveena, Sharma, Aarti, Ryan, Andy, Seif, Mourad W, Amso, Nazar N, Turner, Gillian, Brunell, Carol, Fletcher, Gwendolen, Rangar, Rani, Ford, Kathy, Godfrey, Keith, Lopes, Alberto, Oram, David, Herod, Jonathan, Williamson, Karin, Scott, Ian, Jenkins, Howard, Mould, Tim, Woolas, Robert, Murdoch, John, Dobbs, Stephen, Leeson, Simon, Cruickshank, Derek, Skates, Steven J, Fallowfield, Lesley, Parmar, Mahesh, Campbell, Stuart, and Menon, Usha

Published
2011
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16. Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

Author

Menon, Usha, Gentry-Maharaj, Aleksandra, Hallett, Rachel, Ryan, Andy, Burnell, Matthew, Sharma, Aarti, Lewis, Sara, Davies, Susan, Philpott, Susan, Lopes, Alberto, Godfrey, Keith, Oram, David, Herod, Jonathan, Williamson, Karin, Seif, Mourad W, Scott, Ian, Mould, Tim, Woolas, Robert, Murdoch, John, Dobbs, Stephen, Amso, Nazar N, Leeson, Simon, Cruickshank, Derek, Mcguire, Alistair, Campbell, Stuart, Fallowfield, Lesley, Singh, Naveena, Dawnay, Anne, Skates, Steven J, Parmar, Mahesh, and Jacobs, Ian

Published
2009
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19. Ovarian Cancer Population Screening and Mortality After Long-Term Follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): A Randomised Controlled Trial

Author

Menon, Usha, primary, Gentry-Maharaj, Aleksandra, additional, Burnell, Matthew, additional, Singh, Naveena, additional, Ryan, Andy, additional, Karpinskyj, Chloe, additional, Carlino, Giulia, additional, Taylor, Julie, additional, Massingham, Susan K., additional, Raikou, Maria, additional, Kalsi, Jatinderpal K., additional, Woolas, Robert, additional, Manchanda, Ranjit, additional, Arora, Rupali, additional, Casey, Laura, additional, Dawnay, Anne, additional, Dobbs, Stephen, additional, Leeson, Simon, additional, Mould, Tim, additional, Seif, Mourad W., additional, Sharma, Aarti, additional, Williamson, Karin, additional, Liu, Yiling, additional, Fallowfield, Lesley, additional, McGuire, Alistair J., additional, Campbell, Stuart, additional, Skates, Steven J., additional, Jacobs, Ian J., additional, and Parmar, Mahesh, additional

Published
2021
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22. Performance Characteristics of the Ultrasound Strategy during Incidence Screening in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

Author

Kalsi, Jatinderpal, primary, Gentry-Maharaj, Aleksandra, additional, Ryan, Andy, additional, Singh, Naveena, additional, Burnell, Matthew, additional, Massingham, Susan, additional, Apostolidou, Sophia, additional, Sharma, Aarti, additional, Williamson, Karin, additional, Seif, Mourad, additional, Mould, Tim, additional, Woolas, Robert, additional, Dobbs, Stephen, additional, Leeson, Simon, additional, Fallowfield, Lesley, additional, Skates, Steven J., additional, Parmar, Mahesh, additional, Campbell, Stuart, additional, Jacobs, Ian, additional, McGuire, Alistair, additional, and Menon, Usha, additional

Published
2021
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24. Contributors

Author

Anderson, Annie S., primary, Anderson, Richard A., additional, Arulkumaran, Sabaratnam, additional, Balani, J., additional, Baldacchino, Alexander, additional, Beake, Sarah, additional, Bhandari, Harish Malappa, additional, Bhattacharya, Siladitya, additional, Bick, Debra, additional, Black, Mairead, additional, Bolyakov, Alexander, additional, Brito-Mutunayagam, Savita, additional, Broughton-Pipkin, Fiona, additional, Burden, Christy, additional, Busby, Gail, additional, Cameron, Sharon, additional, Chiswick, Carolyn, additional, Churchill, David, additional, Colin Duncan, W., additional, Craigie, Angela M., additional, Critchley, Hilary O.D., additional, Dafopoulos, Konstantinos, additional, Damodaran, Sujeetha, additional, Dan, Dilip, additional, Smith, Debbie M., additional, Demetrovics, Zsolt, additional, Denison, Fiona C., additional, Deonarine, Kavita, additional, Doshan, Anjum, additional, Draycott, Tim, additional, Edozien, Leroy C., additional, Edwards, Lindsay, additional, Ellison, Joanne, additional, Evans, Margaret J., additional, Forbes, Gemma, additional, George, J.T., additional, Gluckman, Peter D., additional, Gray, Cindy M., additional, Hamilton, Mark, additional, Hanson, Mark A., additional, Hasan, Adnan, additional, Haththotuwa, Rohana N., additional, Ho, Pak Chung, additional, Hornnes, Peter, additional, Huda, Shahzya S., additional, Hyer, Stephen, additional, Ioannis, Ioannidis, additional, Jefferys, Amanda, additional, Kay, Vanessa J., additional, Khan, Khalid S., additional, Kökönyei, Gyöngyi, additional, Konje, Justin C., additional, Lam, Karen Siu Ling, additional, Lauenborg, Jeannet, additional, Lavender, Tina, additional, Lee, Alistair, additional, Lee, Chin Peng, additional, Li, Hang Wun Raymond, additional, Lim, Boon H., additional, Lim, Chu, additional, Ma, R.C.W., additional, Maclaran, Kate, additional, Maheshwari, Abha, additional, Mahmood, Tahir, additional, Malarselvi, Mani, additional, Martins da Silva, Sarah, additional, McAuliffe, Fionnuala M., additional, McInnes, Rhona J., additional, McRobbie, Sarah, additional, Mehasseb, Mohamed K., additional, Messini, Christina I., additional, Messinis, Ioannis E., additional, Milne, Alistair, additional, Nelson, Scott M., additional, Paduch, Darius A., additional, Panay, Nick, additional, Pinelopi, Grigoropoulou, additional, Quenby, Siobhan, additional, Reynolds, Rebecca M., additional, Richens, Yana, additional, Seif, Mourad W., additional, Senarath, Upul, additional, Shafi, Mahmood I., additional, Shehata, Hassan, additional, Swaminathan, Krishnan, additional, Teelucksingh, Surujpal, additional, Thangaratinam, Shakila, additional, Thanoon, Omar, additional, Thomson, Andrew, additional, Tincello, Douglas G., additional, Urbán, Róbert, additional, Vaucher, Laurent, additional, Visser, Gerard H.A., additional, Vyas, Sanjay, additional, Wagner, M., additional, Walsh, Jennifer M., additional, Wijeyaratne, Chandrika N., additional, and Yogev, Yariv, additional

Published
2013
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26. Lynch syndrome for the gynaecologist

Author

Ryan, Neil AJ, primary, McMahon, Raymond FT, additional, Ramchander, Neal C, additional, Seif, Mourad W, additional, Evans, D Gareth, additional, and Crosbie, Emma J, additional

Published
2021
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29. The Manchester International Consensus Group recommendations for the management of gynecological cancers in Lynch syndrome

Author

Crosbie, Emma J, Ryan, Neil AJ, Arends, Mark J, Bosse, Tjalling, Burn, John, Cornes, Joanna M, Crawford, Robin, Eccles, Diana, Frayling, Ian M, Ghaem-Maghami, Sadaf, Hampel, Heather, Kauff, Noah D, Kitchener, Henry C, Kitson, Sarah J, Manchanda, Ranjit, McMahon, Raymond FT, Monahan, Kevin J, Menon, Usha, Møller, Pål, Möslein, Gabriela, Rosenthal, Adam, Sasieni, Peter, Seif, Mourad W, Singh, Naveena, Skarrott, Pauline, Snowsill, Tristan M, Steele, Robert, Tischkowitz, Marc, Manchester International Consensus Group, Evans, D Gareth, Crosbie, Emma J [0000-0003-0284-8630], Evans, D Gareth [0000-0002-8482-5784], and Apollo - University of Cambridge Repository

Subjects
Ovarian Neoplasms, congenital, hereditary, and neonatal diseases and abnormalities, Consensus, Genital Neoplasms, Female, screening, nutritional and metabolic diseases, Colorectal Neoplasms, Hereditary Nonpolyposis, Endometrial Neoplasms, Europe, Lynch syndrome, endometrial cancer, North America, surveillance, Humans, Mass Screening, Female, guidance, Early Detection of Cancer
Abstract

PURPOSE: There are no internationally agreed upon clinical guidelines as to which women with gynecological cancer would benefit from Lynch syndrome screening or how best to manage the risk of gynecological cancer in women with Lynch syndrome. The Manchester International Consensus Group was convened in April 2017 to address this unmet need. The aim of the Group was to develop clear and comprehensive clinical guidance regarding the management of the gynecological sequelae of Lynch syndrome based on existing evidence and expert opinion from medical professionals and patients. METHODS: Stakeholders from Europe and North America worked together over a two-day workshop to achieve consensus on best practice. RESULTS: Guidance was developed in four key areas: (1) whether women with gynecological cancer should be screened for Lynch syndrome and (2) how this should be done, (3) whether there was a role for gynecological surveillance in women at risk of Lynch syndrome, and (4) what preventive measures should be recommended for women with Lynch syndrome to reduce their risk of gynecological cancer. CONCLUSION: This document provides comprehensive clinical guidance that can be referenced by both patients and clinicians so that women with Lynch syndrome can expect and receive appropriate standards of care.

Published
2019

35. Impact on mortality and cancer incidence rates of using random invitation from population registers for recruitment to trials

Author

Woolas Robert, Mould Tim, Jenkins Howard, Williamson Karin, Herod Jonathan, Oram David, Godfrey Keith, Amso Nazar N, Seif Mourad W, Parmar Mahesh, Skates Steven, Kalsi Jatinderpal, Habib Mariam, Apostolidou Sophia, Ryan Andy, Gentry-Maharaj Aleksandra, Burnell Matthew, Murdoch John, Dobbs Stephen, Leeson Simon, Cruickshank Derek, Campbell Stuart, Fallowfield Lesley, Jacobs Ian, and Menon Usha

Subjects
Medicine (General), R5-920
Abstract

Abstract Background Participants in trials evaluating preventive interventions such as screening are on average healthier than the general population. To decrease this 'healthy volunteer effect' (HVE) women were randomly invited from population registers to participate in the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) and not allowed to self refer. This report assesses the extent of the HVE still prevalent in UKCTOCS and considers how certain shortfalls in mortality and incidence can be related to differences in socioeconomic status. Methods Between 2001 and 2005, 202 638 postmenopausal women joined the trial out of 1 243 312 women randomly invited from local health authority registers. The cohort was flagged for deaths and cancer registrations and mean follow up at censoring was 5.55 years for mortality, and 2.58 years for cancer incidence. Overall and cause-specific Standardised Mortality Ratios (SMRs) and Standardised Incidence Ratios (SIRs) were calculated based on national mortality (2005) and cancer incidence (2006) statistics. The Index of Multiple Deprivation (IMD 2007) was used to assess the link between socioeconomic status and mortality/cancer incidence, and differences between the invited and recruited populations. Results The SMR for all trial participants was 37%. By subgroup, the SMRs were higher for: younger age groups, extremes of BMI distribution and with each increasing year in trial. There was a clear trend between lower socioeconomic status and increased mortality but less pronounced with incidence. While the invited population had higher mean IMD scores (more deprived) than the national average, those who joined the trial were less deprived. Conclusions Recruitment to screening trials through invitation from population registers does not prevent a pronounced HVE on mortality. The impact on cancer incidence is much smaller. Similar shortfalls can be expected in other screening RCTs and it maybe prudent to use the various mortality and incidence rates presented as guides for calculating event rates and power in RCTs involving women. Trial Registration This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN22488978. Medical Research Council (grant no. G990102), Cancer Research UK (grant no. C1479/A2884) and Department of Health

Published
2011
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36. The cost-effectiveness of screening for ovarian cancer: results from the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

Author

Menion, Usha, McGuire, Alistair, Raikou, Maria, Ryan, Andy, Davies, Susan, Burnell, Matthew, Gentry-Maharaj, Aleksandra, Kalsi, Jatinderpal, Singh, Naveena, Amso, Nazar, Cruickshank, Derek, Dobbs, Stephen, Godfrey, Keith, Herod, Jonathan, Leeson, Simon, Mould, Tim, Murdoch, John, Oram, David, Scott, Ian, Seif, Mourad, Williamson, Karin, Woolas, Robert, Fallowfield, Lesley, Campbell, Stuart, Skates, Steven, Parmar, Mahesh, and Jacobs, Ian

Subjects
R853.C55, Cost-Benefit Analysis, ovarian cancer screening, R728, TVS, State Medicine, Endosonography, RC0254, CA125, RA0421 Public health. Hygiene. Preventive Medicine, Humans, cost-effectiveness, Early Detection of Cancer, health care economics and organizations, Aged, Ovarian Neoplasms, RC0254 Neoplasms. Tumors. Oncology (including Cancer), Membrane Proteins, Middle Aged, Markov Chains, United Kingdom, CA-125 Antigen, Vagina, Clinical Study, UKCTOCS, Female, Quality-Adjusted Life Years, randomised controlled trial, Algorithms
Abstract

Background: To assess the within trial cost-effectiveness of an NHS ovarian cancer screening (OCS) programme using data from UKCTOCS and extrapolate results based on average life expectancy.\ud \ud Methods: Within trial economic evaluation of no screening (C) versus either (1) an annual OCS programme using transvaginal ultrasound (USS) or (2) an annual ovarian cancer multimodal screening programme with serum CA125 interpreted using a risk algorithm (ROCA) and transvaginal ultrasound as a second line test (MMS), plus comparison of lifetime extrapolation of the no screening arm and the MMS programme using both a predictive and a Markov model.\ud \ud Results: Using a CA125-ROCA cost of £20, the within trial results show USS to be strictly dominated by MMS, with the MMS versus C comparison returning an Incremental Cost-Effectiveness ratio (ICER) of £91,452 per life year gained (LYG). If the CA125-ROCA unit cost is reduced to £15 the ICER becomes £77,818 per LYG. Predictive extrapolation over the expected lifetime of the UKCTOCS women returns an ICER of £30,033 per LYG, while Markov modelling produces an ICER of £46,922 per QALY.\ud \ud Conclusions: Analysis suggests that, after accounting for the lead-time required to establish full mortality benefits, a national OCS programme based on the MMS strategy quickly approaches the current NICE thresholds for cost-effectiveness when extrapolated out to lifetime as compared to the within trial ICER estimates. Whether MMS could be recommended on economic grounds would depend on the confirmation and size of the mortality benefit at the end of an ongoing follow-up of the UKCTOCS cohort.

Published
2017

37. Audit of transvaginal sonography of normal postmenopausal ovaries by sonographers from the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

Author

Stott, Will, primary, Gentry-Maharaj, Aleksandra, additional, Ryan, Andy, additional, Amso, Nazar, additional, Seif, Mourad, additional, Jones, Chris, additional, Jacobs, Ian, additional, Parmar, Max, additional, Menon, Usha, additional, Campbell, Stuart, additional, and Burnell, Matthew, additional

Published
2018
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38. The cost-effectiveness of screening for ovarian cancer: results from the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

Author

Menon, Usha, primary, McGuire, Alistair J, additional, Raikou, Maria, additional, Ryan, Andy, additional, Davies, Susan K, additional, Burnell, Matthew, additional, Gentry-Maharaj, Aleksandra, additional, Kalsi, Jatinderpal K, additional, Singh, Naveena, additional, Amso, Nazar N, additional, Cruickshank, Derek, additional, Dobbs, Stephen, additional, Godfrey, Keith, additional, Herod, Jonathan, additional, Leeson, Simon, additional, Mould, Tim, additional, Murdoch, John, additional, Oram, David, additional, Scott, Ian, additional, Seif, Mourad W, additional, Williamson, Karin, additional, Woolas, Robert, additional, Fallowfield, Lesley, additional, Campbell, Stuart, additional, Skates, Steven J, additional, Parmar, Mahesh, additional, and Jacobs, Ian J, additional

Published
2017
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39. Risk Algorithm Using Serial Biomarker Measurements Doubles the Number of Screen-Detected Cancers Compared With a Single-Threshold Rule in the United Kingdom Collaborative Trial of Ovarian Cancer Screening

Author

Menon, Usha, Ryan, Andy, Kalsi, Jatinderpal, Gentry-Maharaj, Aleksandra, Dawnay, Anne, Habib, Mariam, Apostolidou, Sophia, Singh, Naveena, Benjamin, Elizabeth, Burnell, Matthew, Davies, Susan, Sharma, Aarti, Gunu, Richard, Godfrey, Keith, Lopes, Alberto, Oram, David, Herod, Jonathan, Williamson, Karin, Seif, Mourad W., Jenkins, Howard, Mould, Tim, Woolas, Robert, Murdoch, John B., Dobbs, Stephen, Amso, Nazar N., Leeson, Simon, Cruickshank, Derek, Scott, Ian, Fallowfield, Lesley, Widschwendter, Martin, Reynolds, Karina, McGuire, Alistair, Campbell, Stuart, Parmar, Mahesh, Skates, Steven J., and Jacobs, Ian

Subjects
Sensitivity and Specificity, RC0254, Gync21, Predictive Value of Tests, Risk Factors, RA0421 Public health. Hygiene. Preventive Medicine, Surveys and Questionnaires, Biomarkers, Tumor, Humans, Mass Screening, Oncology & Carcinogenesis, Early Detection of Cancer, Aged, Ovarian Neoplasms, Gynecologic Cancer, RC0254 Neoplasms. Tumors. Oncology (including Cancer), Great Britain, To2, ORIGINAL REPORTS, Middle Aged, Gync16, United Kingdom, Treatment Outcome, CA-125 Antigen, Female, sense organs, 1112 Oncology And Carcinogenesis, Algorithms, RC, Follow-Up Studies
Abstract

PURPOSE: Cancer screening strategies have commonly adopted single-biomarker thresholds to identify abnormality. We investigated the impact of serial biomarker change interpreted through a risk algorithm on cancer detection rates. \ud \ud PATIENTS AND METHODS: In the United Kingdom Collaborative Trial of Ovarian Cancer Screening, 46,237 women, age 50 years or older underwent incidence screening by using the multimodal strategy (MMS) in which annual serum cancer antigen 125 (CA-125) was interpreted with the risk of ovarian cancer algorithm (ROCA). Women were triaged by the ROCA: normal risk, returned to annual screening; intermediate risk, repeat CA-125; and elevated risk, repeat CA-125 and transvaginal ultrasound. Women with persistently increased risk were clinically evaluated. All participants were followed through national cancer and/or death registries. Performance characteristics of a single-threshold rule and the ROCA were compared by using receiver operating characteristic curves. \ud \ud RESULTS: After 296,911 women-years of annual incidence screening, 640 women underwent surgery. Of those, 133 had primary invasive epithelial ovarian or tubal cancers (iEOCs). In all, 22 interval iEOCs occurred within 1 year of screening, of which one was detected by ROCA but was managed conservatively after clinical assessment. The sensitivity and specificity of MMS for detection of iEOCs were 85.8% (95% CI, 79.3% to 90.9%) and 99.8% (95% CI, 99.8% to 99.8%), respectively, with 4.8 surgeries per iEOC. ROCA alone detected 87.1% (135 of 155) of the iEOCs. Using fixed CA-125 cutoffs at the last annual screen of more than 35, more than 30, and more than 22 U/mL would have identified 41.3% (64 of 155), 48.4% (75 of 155), and 66.5% (103 of 155), respectively. The area under the curve for ROCA (0.915) was significantly (P = .0027) higher than that for a single-threshold rule (0.869). \ud \ud CONCLUSION: Screening by using ROCA doubled the number of screen-detected iEOCs compared with a fixed cutoff. In the context of cancer screening, reliance on predefined single-threshold rules may result in biomarkers of value being discarded.

Published
2015

40. Ovarian Cancer Screening and Mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

Author

Jacobs, Ian J., primary, Menon, Usha, additional, Ryan, Andy, additional, Gentry-Maharaj, Aleksandra, additional, Burnell, Matthew, additional, Kalsi, Jatinderpal K., additional, Amso, Nazar N., additional, Apostolidou, Sophia, additional, Benjamin, Elizabeth, additional, Cruickshank, Derek, additional, Crump, Danielle N., additional, Davies, Susan K., additional, Dawnay, Anne, additional, Dobbs, Stephen, additional, Fletcher, Gwendolen, additional, Ford, Jeremy, additional, Godfrey, Keith, additional, Gunu, Richard, additional, Habib, Mariam, additional, Hallett, Rachel, additional, Herod, Jonathan, additional, Jenkins, Howard, additional, Karpinskyj, Chloe, additional, Leeson, Simon, additional, Lewis, Sara J., additional, Liston, William R., additional, Lopes, Alberto, additional, Mould, Tim, additional, Murdoch, John, additional, Oram, David, additional, Rabideau, Dustin J., additional, Reynolds, Karina, additional, Scott, Ian, additional, Seif, Mourad W., additional, Sharma, Aarti, additional, Singh, Naveena, additional, Taylor, Julie, additional, Warburton, Fiona, additional, Widschwendter, Martin, additional, Williamson, Karin, additional, Woolas, Robert, additional, Fallowfield, Lesley, additional, McGuire, Alistair J., additional, Campbell, Stuart, additional, Parmar, Mahesh, additional, and Skates, Steven J., additional

Published
2016
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42. Factors affecting visualisation of postmenopausal ovaries - descriptive study from the multicentre United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

Author

Sharma, Aarti, Burnell, Matthew, Gentry-Maharaj, Aleksandra, Campbell, Stuart, Amso, Nazar Najib, Seif, Mourad W., Fletcher, Gwendolen, Brunel, Carol, Turner, Gill, Rangar, Rani, Ryan, Andy, Jacobs, Ian, and Menon, Usha

Subjects
RG
Abstract

Objective: Transvaginal sonography (TVS) is core to any ovarian cancer screening strategy. General-population screening involves older postmenopausal women in whom ovarian visualization is difficult because of decreasing ovarian size and lack of follicular activity. We report on factors affecting the visualization of postmenopausal ovaries in the multicenter United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS).\ud Methods: The UKCTOCS is a randomized controlled trial of 202 638 postmenopausal women with 50 639 women in the ultrasound scan arm. TVS is the primary screening modality in the ultrasound scan arm. Age, education, ethnicity, body mass index (BMI), previous pelvic surgery, lifestyle and reproductive factors, and a personal/family history of cancer were assessed for their effects on ovarian visualization at the initial TVS.\ud Results: Between 11 June 2001 and 18 August 2007, 43 867 women underwent TVS. The median age and BMI of the women were 60.6 (interquartile range (IQR), 9.9) years and 25.7 (IQR, 5.8), respectively. The right ovary was visualized in 29 297 (66.8%) and the left ovary was visualized in 28 726 (65.5%). Visualization of ovaries decreased with previous hysterectomy (odds ratio (OR) = 0.534; 95% CI, 0.504–0.567), previous tubal ligation (OR = 0.895; 95% CI, 0.852–0.940), increasing age (OR = 0.953; 95% CI, 0.950–0.956), unilateral oophorectomy (OR = 0.224; 95% CI, 0.186–0.269) and being overweight (OR = 0.918; 95% CI, 0.876–0.962) or obese (OR = 0.715; 95% CI, 0.677–0.755). Increased visualization was observed with a history of infertility (OR = 1.134; 95% CI, 1.005–1.279) and increasing age (in years) at menopause (OR = 1.005; 95% CI, 1.001–1.009).\ud Conclusions: Several factors affect the visualization of postmenopausal ovaries. Their impact needs to be taken into consideration when developing quality assurance for ovarian ultrasound scanning or comparing study results as their prevalence may differ between populations.

Published
2013

44. Impact on mortality and cancer incidence rates of using random invitation from population registers for recruitment to trials

Author

Burnell, Matthew, primary, Gentry-Maharaj, Aleksandra, additional, Ryan, Andy, additional, Apostolidou, Sophia, additional, Habib, Mariam, additional, Kalsi, Jatinderpal, additional, Skates, Steven, additional, Parmar, Mahesh, additional, Seif, Mourad W, additional, Amso, Nazar N, additional, Godfrey, Keith, additional, Oram, David, additional, Herod, Jonathan, additional, Williamson, Karin, additional, Jenkins, Howard, additional, Mould, Tim, additional, Woolas, Robert, additional, Murdoch, John, additional, Dobbs, Stephen, additional, Leeson, Simon, additional, Cruickshank, Derek, additional, Campbell, Stuart, additional, Fallowfield, Lesley, additional, Jacobs, Ian, additional, and Menon, Usha, additional

Published
2011
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47. Sensitivity and Specificity of Multimodal and Ultrasound Screening for Ovarian Cancer, and Stage Distribution of Detected Cancers: Results of the Prevalence Screen of the United Kingdom Collaborative Trial of Ovarian Cancer Screening

Author

Menon, Usha, primary, Gentry-Maharaj, Aleksandra, additional, Hallett, Rachel, additional, Ryan, Andy, additional, Burnell, Matthew, additional, Sharma, Aarti, additional, Lewis, Sara, additional, Davies, Susan, additional, Philpott, Susan, additional, Lopes, Alberto, additional, Godfrey, Keith, additional, Oram, David, additional, Herod, Jonathatn, additional, Williamson, Karin, additional, Seif, Mourad W., additional, Scott, Ian, additional, Mould, Tim, additional, Woolns, Robert, additional, Murdoch, John, additional, Dobbs, Stephen, additional, Amso, Nazar N., additional, Leeson, Simon, additional, Cruickshank, Derek, additional, Mcguire, Alistair, additional, Campbell, Stuart, additional, Fallowfield, Lesley, additional, Singh, Naveena, additional, Dawnay, Anne, additional, Skates, Steven J., additional, Parmar, Mahesh, additional, and Jacobs, Ian, additional

Published
2009
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