Transabdominal ultrasound screening for early ovarian cancer.

OBJECTIVE--To assess the value of ultrasonography in a screening procedure for early ovarian cancer. DESIGN--Prospective study of at least 5000 self referred women without symptoms of ovarian cancer. Each woman was scheduled to undergo three annual screenings (consisting of one or more scans) to detect grossly abnormal ovaries or non-regressing masses. SETTING--The ovarian screening clinic at King''s College Hospital, London. SUBJECTS--5479 Self referred women without symptoms (aged 18-78, mean age 52). INTERVENTIONS--Women with a positive result on screening were referred for laparoscopy or laparotomy, or both. MAIN OUTCOME MEASURES--Findings at surgery and from histology of abnormal ovaries. RESULTS--A total of 14,594 screenings (15,977 scans) were performed. A positive result was obtained at 338 screens (2.3%) comprising 326 subjects (5.9%). Five patients with primary ovarian cancer (four stage Ia, one stage Ib; two at first screening three at second) were identified (prevalence 0.09%). An additional four patients had metastatic ovarian cancer (three at first screening, one at second). The apparent detection rate was 100%. It was not possible to differentiate between the ultrasonic appearance of early malignant and benign tumours. The rate of false positive results for primary ovarian cancer was 3.5% at the first screening, 1.8% at the second, and 1.2% at the third. Overall the rate of false positive results was 2.3%; the specificity was 97.7% and the predictive value of a positive result on screening was 1.5%. The odds that a positive result on screening indicated the presence of an ovarian tumour, any ovarian cancer, or primary ovarian cancer were about one to two, one to 37, and one to 67 respectively. CONCLUSION--Ultrasonography can be used to screen women without symptoms for persistent ovarian masses that will include early ovarian cancer.     

Molecular biomarker-based screening for early detection of cervical cancer

OBJECTIVE: To evaluate the effectiveness of a molecular biomarker-based screening method for early detection of cervical cancer. STUDY DESIGN: Fluorescent immunochemical labeling was used to classify cervical cytology specimens as probably normal or probably abnormal. These specimens were then Papanicolaou stained and evaluated twice by a cytotechnologist and by a pathologist when appropriate. The first evaluation was performed as conventional Pap screening to assign a reference per-specimen diagnosis. The second evaluation assigned a cytologic diagnosis to each cell in the specimen. The fluorescence results were correlated with those from each of the two morphologic evaluations to determine the sensitivity and specificity of the method on a per-specimen and a per-cell basis. Where available, in cases of positive morphologic analysis, biopsy was compared to fluorescence results. RESULTS: The per-specimen sensitivity and specificity were 87.5% and 81.8%, respectively, when using atypical squamous cells of undetermined significance and "above" as the decision threshold. For the same specimens evaluated on a cell-by-cell basis, the corresponding sensitivity and specificity were 71.4% and 66.3% when the same threshold was used. The per-specimen sensitivity for high grade squamous intraepithelial lesions was 100% under these conditions. CONCLUSION: This method appears to be a robust and reliable means of detecting cervical dysplasia and is now being evaluated in additional clinical studies.     

Defining a mutational signature for endometrial cancer screening and early detection

IntroductionThe current availability of genomic information represents an opportunity to develop new strategies for early detection of cancer. New molecular tests for endometrial cancer may improve performance and failure rates of histological aspirate-based diagnosis, and provide promising perspectives for a potential screening scenario. However, the selection of relevant biomarkers to develop efficient strategies can be a challenge.Materials and methodsWe developed an algorithm to identify the largest number of patients with endometrial cancer using the minimum number of somatic mutations based on The Cancer Genome Atlas (TCGA) dataset.ResultsThe algorithm provided the number of subjects with mutations (sensitivity) for a given number of biomarkers included in the signature. For instance, by evaluating the 50 most representative point mutations, up to 81.9% of endometrial cancers can be identified in the TCGA dataset. At gene level, a 92.9% sensitivity can be obtained by interrogating five genes.DiscussionWe developed a computational method to aid in the selection of relevant genomic biomarkers in endometrial cancer that can be adapted to other cancer types or diseases.     

Characterization of serum biomarkers for detection of early stage ovarian cancer

We have previously reported the identification of three ovarian cancer biomarker panels comprised of SELDI-TOF-MS peaks representing 14 differentially expressed serum proteins for the diagnosis of ovarian cancer. Using micro-LC-MS/MS, we identified five m/z peaks as transthyretin (TTR 13.9 kDa, TTR fragment 12.9 kDa), beta-hemoglobin (Hb, 15.9 kDa), apolipoprotein AI (ApoAI, 28 kDa) and transferrin (TF, 79 kDa). Western and/or ELISA methods confirmed the differential expression of TTR, Hb, and TF, and multivariate analyses resulted in improving the detection of early stage ovarian tumors (low malignant potential and malignant; receiver operating characteristic, ROC 0.933) as compared to cancer antigen CA125 alone (ROC 0.833). Interestingly, when CA125 was included with our markers in the multivariate analysis, the ROC increased to 0.959. Furthermore, multivariate analysis with only the mucinous subtype of early stage ovarian tumors, showed our markers to greatly improve the detection of disease (ROC 0.959) as compared to CA125 alone (ROC 0.613). Interestingly, the combination of CA125 with our markers did not seem to further improve the detection of mucinous tumors (ROC 0.955). We conclude that TTR, Hb, ApoAI and TF, when combined with CA125 should significantly improve the detection of early stage ovarian cancer.     

Steroids and cancer: faecal bile acid screening for early detection of cancer risk

The analyses of faecal bile acids in colorectal cancer patients, breast cancer patients and healthy control subjects is described. Faecal excretion of total bile acids was similar in the three groups. The major bile acids detected were lithocholic acid (LCA) and deoxycholic acid (DCA) and the proportions of these (LCA:DCA ratio) were diametrically opposed in the colorectal cancer patients (1.91 +/- 0.33) and control subjects (0.90 +/- 0.09). Patients with adenocarcinoma of the breast also exhibited a higher LCA:DCA ratio (1.24 +/- 0.10) than the control group. The faecal LCA:DCA ratio is an important marker of cancer risk especially cancer of the large bowel and it is suggested that it may be a useful adjunct to future screening procedures.     

Acetic acid test: a promising screening test for early detection of cervical cancer

OBJECTIVE: To determine whether the acetic acid test (AAT) could be used as a screening testfor early detection of cervical cancer. STUDY DESIGN: A hospital-based study was carried out. A sample of 376 women who attended the early cancer detection program of the Instituto Mexicano del Seguro Social in the state of Durango during 1998 was included. The AAT was applied during the gynecologic examination. Each women underwent colposcopy and directed cervical biopsy. RESULTS: The biopsies revealed that five women had cervical intraepithelial neoplasia grade 1 (CIN 1) and 51, 2/3. Four values (true positive,false positive, false negative and true negative) were obtained according to the pathologic test for CIN 1(5, 129, 0 and 191) andfor CIN 2/3 (47, 129, 4 and 191). Sensitivity, specificity, negative predictive value and positive predictive value in women with CIN 1 were 1.00, .60, 1.00 and .04 and with CIN 2/3 were .92, .60, .98 and .27, respectively. CONCLUSION: This test is promisingfor early detection of cervical cancer given its high sensitivity. Understanding the biologic mechanisms underlying acetowhite changes necessitates further studies.     

The role of CA 125 in screening for ovarian cancer

Ovarian cancer has the worst prognosis of any gynaecological malignancy, primarily because it tends to present at an advanced stage. The excellent survival rates of early stage disease have provided the rationale for efforts to detect ovarian cancer early by screening, in the hope that survival rates will be improved. Available data suggests that CA 125 is elevated in the majority of epithelial ovarian malignancies prior to clinical presentation. Large trials of screening for ovarian cancer indicate that using a CA 125 cutoff value of 30 U/mL has good sensitivity, but inadequate specificity for detecting preclinical disease. Use of transvaginal ultrasonography as a second-line test in women with elevated CA 125 levels improves specificity to acceptable levels, as does use of a mathematical algorithm which analyses rates of change of CA 125. Two major randomised controlled trials, investigating the effect of screening strategies incorporating CA 125 on mortality, are currently underway.     

Use of DNA methylation for cancer detection: promises and challenges

DNA methylation is an important and reversible epigenetic modification, which regulates genomic stability and cellular plasticity. Faithful DNA methylation is essential for mammalian development and health, and perturbation of methylation dynamics contributes to the development of disease, including cancer. The discovery and validation of the biological indicators (biomarkers) for human cancers are essential steps in the development of methods for accurate subtype classification and outcome prediction in clinic oncology. While genetics (SNP, LOH and mutation) and expression profiling (mRNA and protein) of biomarkers have been extensively assessed for cancer diagnosis and prognosis, the potential for using epigenetic fingerprints for early diagnosis and outcome prediction in clinic oncology propels the exploration of using DNA methylation as a biomarker for cancer prognosis. Both the promises and challenges to realizing the clinical utility of the DNA methylation in cancer management are discussed in this review.     

Proteomic biomarker identification for diagnosis of early relapse in ovarian cancer

Ovarian cancer recurs at the rate of 75% within a few months or several years later after therapy. Early recurrence, though responding better to treatment, is difficult to detect. Surface-enhanced laser desorption/ionization time-of-flight (SELDI-TOF) mass spectrometry has showed the potential to accurately identify disease biomarkers to help early diagnosis. A major challenge in the interpretation of SELDI-TOF data is the high dimensionality of the feature space. To tackle this problem, we have developed a multi-step data processing method composed of t-test, binning and backward feature selection. A new algorithm, support vector machine-Markov blanket/recursive feature elimination (SVM-MB/RFE) is presented for the backward feature selection. This method is an integration of minimum weight feature elimination by SVM-RFE and information theory based redundant/irrelevant feature removal by Markov Blanket. Subsequently, SVM was used for classification. We conducted the biomarker selection algorithm on 113 serum samples to identify early relapse from ovarian cancer patients after primary therapy. To validate the performance of the proposed algorithm, experiments were carried out in comparison with several other feature selection and classification algorithms.     

The promise of biomarkers in cancer screening and detection

Despite the recent decline in the incidence of cancer, long-term mortality rates remain unchanged. One of the most important factors in the survival of cancer is detection at an early stage. Clinical assays that detect the early events of cancer offer an opportunity to intervene and prevent cancer progression. Biomarkers are important molecular signatures of the phenotype of a cell that aid in early cancer detection and risk assessment. Although new information and technologies are clearly important for new biomarker discovery, we face major hurdles in translating new findings into clinical application. Here, we discuss examples of recent advances and limitations in cancer biomarker identification and validation, and the implications for cancer prevention.     

Malignant cell detection and cervical cancer screening

A study was conducted to determine the isolated, single-cell detection characteristics of human observers as this information relates to cervical cancer screening. Two interrelated experiments were performed. First, the receiver operating characteristic (ROC) was obtained for slide screening. In this experiment, approximately 1,200 slides were examined. Second, ROCs were obtained for human observer cell discrimination, using a rating method. An individual's curves were computed, assuming a multiple decision criterion. In this experiment, 6,375 cells from the same specimens used in the slide screening experiment were studied. In both experiments, results were analyzed using a Gaussian signal-detection model. This approach provided analytical detection criteria and rigorous definition of ROCs. These experiments addressed the problem of where the screening information lies: (1) in individual cells alone or (2) with additional components in global or other a priori information. We quantified the detection requirements of (1) the Papanicolaou smear screening process, Az = 0.99, and (2) the capabilities of trained cytotechnologists on isolated single cells, Az = 0.87. System modeling using intermediate cell detection instead of "rare event" detection resulted in a reduction of the predicted number of cells required for analysis from approximately 60,000 to 750.     

Genome-scale screen for DNA methylation-based detection markers for ovarian cancer

Background

The identification of sensitive biomarkers for the detection of ovarian cancer is of high clinical relevance for early detection and/or monitoring of disease recurrence. We developed a systematic multi-step biomarker discovery and verification strategy to identify candidate DNA methylation markers for the blood-based detection of ovarian cancer.

Methodology/Principal Findings

We used the Illumina Infinium platform to analyze the DNA methylation status of 27,578 CpG sites in 41 ovarian tumors. We employed a marker selection strategy that emphasized sensitivity by requiring consistency of methylation across tumors, while achieving specificity by excluding markers with methylation in control leukocyte or serum DNA. Our verification strategy involved testing the ability of identified markers to monitor disease burden in serially collected serum samples from ovarian cancer patients who had undergone surgical tumor resection compared to CA-125 levels.We identified one marker, IFFO1 promoter methylation (IFFO1-M), that is frequently methylated in ovarian tumors and that is rarely detected in the blood of normal controls. When tested in 127 serially collected sera from ovarian cancer patients, IFFO1-M showed post-resection kinetics significantly correlated with serum CA-125 measurements in six out of 16 patients.

Conclusions/Significance

We implemented an effective marker screening and verification strategy, leading to the identification of IFFO1-M as a blood-based candidate marker for sensitive detection of ovarian cancer. Serum levels of IFFO1-M displayed post-resection kinetics consistent with a reflection of disease burden. We anticipate that IFFO1-M and other candidate markers emerging from this marker development pipeline may provide disease detection capabilities that complement existing biomarkers.