Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
  1. Home
  2. Search

Refine search

Refine search

Access:
Content type:
Publication date:
Apply   From and To filters
Subject: Show more
Journals Show more
Publishers: Show more
Societies Show more
Series: Show more
Collections: Show more

Actions for selected content:

Select all | Deselect all
  • View selected items
  • Export citations
  • Download PDF (zip)
  • Save to Kindle
  • Save to Dropbox
  • Save to Google Drive

Save Search

You can save your searches here and later view and run them again in "My saved searches".

Please provide a title, maximum of 40 characters.
Cancel
×

6 results

  • Canadian cost-effectiveness model of BRCA-driven surgical prevention of breast/ovarian cancers compared to treatment if cancer develops

  • Manjusha Hurry, Anthony Eccleston, Matthew Dyer, Paul Hoskins
  • Journal:
    International Journal of Technology Assessment in Health Care / Volume 36 / Issue 2 / April 2020
    Published online by Cambridge University Press:
    19 May 2020, pp. 104-112
    • Article
      • You have access
      • Open access
    • PDF
    • HTML
    • Export citation
  • Objectives

    To assess the cost effectiveness from a Canadian perspective of index patient germline BRCA testing and then, if positive, family members with subsequent risk-reducing surgery (RRS) in as yet unaffected mutation carriers compared with no testing and treatment of cancer when it develops.

    Methods

    A patient level simulation was developed comparing outcomes between two groups using Canadian data. Group 1: no mutation testing with treatment if cancer developed. Group 2: cascade testing (index patient BRCA tested and first-/second-degree relatives tested if index patient/first-degree relative is positive) with RRS in carriers. End points were the incremental cost-effectiveness ratio (ICER) and budget impact.

    Results

    There were 29,102 index patients: 2,786 ovarian cancer and 26,316 breast cancer (BC). Using the base-case assumption of 44 percent and 21 percent of women with a BRCA mutation receiving risk-reducing bilateral salpingo-oophorectomy and risk-reducing mastectomy, respectively, testing was cost effective versus no testing and treatment on cancer development, with an ICER of CAD 14,942 (USD 10,555) per quality-adjusted life-year (QALY), 127 and 104 fewer cases of ovarian and BC, respectively, and twenty-one fewer all-cause deaths. Testing remained cost effective versus no testing at the commonly accepted North American threshold of approximately CAD 100,000 (or USD 100,000) per QALY gained in all scenario analyses, and cost effectiveness improved as RRS uptake rates increased.

    Conclusions

    Prevention via testing and RRS is cost effective at current RRS uptake rates; however, optimization of uptake rates and RRS will increase cost effectiveness and can provide cost savings.

  • 15 - Current clinical trials in ovarian cancer

  • from SECTION 4 - WHAT QUESTIONS ARE BEING ASKED BY CURRENT CLINICAL TRIALS?
  • Edited by Sean Kehoe, Richard J. Edmondson, Martin Gore, Iain A. McNeish
  • Book:
    Gynaecological Cancers
    Published online:
    05 February 2014
    Print publication:
    01 June 2011, pp 205-222

  • Summary

    Epithelial ovarian cancer (EOC) is the most common cause of death among women who develop gynaecological cancer and the fifth most common cause of cancer related death in females in Western countries. The value of the neoadjuvant approach in the primary treatment of advanced EOC is currently one of the most debated issues in gynaecological oncology worldwide. The disease-free interval, number of recurrence sites, patient's performance status, surgical outcome of the primary surgery and current amount of ascites have been discussed as possible predictive factors of clinical outcome in surgery at recurrence. Anti-angiogenic therapy represents huge effort in translational research, with high expectations from investigators and patients alike. The proliferation of clinical trials in ovarian cancer reflects the focus and determination of investigators internationally and many promising hypotheses are being explored within the international collaborative efforts.

  • 4 - Predictive biology of ovarian cancer

  • from SECTION 1 - BIOLOGY OF GYNAECOLOGICAL CANCERS: OUR CURRENT UNDERSTANDING
  • Edited by Sean Kehoe, Richard J. Edmondson, Martin Gore, Iain A. McNeish
  • Book:
    Gynaecological Cancers
    Published online:
    05 February 2014
    Print publication:
    01 June 2011, pp 41-54

  • Summary

    This chapter concentrates on recent robust advances that are likely to affect clinical care over the short to medium term. It discusses potential biomarkers for stratified treatment of high-grade serous (HGSOC) and their relationship with platinum sensitivity and resistance. The accurate diagnosis of sub-type before chemotherapy treatment is vital as it provides strong prognostic and biological information. Many expression microarray studies have attempted to define prognostic and predictive signatures for chemoresistance in epithelial ovarian cancer (EOC). DNA copy number analysis has also been investigated as a predictive marker. Ultrasound- or computed tomography (CT)-guided biopsy is the standard of care for initial diagnosis of women with suspected ovarian cancer. Intratumoral genetic heterogeneity in HGSOC has been demonstrated both within a region of tumour and between different metastatic sites. These genetic differences could be expected to alter chemosensitivity.

  • Chapter 33 - In vitro growth systems for human oocytes

  • from Section 8 - In vitro follicle growth and maturation
  • Edited by Jacques Donnez, Université Catholique de Louvain, Belgium, S. Samuel Kim, University of Kansas
  • Book:
    Principles and Practice of Fertility Preservation
    Published online:
    04 February 2011
    Print publication:
    03 February 2011, pp 397-408

  • Summary

    Ovarian cancers are classified as epithelial (including borderline and malignant tumors) and non-epithelial cancers. The standard treatment of borderline ovarian tumours (BOT) consisted of a total abdominal hysterectomy and bilateral salpingo-oophorectomy, peritoneal cytology, omentectomy and multiple peritoneal biopsies. The differential criterion between epithelial ovarian cancer (EOC) and BOT is the invasion of the ovarian stroma. The standard surgical procedure for EOC is a radical hysterectomy with bilateral salpingo-oophorectomy. Non-epithelial malignant tumors are characterized by: the occurrence of disease in younger patients; and a good prognosis of this tumor. Conservative treatment yields good fertility results and does not affect the survival of patients with BOT. It should be considered for young women desiring fertility, even if peritoneal implants are discovered at the time of initial surgery. In case of infertility, medically-assisted procreation techniques may be proposed to patients with stage I BOT with a limited number of stimulation cycles.

  • 8 - Chemotherapy: principles and applications

  • Edited by Nigel Acheson, David Luesley
  • Book:
    Gynaecological Oncology for the MRCOG and Beyond
    Published online:
    05 August 2014
    Print publication:
    01 January 2011, pp 103-114

  • Summary

    This chapter lists the uses of chemotherapy in gynaecological oncology. In endometrial cancer, chemotherapy is used to treat advanced or relapsed cases where surgery and or radiotherapy are considered inappropriate, although hormone treatment is also used in these situations. In some situations, the intent of treatment may be curative, an example being trophoblastic tumours, while in others the intent is palliative, for example in recurrent epithelial ovarian cancer. In all situations, conventional chemotherapy used to kill tumour cells will also kill normal, healthy cells. This gives rise to treatment-related toxicity such as myelosuppression, emesis, alopecia and peripheral neuropathy. In general terms, until recently, the first-line therapy for cervical cancer was a choice between surgery and radiotherapy for early-stage disease with radiotherapy for advanced disease. The malignant non-epithelial tumours comprise mainly sex-cord stromal and germ-cell tumours. Of the sex-cord stromal tumours, granulosa cell tumours may require chemotherapy.

  • 16 - Interpreting science in the policy context

  • Edited by Tracey J. Woodruff, University of California, San Francisco, Sarah J. Janssen, University of California, San Francisco, Louis J. Guillette, Jr, University of Florida, Linda C. Giudice, University of California, San Francisco
  • Book:
    Environmental Impacts on Reproductive Health and Fertility
    Published online:
    23 February 2010
    Print publication:
    28 January 2010, pp -

  • Summary

    Epidemiologic studies and animal studies increasingly suggest that exposures to environmental chemicals, nutrition, physical factors, and other factors early in development have a role in susceptibility to disease in later life. The mammalian female reproductive system arises from the uniform paramesonephric duct, the müllerian duct. The major subtypes of epithelial ovarian cancer (EOC) show morphologic features that resemble those of the müllerian duct-derived epithelia of the reproductive tract. Exposure of the developing female reproductive tract to diethylstilbestrol (DES), either in vivo or in organ culture, repressed the expression of HOXA10 in the uterus and resulted in uterine metaplasia. Epigenetic change in the molecular program of cell differentiation in the affected tissues may be a common mechanism. Most regions of the mammalian genome exhibit little variability among individuals in tissue-specific DNA methylation levels. Future analyses of epigenetic imprints of genes explain the developmental origins of disease.