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class="bkr_bib"><h1 id="_NBK604294_"><span itemprop="name">Benefits and risks of surveillance</span></h1><div class="subtitle">Ovarian cancer: identifying and managing familial and genetic risk</div><p><b>Evidence review K</b></p><p><i>NICE Guideline, No. 241</i></p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2024 Mar</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-5831-3</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2024.</div></div><div class="bkr_clear"></div></div><div id="niceng241er11.s1"><h2 id="_niceng241er11_s1_">Benefits and risks of surveillance</h2><div id="niceng241er11.s1.1"><h3>Review question</h3><p>What are the benefits and risks of surveillance for women at increased risk of familial ovarian cancer?</p><div id="niceng241er11.s1.1.1"><h4>Introduction</h4><p>Not all women can undergo risk reducing surgery as they may wish to preserve their fertility, choose to avoid surgery or are not well enough to undergo surgery. The use of surveillance in this high-risk group is different to its application in the general population as the burden of disease and the biology of ovarian cancer is different. The proposed benefit of surveillance for ovarian cancer in those with a familial cancer risk is to improve survival by detecting disease earlier. Surveillance however is not without risks as it can give false positive results leading to unnecessary surgery and false negative results in which a cancer is missed. This review investigates the current evidence base as to the risks and benefits of ovarian cancer surveillance in those with a familial cancer risk.</p></div><div id="niceng241er11.s1.1.2"><h4>Summary of the protocol</h4><p>See <a href="/books/NBK604294/table/niceng241er11.tab1/?report=objectonly" target="object" rid-ob="figobniceng241er11tab1">Table 1</a> for a summary of the Population, Intervention, Comparison and Outcome (PICO) characteristics of this review.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng241er11tab1"><a href="/books/NBK604294/table/niceng241er11.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img" rid-ob="figobniceng241er11tab1"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng241er11.tab1"><a href="/books/NBK604294/table/niceng241er11.tab1/?report=objectonly" target="object" rid-ob="figobniceng241er11tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">Summary of the protocol (PICO table). </p></div></div><p>For further details see the review protocol in <a href="#niceng241er11.appa">appendix A</a>.</p></div><div id="niceng241er11.s1.1.3"><h4>Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng241er11.appa">appendix A</a> and the <a href="/books/NBK604294/bin/NG241-Supplement1-Methods.pdf">methods</a> document (supplementary document 1).</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng241er11.s1.1.4"><h4>Effectiveness evidence</h4><div id="niceng241er11.s1.1.4.1"><h5>Included studies</h5><p>Two studies were included for this review: 1 randomised controlled trial (RCT; <a class="bibr" href="#niceng241er11.s1.ref1" rid="niceng241er11.s1.ref1">Lai 2016</a>) and 1 prospective cohort study (<a class="bibr" href="#niceng241er11.s1.ref2" rid="niceng241er11.s1.ref2">Mai 2020</a>).</p><p>The studies compared ovarian cancer screening with usual medical care (<a class="bibr" href="#niceng241er11.s1.ref1" rid="niceng241er11.s1.ref1">Lai 2016</a>) and with risk reducing salpingo-oophorectomy (RRSO; <a class="bibr" href="#niceng241er11.s1.ref2" rid="niceng241er11.s1.ref2">Mai 2020</a>), respectively.</p><p>The included studies are summarised in <a href="/books/NBK604294/table/niceng241er11.tab2/?report=objectonly" target="object" rid-ob="figobniceng241er11tab2">Table 2</a>.</p><p>See the literature search strategy in <a href="#niceng241er11.appb">appendix B</a> and study selection flow chart in <a href="#niceng241er11.appc">appendix C</a>.</p></div><div id="niceng241er11.s1.1.4.2"><h5>Excluded studies</h5><p>Studies not included in this review are listed, and reasons for their exclusion are provided in <a href="#niceng241er11.appk">appendix K</a>.</p></div></div><div id="niceng241er11.s1.1.5"><h4>Summary of included studies</h4><p>Summaries of the studies that were included in this review are presented in <a href="/books/NBK604294/table/niceng241er11.tab2/?report=objectonly" target="object" rid-ob="figobniceng241er11tab2">Table 2</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng241er11tab2"><a href="/books/NBK604294/table/niceng241er11.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img" rid-ob="figobniceng241er11tab2"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng241er11.tab2"><a href="/books/NBK604294/table/niceng241er11.tab2/?report=objectonly" target="object" rid-ob="figobniceng241er11tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of included studies. </p></div></div><p>See the full evidence tables in <a href="#niceng241er11.appd">appendix D</a>. No meta-analysis was conducted (and so there are no forest plots in <a href="#niceng241er11.appe">appendix E</a>).</p></div><div id="niceng241er11.s1.1.6"><h4>Summary of the evidence</h4><p>There was a lack of randomised trials or observational studies comparing different surveillance protocols in women at increased risk of familial ovarian cancer. The evidence consisted of 1 randomised and 1 observational study comparing surveillance with usual medical care or risk-reducing surgery. No evidence was identified for recurrence free survival, ovarian cancer incidence, screen detected and interval related cancers, histological types, investigation of false positive results, patient acceptability and satisfaction and healthcare use outcomes.</p><div id="niceng241er11.s1.1.6.1"><h5>Ovarian cancer screening versus usual medical care</h5><p>Very low quality evidence showed no important difference between the screening and usual medical care groups in terms of overall mortality, ovarian cancer specific mortality and proportion of ovarian cancers that were stage I or II. However, very low quality evidence showed that overall survival was improved in the screening group compared to the usual medical care group.</p></div><div id="niceng241er11.s1.1.6.2"><h5>RRSO versus ovarian cancer screening</h5><p>Moderate quality evidence showed no important differences in terms of different quality of life, anxiety or depression measures between women who received risk-reducing salpingo-oophorectomy and cancer screening.</p><p>See <a href="#niceng241er11.appf">appendix F</a> for full GRADE tables.</p></div></div><div id="niceng241er11.s1.1.7"><h4>Economic evidence</h4><div id="niceng241er11.s1.1.7.1"><h5>Included studies</h5><p>Four economic studies were identified which were relevant to this review (<a class="bibr" href="#niceng241er11.s1.ref3" rid="niceng241er11.s1.ref3">Bommer 2022</a>, <a class="bibr" href="#niceng241er11.s1.ref4" rid="niceng241er11.s1.ref4">Muller 2018</a>, <a class="bibr" href="#niceng241er11.s1.ref5" rid="niceng241er11.s1.ref5">Philpott 2023</a>, <a class="bibr" href="#niceng241er11.s1.ref6" rid="niceng241er11.s1.ref6">Yamauchi 2018</a>).</p><p>A single economic search was undertaken for all topics included in the scope of this guideline. See <a href="/books/NBK604294/bin/NG241-Supplement2-Economic-Literature-pdf.pdf">supplementary material 2</a> for details.</p></div><div id="niceng241er11.s1.1.7.2"><h5>Excluded studies</h5><p>Economic studies not included in this review are listed, and reasons for their exclusion are provided in <a href="/books/NBK604294/bin/NG241-Supplement2-Economic-Literature-pdf.pdf">Supplement 2</a>.</p></div></div><div id="niceng241er11.s1.1.8"><h4>Summary of included economic evidence</h4><p>The systematic search of the economic literature undertaken for the guideline identified the following studies:
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<ul><li class="half_rhythm"><div>One Swiss study on the cost-utility of intensified surveillance (age-related imaging procedures and gynaecological consultations) for a cohort of female <i>BRCA</i> genetic mutation carriers aged 40 years (<a class="bibr" href="#niceng241er11.s1.ref3" rid="niceng241er11.s1.ref3">Bommer 2022</a>);</div></li><li class="half_rhythm"><div>One German study on the cost-utility of intensified surveillance (half-yearly palpation and ultrasound, yearly mammography, and breast magnetic resonance imaging) for a cohort of female <i>BRCA</i> mutation carriers aged 30 years (<a class="bibr" href="#niceng241er11.s1.ref4" rid="niceng241er11.s1.ref4">Muller 2018</a>);</div></li><li class="half_rhythm"><div>One UK study on the cost-utility of surveillance (the ROCA Test for a cohort of <i>BRCA</i> genetic mutation carriers aged 35 years (<a class="bibr" href="#niceng241er11.s1.ref5" rid="niceng241er11.s1.ref5">Philpott 2023</a>);</div></li><li class="half_rhythm"><div>One Japanese study on the cost-utility of surveillance (once a year mammogram, magnetic resonance imaging, and examination) for a cohort of female <i>BRCA</i> genetic mutation carriers aged 35 years (<a class="bibr" href="#niceng241er11.s1.ref6" rid="niceng241er11.s1.ref6">Yamauchi 2018</a>).</div></li></ul></p><p>See the economic evidence tables in <a href="#niceng241er11.apph">appendix H</a>. See <a href="/books/NBK604294/table/niceng241er11.tab3/?report=objectonly" target="object" rid-ob="figobniceng241er11tab3">Table 3</a> for the economic evidence profile of the included studies.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng241er11tab3"><a href="/books/NBK604294/table/niceng241er11.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img" rid-ob="figobniceng241er11tab3"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng241er11.tab3"><a href="/books/NBK604294/table/niceng241er11.tab3/?report=objectonly" target="object" rid-ob="figobniceng241er11tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Economic evidence profile of a systematic review of economic evaluations of intensified surveillance (IS) for women <i>BRCA</i> mutation carriers. </p></div></div></div><div id="niceng241er11.s1.1.9"><h4>Expert witness</h4><p>During the development of this guidance the committee identified an ongoing economic analysis that examined the cost-effectiveness of ovarian cancer surveillance in women with pathogenic germline <i>BRCA1</i> and <i>BRCA2</i> variants. In this study the surveillance included the ROCA Test and was compared with no-surveillance (where women were assumed to have the self-determined choice of undertaking risk-reducing surgery). The analysis focussed on reporting the clinical results from the surveillance trial (ALDO) but also included the cost-effectiveness as a secondary outcome.</p><p>At the time of the evidence consideration by the committee the analysis was still unpublished. Since this was an area where the committee was considering making a recommendation, they agreed that it was essential to understand the analysis. As a result, the committee invited an expert witness from London School of Economics to present the analysis. The testimony covered the cost-effectiveness of surveillance for a population at high risk of ovarian cancer in the ALDO trial. A copy of the completed expert testimony form is provided in <a href="#niceng241er11.appl">appendix L</a>.</p><p>Since the presentation to the committee the analysis was published and is included in the existing economic evidence review. For details see the economic evidence table in <a href="#niceng241er11.apph">appendix H</a> and <a href="/books/NBK604294/table/niceng241er11.tab3/?report=objectonly" target="object" rid-ob="figobniceng241er11tab3">Table 3</a> for the economic evidence profile for this study.</p></div><div id="niceng241er11.s1.1.10"><h4>Economic model</h4><p>No economic modelling was undertaken for this review because a recent economic study already explored the cost-effectiveness of a surveillance strategy that the committee recommended. Moreover, the identified effectiveness evidence was insufficient to develop a more informative economic model.</p></div><div id="niceng241er11.s1.1.11"><h4>Evidence statements</h4><div id="niceng241er11.s1.1.11.1"><h5>Economic</h5><ul><li class="half_rhythm"><div>Evidence from one UK cost-utility analysis based on modelling suggests that surveillance using the ROCA Test for female <i>BRCA</i> mutation carriers was dominant, resulting in lower costs and higher QALYs, compared to no surveillance. This study was directly applicable to the NICE decision-making context and was characterised by potentially serious limitations (<a class="bibr" href="#niceng241er11.s1.ref5" rid="niceng241er11.s1.ref5">Philpott 2023</a>).</div></li><li class="half_rhythm"><div>Evidence from three non-UK cost-utility analyses based on modelling suggests that surveillance for female <i>BRCA</i> mutation carriers is not cost-effective compared to preventative surgical management. All studies were non-UK and are partially applicable to the NICE decision-making context. Two studies had minor limitations (<a class="bibr" href="#niceng241er11.s1.ref3" rid="niceng241er11.s1.ref3">Bommer 2022</a>, <a class="bibr" href="#niceng241er11.s1.ref4" rid="niceng241er11.s1.ref4">Muller 2018</a>), and one study had potentially serious limitations (<a class="bibr" href="#niceng241er11.s1.ref6" rid="niceng241er11.s1.ref6">Yamauchi 2018</a>).</div></li></ul></div></div><div id="niceng241er11.s1.1.12"><h4>The committee’s discussion and interpretation of the evidence</h4><div id="niceng241er11.s1.1.12.1"><h5>The outcomes that matter most</h5><p>Quality of life and overall survival were prioritised as critical outcomes by the committee because deferring risk reducing treatments in favour of surveillance may have a negative impact on overall survival – but this choice might be made for quality of life reasons, for example preservation of fertility. Similarly, surveillance compared to no surveillance or treatment could have a positive impact on overall survival. Cancer specific and recurrence free survival were also identified as critical outcomes because the aim of surveillance is to identify ovarian cancer at a pre-symptomatic stage when it is more treatable.</p><p>Incidence of ovarian cancer, screen detected and interval related cancers were chosen as critical outcomes because they indicate whether surveillance picks up pre-symptomatic ovarian cancers (screen detected) or whether they present as symptomatic between surveillance visits (interval cancers). Stage at diagnosis and histological type were also critical outcomes because they indicate the likely prognosis and response to treatment of any cancers detected.</p><p>The committee agreed that treatment related adverse effects and test related morbidity should be important outcomes. This is due to the potential anxiety associated with waiting for surveillance test results and the possible harms associated with investigation of false positive results.</p><p>Psychological outcomes and wellbeing such as patient satisfaction, acceptability and attitudes were also chosen as important outcomes because the choice of surveillance or risk reducing treatment is a trade off between harms of risk reducing treatment such as infertility and early menopause and the risk of ovarian cancer. This trade-off will likely depend on the individual’s attitudes and other factors such as age.</p><p>The committee agreed that healthcare use should be an important outcome as surveillance typically requires repeated tests and healthcare appointments.</p></div><div id="niceng241er11.s1.1.12.2"><h5>The quality of the evidence</h5><p>The quality of the evidence from the included studies was assessed with GRADE and was rated as very low to moderate mainly due to serious risk of bias of individual studies and imprecision. One of the studies also had very serious indirectness because its participants did not have assessment of carrier probability or genetic testing and likely represented an intermediate to moderate risk group.</p><p>The committee discussed that there were not many studies that were identified as evidence and that there were limitations in the applicability of the populations used in the studies and in the comparisons that they were investigating. Due to the uncertainty in evidence the committee drew on their experience when making recommendations as well as expert testimony on the cost-effectiveness of surveillance and evidence from evidence review L on the diagnostic performance of difference surveillance protocols.</p></div><div id="niceng241er11.s1.1.12.3"><h5>Benefits and harms</h5></div><div id="niceng241er11.s1.1.12.4"><h5>Information about surveillance for people who choose to delay or not have risk-reducing surgery (ovarian cancer surveillance)</h5><p>The committee discussed the evidence that compared surveillance to usual care which showed a difference in overall survival favouring the surveillance group but that this did not translate into reduced ovarian cancer mortality. The committee noted that, by definition, surveillance is a health strategy that aims to detect a condition earlier rather than preventing a condition to develop. This makes it essentially inferior to risk reducing surgery which removes the organs in which ovarian cancer can develop and therefore minimises the risk of this happening (see evidence report N). This is particularly relevant to ovarian cancer which is an aggressive form of cancer which once detected is associated with serious risks. The evidence comparing surveillance to risk-reducing surgery did not show a difference in quality of life, anxiety or depression. The committee noted that this lack of difference does not mean that the two strategies are equally effective but reflected that it was reassuring to see that these outcomes were not showing an increase associated with risk-reducing surgery even though it is more invasive and induces the menopause. An advantage in undergoing surveillance is a potential shift in ovarian cancer stage (downstaging) with cancer being detected at an earlier stage, which some of the evidence in the related evidence report on methods of surveillance (evidence report L) indicated. This is assumed to be beneficial in terms of cancer related survival because of earlier treatment. However, the committee noted that the evidence has not proven this to be the case and noted that there are no studies for people at increased risk of familial ovarian cancer designed to measure cancer related survival related to this. The committee therefore made a research recommendation to establish this (see <a href="#niceng241er11.appk">appendix K</a>). Given that surveillance cannot prevent cancer developing and that the only established finding is that it leads to earlier detection of cancer (without a known survival benefit) the committee decided that this strategy is clearly inferior and not an alternative to having risk-reducing surgery. They also discussed that a potential earlier detection has the disadvantage that it would not make people eligible for PARP inhibitors which is a class of drugs used in cancer therapy for people at late stage cancer, specifically targeting tumours with certain DNA repair deficiencies, such as those caused by mutations in the BRCA genes. PARP stands for Poly (ADP-ribose) polymerase, which is an enzyme involved in DNA repair. This could save lives but is not prescribed for low stage cancers. The committee concluded that surveillance should only be considered for people who delay surgery and the committee agreed that this should be made clear to the person before a decision on surveillance is made.</p><p>Given that the committee decided that surveillance should be an option for those delaying risk-reducing surgery they wanted to ensure that people were given the information that they need to make an informed choice. The committee therefore made recommendations to inform the person that their risk of developing cancer can only be reduced by risk-reducing surgery and that delaying it should therefore only be short-term. Healthcare professionals should also advise that surveillance does not decrease the risk of developing cancer. That it is therefore not an alternative to risk-reducing surgery (which the committee discussed is a common misconception) because there is little evidence on whether this leads to improved outcomes and saves lives. They also agreed to explain to the person what surveillance would involve and that there is the possibility that they may receive a false positive result (which will lead to anxiety and possibly unnecessary surgery) or false negative result (which could lead to reassurance and a potential cancer not being managed). Given the discussion above it should be emphasised to the women that surveillance is not an alternative to risk reducing surgery and that there are uncertainties about whether or not earlier detection of ovarian cancer leads to improved outcomes. The committee noted that the need of information provision in this topic, was also consistent with the qualitative evidence in evidence review A which also highlighted that people particularly valued information related to surveillance (see the relevant themes and subthemes in evidence review A – information and support).</p></div><div id="niceng241er11.s1.1.12.5"><h5>Surveillance by the familial cancer multidisciplinary team for people who choose to delay or not have risk-reducing surgery</h5><p>Whilst there were uncertainties about mortality, the majority of the committee was convinced by the evidence of downstaging as the deciding factor for their recommendation. They agreed that surveillance should be recommended as an option (i.e. a weaker recommendation) for women delaying surgery, for example those planning pregnancy. There was a discussion about responsibilities for any type of surveillance and whether there would be primary care involvement in this. Based on experience of the time constraints in primary care, the committee decided that all activities related to this would take place in secondary or tertiary care under the responsibility of the familial ovarian multidisciplinary team.</p><p>The committee outlined that risk-reducing surgery (the preferred risk management strategy) becomes relevant at difference ages (this is related to risk-reducing surgery as discussed in evidence report N) due to the different ovarian cancer risks according to age and pathogenic variant. This means therefore that surveillance should only be considered if risk-reducing surgery has been delayed beyond the time when it becomes relevant for the individual. The committee noted the ages associated with risk-reducing surgery in accordance with the related pathogenic variant (for related evidence see evidence review N) which depend on the difference of risk of the general population at a given age and risk of people with a particular pathogenic variant. In evidence N the optimal age for this was established in an economic model and it was shown that for <i>BRCA1</i> this would be no earlier than 35, for <i>BRCA2</i> no earlier than 40, for <i>RAD51C, RAD51D, BRIP1</i> or PALB2 no earlier than 45 and for <i>MLH1</i>, <i>MSH2</i> or <i>MSH6</i> no earlier than 35 years. They decided that these would also be relevant for ovarian cancer surveillance for people with all pathogenic variants apart from <i>MLH1</i>, <i>MSH2</i> or <i>MSH6</i> which is associated with Lynch syndrome and based on knowledge the committee were aware that people with Lynch syndrome would already be regularly surveyed.</p></div><div id="niceng241er11.s1.1.12.6"><h5>How to survey and once yearly review</h5><p>They noted that a published economic model on surveillance using serial 4-monthly CA125 longitudinal testing using an algorithm (the ROCA Test) testing showed it to be a cost-effective strategy (see below and expert witness testimony in <a href="#niceng241er11.appl">Appendix L</a>). Based on this evidence, if a person is at risk of developing ovarian cancer and chooses to delay or not have risk-reducing surgery and if surveillance is being carried out, the committee recommended that the familial ovarian cancer multidisciplinary team should carry out serial 4-monthly CA125 longitudinal testing using an algorithm. They gave the ROCA Test as an example because they were aware that other such algorithms are in use or in development and did not want to be prescriptive about any other particular algorithm that may be developed as long as it has demonstrated accuracy. They noted the organisation of this would require the familial ovarian cancer MDT to coordinate, audit and interpret CA125 testing and review with a call and recall mechanism.</p><p>To ensure that it remains clear to the person that surveillance would not prevent them developing cancer and is not an alternative to risk-reducing surgery, the committee decided that there should be a review to discuss the recommendation of having risk-reducing surgery (see evidence review N) at least once a year.</p></div><div id="niceng241er11.s1.1.12.7"><h5>Research recommendation</h5><p>Due to the lack of evidence on long-term outcomes in people at risk of ovarian cancer the committee prioritised this topic for a research recommendation (see <a href="#niceng241er11.appk">appendix K</a>).</p></div><div id="niceng241er11.s1.1.12.8"><h5>Cost effectiveness and resource use</h5><p>There were four existing economic studies on the cost-effectiveness of surveillance in female <i>BRCA</i> genetic mutation carriers.</p><p>Only one study was conducted in the UK and it assessed the cost-utility of 4-monthly surveillance using the ROCA Test. This study was directly applicable to the NICE decision-making context but was characterised by potentially serious methodological limitations. The committee received expert testimony on this health economic model but questioned the conclusion that cancer stage shift leads to lives saved. In the model, the effectiveness of the ROCA Test was from a single arm trial with a one-year follow-up (ALDO) which showed downstaging in ovarian cancer.</p><p>Control arm cancer stage distribution was from the published literature. The model applied the same stage specific survival for the ROCA Test arm and the control arm. The committee discussed the credibility of this assumption. For example, it was noted that the evidence from the UKCTOCS trial suggested that ovarian cancer stage shift does not translate into survival gains. However, it was acknowledged that the ALDO study which informed the economic analysis included a high-risk population and that there may be a potential for stage shift to lead to a survival benefit.</p><p>The committee explained that due to biological differences, the proportion of high-grade ovarian cancer is greater in people with pathogenic variants such as <i>BRCA</i>, when compared with the general ovarian cancer population. There may also be differences in how responsive people with high grade serous pathogenic variants are to chemotherapy when compared with people with high grade serous cancers but who are not pathogenic variant carriers. Such differences between ovarian cancers in the general population and in people who are pathogenic variant carriers make it difficult to extrapolate from data on stage shift and survival benefit in the general ovarian cancer population.</p><p>The committee also discussed current PARP inhibitor funding arrangements and that ovarian cancer downstaging observed in the ALDO study may mean that some people may not be eligible for treatment with PARP inhibitors. This is because only advanced stage ovarian cancers are eligible for treatment with PARP inhibitors. The committee also noted that in the base-case analysis the model included PARP inhibitor costs but not outcomes which may potentially overestimate the cost-effectiveness of the surveillance arm.</p><p>It was also highlighted that there is evidence that adjuvant treatment with PARP inhibitors is associated with survival benefit in advanced stage cancers and in patients who get PARP inhibitors on relapse. In response to the above limitation, the authors have undertaken an additional sensitivity analysis which considered the potential PARP inhibitor survival benefit and the results were unchanged.</p><p>The committee also noted that the NHS reference costs do not differentiate between the extent of ovarian cancer surgery. This means that the economic analysis used the same unit cost for operating early stage versus late-stage cancer. Early-stage cancer surgery as a result of surveillance (due to downstaging) is likely to be less extensive. It may require shorter hospital stay and is less likely to need a prolonged stay on a high dependency unit or intensive care. The use of a single unit cost for ovarian cancer surgery may potentially have underestimated the cost-effectiveness of the surveillance arm.</p><p>The committee discussed the generalisability of this analysis to other genes, such as <i>RAD51C</i>, <i>RAD51D</i> and <i>BRIP1</i>. It was explained that such genes also work in the same biological pathways as <i>BRCA</i> and are more likely to have a greater proportion of high-grade serous cancers. The committee agreed that the expert testimony which presented findings from the ALDO trial on downstaging and survival benefit may potentially be generalisable to other genes too.</p><p>The remainder of the evidence was from three non-UK studies which assessed the cost-effectiveness of surveillance compared with risk-reducing surgery. None of these studies assessed the clinically effective surveillance strategy identified in the effectiveness review. As a result, these studies were of limited use to the committee decision making.</p><p>The committee explained that people who opt to delay or not to have risk-reducing surgery would be seen by clinicians once a year to revisit this option since it is the optimal choice. This annual review is current practice. It was noted that ovarian cancer surveillance’s annual review would simply become part of this ongoing process, which is already in place. Consequently, implementing this recommendation is not expected to require additional resources.</p><p>The committee discussed the age cut-offs for surveillance. These age cut-offs reflect the ages at which ovarian and breast cancer risks start increasing. For example, the incidence of cancer is very low, under the age 40 in <i>BRCA2</i>. These age cut-offs also include some lead time for surveillance to pick up cancers early. It was noted that the economic evidence showed that surveillance for <i>BRCA</i> carriers was cost-effective if it was initiated at the age of 35. However, by limiting surveillance to age 40 in <i>BRCA2</i> pathogenic variants the cost effectiveness is likely to be improved further. This is because of the reduced costs in the surveillance arm due to surveillance not being initiated until age 40 in some people.</p></div><div id="niceng241er11.s1.1.12.9"><h5>Other factors the committee took into account</h5><p>The committee noted that surveillance would be a change to current practice and that therefore the infrastructure for services is not established and implementation may be a challenge and associated with a considerable resource impact. Implementation would take up clinical as well as administrative time, for example screening invites, appointments, cost of tests (the ROCA Test is currently not available in the NHS), interpretation of tests and providing the outcomes of tests.</p></div></div><div id="niceng241er11.s1.1.13"><h4>Recommendations supported by this evidence review</h4><p>This evidence review supports recommendations 1.8.18 to 1.8.20 (including information on surveillance in <a href="/books/NBK604294/table/niceng241er11.tab3/?report=objectonly" target="object" rid-ob="figobniceng241er11tab3">Table 3</a>) and research recommendation 4 on long-term benefits and risks of ovarian cancer surveillance in the NICE guideline.</p></div></div><div id="niceng241er11.s1.rl.r1"><h3>References – included studies</h3><ul class="simple-list"><div id="niceng241er11.s1.rl.r1.1"><h4>Effectiveness</h4><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng241er11.s1.ref1"><p id="p-238">
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<strong>Lai 2016</strong>
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</p>Lai, Tiffany, Kessel, Bruce, Ahn, Hyeong Jun
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et al. Ovarian cancer screening in menopausal females with a family history of breast or ovarian cancer. J. Gynecol. Oncol. 27(4): e41, 2016
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[<a href="/pmc/articles/PMC4864517/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4864517</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27102249" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27102249</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng241er11.s1.ref2"><p id="p-239">
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<strong>Mai 2020</strong>
|
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</p>Mai, Phuong L, Huang, Helen Q, Wenzel, Lari B
|
|
et al. Prospective follow-up of quality of life for participants undergoing risk-reducing salpingo-oophorectomy or ovarian cancer screening in GOG-0199: An NRG Oncology/GOG study. Gynecol. Oncol. 156(1): 131–139, 2020
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[<a href="/pmc/articles/PMC6980744/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6980744</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31759774" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31759774</span></a>]</div></p></li></ul></div><div id="niceng241er11.s1.rl.r1.2"><h4>Economic</h4><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng241er11.s1.ref3"><p id="p-240">
|
|
<strong>Bommer 2022</strong>
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|
</p>Bommer
|
|
C, Lupatsch
|
|
J, Bürki
|
|
N, Schwenkglenks
|
|
M., Cost–utility analysis of risk-reducing strategies to prevent breast and ovarian cancer in BRCA-mutation carriers in Switzerland, The European Journal of Health Economics, 23, 807–21, 2022
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[<a href="/pmc/articles/PMC9170622/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9170622</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34767113" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34767113</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng241er11.s1.ref4"><p id="p-241">
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|
<strong>Muller 2018</strong>
|
|
</p>Müller, D., Danner, M., Rhiem, K., Stollenwerk, B., Engel, C., Rasche, L., Borsi, L., Schmutzler, R., Stock, S., Cost-effectiveness of different strategies to prevent breast and ovarian cancer in German women with a BRCA 1 or 2 mutation, The European Journal of Health Economics, 19, 341–53, 2018
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[<a href="https://pubmed.ncbi.nlm.nih.gov/28382503" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28382503</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng241er11.s1.ref5"><p id="p-242">
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|
<strong>Phillpot 2023</strong>
|
|
</p>Philpott, S., Raikou, M., Manchanda, R., Lockley, M., Singh, N., Scott, M., et al., The avoiding late diagnosis of ovarian cancer (ALDO) project; a pilot national surveillance programme for women with pathogenic germline variants in BRCA1 and BRCA2, Journal of medical genetics, 60, 440–49, 2023
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[<a href="/pmc/articles/PMC10176325/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10176325</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/36319079" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 36319079</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng241er11.s1.ref6"><p id="p-243">
|
|
<strong>Yamauchi 2018</strong>
|
|
</p>Yamauchi, H., Nakagawa, C., Kobayashi, M., Kobayashi, Y., Mano, T., Nakamura, S., Arai
|
|
M., Cost-effectiveness of surveillance and prevention strategies in BRCA1/2 mutation carriers, Breast Cancer, 25,141–50, 2018
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/29019095" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29019095</span></a>]</div></p></li></ul></div></ul></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng241er11.appa"><h3>Appendix A. Review protocol</h3><p id="niceng241er11.appa.et1"><a href="/books/NBK604294/bin/niceng241er11-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for review question: What are the benefits and risks of surveillance for women at increased risk of familial ovarian cancer?</a><span class="small"> (PDF, 258K)</span></p></div><div id="niceng241er11.appb"><h3>Appendix B. Literature search strategies</h3><p id="niceng241er11.appb.et1"><a href="/books/NBK604294/bin/niceng241er11-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Literature search strategies for review question: What are the benefits and risks of surveillance for women at increased risk of familial ovarian cancer?</a><span class="small"> (PDF, 234K)</span></p></div><div id="niceng241er11.appc"><h3>Appendix C. Effectiveness evidence study selection</h3><p id="niceng241er11.appc.et1"><a href="/books/NBK604294/bin/niceng241er11-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Study selection for: What are the benefits and risks of surveillance for women at increased risk of familial ovarian cancer?</a><span class="small"> (PDF, 273K)</span></p></div><div id="niceng241er11.appd"><h3>Appendix D. Evidence tables</h3><p id="niceng241er11.appd.et1"><a href="/books/NBK604294/bin/niceng241er11-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Evidence tables for review question: What are the benefits and risks of surveillance for women at increased risk of familial ovarian cancer?</a><span class="small"> (PDF, 272K)</span></p></div><div id="niceng241er11.appe"><h3>Appendix E. Forest plots</h3><div id="niceng241er11.appe.s1"><h4>Forest plots for review question: What are the benefits and risks of surveillance for women at increased risk of familial ovarian cancer?</h4><p>No meta-analysis was conducted for this review question and so there are no forest plots.</p></div></div><div id="niceng241er11.appf"><h3>Appendix F. GRADE tables</h3><p id="niceng241er11.appf.et1"><a href="/books/NBK604294/bin/niceng241er11-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">GRADE tables for review question: What are the benefits and risks of surveillance for women at increased risk of familial ovarian cancer?</a><span class="small"> (PDF, 217K)</span></p></div><div id="niceng241er11.appg"><h3>Appendix G. Economic evidence study selection</h3><div id="niceng241er11.appg.s1"><h4>Study selection for: What are the benefits and risks of surveillance for women at increased risk of familial ovarian cancer?</h4><p>One global search was undertaken – please see <a href="/books/NBK604294/bin/NG241-Supplement2-Economic-Literature-pdf.pdf">Supplement 2</a> for details on study selection.</p></div></div><div id="niceng241er11.apph"><h3>Appendix H. Economic evidence tables</h3><p id="niceng241er11.apph.et1"><a href="/books/NBK604294/bin/niceng241er11-apph-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Economic evidence tables for review question: What are the benefits and risks of surveillance for women at increased risk of familial ovarian cancer?</a><span class="small"> (PDF, 218K)</span></p></div><div id="niceng241er11.appi"><h3>Appendix I. Economic model</h3><div id="niceng241er11.appi.s1"><h4>Economic model for review question: What are the benefits and risks of surveillance for women at increased risk of familial ovarian cancer?</h4><p>No economic analysis was conducted for this review question.</p></div></div><div id="niceng241er11.appj"><h3>Appendix J. Excluded studies</h3><div id="niceng241er11.appj.s1"><h4>Excluded studies for review question: What are the benefits and risks of surveillance for women at increased risk of familial ovarian cancer?</h4></div><div id="niceng241er11.appj.s2"><h4>Excluded effectiveness/diagnostic studies</h4><p>One literature search was performed for the review questions K and L. Studies included in this review were excluded from review L and studies included in review L were excluded from this review however, these studies do not appear in the ‘Records excluded’ box in Figure 1, or in the respective excluded studies tables below.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng241er11appjtab1"><a href="/books/NBK604294/table/niceng241er11.appj.tab1/?report=objectonly" target="object" title="Table 8" class="img_link icnblk_img" rid-ob="figobniceng241er11appjtab1"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng241er11.appj.tab1"><a href="/books/NBK604294/table/niceng241er11.appj.tab1/?report=objectonly" target="object" rid-ob="figobniceng241er11appjtab1">Table 8</a></h4><p class="float-caption no_bottom_margin">Excluded studies and reasons for their exclusion. </p></div></div></div><div id="niceng241er11.appj.s3"><h4>Excluded economic studies</h4><p>See <a href="/books/NBK604294/bin/NG241-Supplement2-Economic-Literature-pdf.pdf">Supplement 2</a> for the list of excluded studies across all reviews.</p></div></div><div id="niceng241er11.appk"><h3>Appendix K. Research recommendations – full details</h3><p id="niceng241er11.appk.et1"><a href="/books/NBK604294/bin/niceng241er11-appk-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Research recommendations for review question: What are the benefits and risks of surveillance for women at increased risk of familial ovarian cancer?</a><span class="small"> (PDF, 176K)</span></p></div><div id="niceng241er11.appl"><h3>Appendix L. Testimony from expert witness</h3><p id="niceng241er11.appl.et1"><a href="/books/NBK604294/bin/niceng241er11-appl-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Testimony from expert witness for review question: What are the benefits and risks of surveillance for women at increased risk of familial ovarian cancer?</a><span class="small"> (PDF, 173K)</span></p></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Evidence reviews underpinning recommendations 1.8.18 to 1.8.20 (including information on surveillance in <a href="/books/NBK604294/table/niceng241er11.tab3/?report=objectonly" target="object" rid-ob="figobniceng241er11tab3">table 3</a>) and research recommendation 4 in the NICE guideline</p><p>This evidence review was developed by NICE</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="https://www.gov.wales/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2024.</div><div class="small"><span class="label">Bookshelf ID: NBK604294</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/38889258" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">38889258</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng241er11tab1"><div id="niceng241er11.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">Summary of the protocol (PICO table)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK604294/table/niceng241er11.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng241er11.tab1_lrgtbl__"><table class="no_bottom_margin"><tbody><tr><th id="hd_b_niceng241er11.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng241er11.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Women at increased risk of familial ovarian cancer</td></tr><tr><th id="hd_b_niceng241er11.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><td headers="hd_b_niceng241er11.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Regular (for example annual) screening for ovarian cancer using a combination of:
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|
<ul><li class="half_rhythm"><div>CA125 test</div></li><li class="half_rhythm"><div>Imaging:
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|
<ul class="circle"><li class="half_rhythm"><div>transvaginal ultrasound (TVUS)</div></li><li class="half_rhythm"><div>MRI</div></li><li class="half_rhythm"><div>CT</div></li></ul></div></li><li class="half_rhythm"><div>Prediction rules:
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|
<ul class="circle"><li class="half_rhythm"><div>Risk of Ovarian Cancer Algorithm test (the ROCA Test)</div></li><li class="half_rhythm"><div>multi-maker algorithms</div></li><li class="half_rhythm"><div>mathematical evaluation (other algorithms or techniques)</div></li></ul></div></li></ul></td></tr><tr><th id="hd_b_niceng241er11.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><td headers="hd_b_niceng241er11.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>No surveillance</div></li><li class="half_rhythm"><div>Risk reducing treatments:
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|
<ul class="circle"><li class="half_rhythm"><div>surgery</div></li><li class="half_rhythm"><div>chemoprevention</div></li></ul></div></li></ul></td></tr><tr><th id="hd_b_niceng241er11.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_niceng241er11.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Critical</b>
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|
<ul><li class="half_rhythm"><div>Quality of life</div></li><li class="half_rhythm"><div>Survival:
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|
<ul class="circle"><li class="half_rhythm"><div>cancer specific survival</div></li><li class="half_rhythm"><div>overall survival</div></li><li class="half_rhythm"><div>recurrence free survival (surrogates: zero residual after definitive ovarian cancer treatment)</div></li></ul></div></li><li class="half_rhythm"><div>Ovarian cancer:
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<ul class="circle"><li class="half_rhythm"><div>incidence</div></li><li class="half_rhythm"><div>stage at diagnosis</div></li><li class="half_rhythm"><div>screen detected and interval related cancers</div></li><li class="half_rhythm"><div>histological type</div></li></ul></div></li></ul>
|
|
<b>Important</b>
|
|
<ul><li class="half_rhythm"><div>Treatment related adverse effects and test related morbidity such as:
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|
<ul class="circle"><li class="half_rhythm"><div>anxiety</div></li><li class="half_rhythm"><div>investigation of false positive results</div></li></ul></div></li><li class="half_rhythm"><div>Psychological outcomes and wellbeing including:
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|
<ul class="circle"><li class="half_rhythm"><div>patient satisfaction</div></li><li class="half_rhythm"><div>acceptability and attitudes</div></li></ul></div></li><li class="half_rhythm"><div>Healthcare use</div></li></ul></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">CA125: cancer antigen 125; CT: computer tomography; MRI: magnetic resonance imaging; ROCA: risk of ovarian cancer algorithm; TVUS: transvaginal ultrasound</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng241er11tab2"><div id="niceng241er11.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of included studies</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK604294/table/niceng241er11.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng241er11.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng241er11.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng241er11.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng241er11.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><th id="hd_h_niceng241er11.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><th id="hd_h_niceng241er11.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><th id="hd_h_niceng241er11.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng241er11.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng241er11.s1.ref1" rid="niceng241er11.s1.ref1">Lai 2016</a>
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</p>
|
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<p>(PLCO trial)</p>
|
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<p>RCT</p>
|
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<p>USA</p>
|
|
</td><td headers="hd_h_niceng241er11.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N=22355 with family history of breast or ovarian cancer</p>
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<p>Age, mean (SD), years: OCS 62.8 (5.4); usual medical care 62.9 (5.5)</p>
|
|
</td><td headers="hd_h_niceng241er11.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>
|
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<u>OCS</u>
|
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</p>
|
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<p>Baseline pelvic ultrasound and serum CA125, with subsequent annual pelvic ultrasound for an additional 3 years, and annual CA-125 for 5 years</p>
|
|
</td><td headers="hd_h_niceng241er11.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>
|
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<u>Usual medical care</u>
|
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</p>
|
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<p>No details reported other than that the women did not undergo cancer specific screening</p>
|
|
</td><td headers="hd_h_niceng241er11.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Survival
|
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<ul class="circle"><li class="half_rhythm"><div>overall survival</div></li><li class="half_rhythm"><div>overall mortality</div></li><li class="half_rhythm"><div>ovarian cancer specific mortality</div></li></ul></div></li><li class="half_rhythm"><div>Ovarian cancer
|
|
<ul class="circle"><li class="half_rhythm"><div>stage at diagnosis</div></li></ul></div></li></ul></td><td headers="hd_h_niceng241er11.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Most patients did not have genetic tests, so their level of cancer risk is uncertain. It is likely that they are a heterogeneous group with an intermediate to moderate cancer risk</td></tr><tr><td headers="hd_h_niceng241er11.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng241er11.s1.ref2" rid="niceng241er11.s1.ref2">Mai 2020</a>
|
|
</p>
|
|
<p>(GOG-0199 study)</p>
|
|
<p>USA</p>
|
|
<p>Prospective cohort</p>
|
|
</td><td headers="hd_h_niceng241er11.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=1780 with family history of ovarian cancer or ≥ 20% probability of pathogenic <i>BRCA1/2</i> variant</p>
|
|
<p>Age, mean (SD), years: not reported</p>
|
|
<p>Age-groups (years, %):</p>
|
|
<p>RRSO 30-39 = 17.08%, 40-49 = 42.53%, 50-59 = 30.25%, 60-69 = 8.36%, >=70 = 1.78%;</p>
|
|
<p>OCS 30-39 = 27.13%, 40-49 = 31.78%, 50-59 = 29.8%, 60-69 = 9.9%, >=70 = 1.39%</p>
|
|
</td><td headers="hd_h_niceng241er11.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<u>OCS</u>
|
|
</p>
|
|
<p>Participants were screened according to the ROCA Test, with CA125 measurements and the ROCA Test score calculations every 3 months and annual transvaginal ultrasound</p>
|
|
</td><td headers="hd_h_niceng241er11.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<u>RRSO</u>
|
|
</p>
|
|
<p>Participants underwent the protocol-defined procedure within 90 days of enrolment. Hysterectomy was performed electively per patient and physician discretion</p>
|
|
</td><td headers="hd_h_niceng241er11.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Quality of life
|
|
<ul class="circle"><li class="half_rhythm"><div>MOS SF-36</div></li><li class="half_rhythm"><div>IES overall</div></li></ul></div></li><li class="half_rhythm"><div>Anxiety
|
|
<ul class="circle"><li class="half_rhythm"><div>STAI</div></li></ul></div></li><li class="half_rhythm"><div>Psychological outcomes and wellbeing
|
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<ul class="circle"><li class="half_rhythm"><div>CES-D</div></li></ul></div></li></ul></td><td headers="hd_h_niceng241er11.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">CES-D: The Center for Epidemiology Studies Depression Scale; GOG: The Gynecologic Oncology Group trial; IES: The Impact of Events Scale (IES); MOS SF-36: The Medical Outcome Study Short Form-36; OCS: ovarian cancer screening; PLCO: The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial; ROCA: Risk of Ovarian Cancer Algorithm; RRSO: risk reducing salpingo-oophorectomy; SD: standard deviation; STAI: Spielberger State-Trait Anxiety Inventory</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng241er11tab3"><div id="niceng241er11.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Economic evidence profile of a systematic review of economic evaluations of intensified surveillance (IS) for women <i>BRCA</i> mutation carriers</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK604294/table/niceng241er11.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng241er11.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng241er11.tab3_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng241er11.tab3_1_1_1_1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_niceng241er11.tab3_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng241er11.tab3_1_1_1_2" style="text-align:left;vertical-align:bottom;">Limitations</th><th id="hd_h_niceng241er11.tab3_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng241er11.tab3_1_1_1_3" style="text-align:left;vertical-align:bottom;">Applicability</th><th id="hd_h_niceng241er11.tab3_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng241er11.tab3_1_1_1_4" style="text-align:left;vertical-align:bottom;">Other comments</th><th id="hd_h_niceng241er11.tab3_1_1_1_5" colspan="3" rowspan="1" style="text-align:left;vertical-align:bottom;">Incremental</th><th id="hd_h_niceng241er11.tab3_1_1_1_6" rowspan="2" colspan="1" headers="hd_h_niceng241er11.tab3_1_1_1_6" style="text-align:left;vertical-align:bottom;">Uncertainty</th></tr><tr><th headers="hd_h_niceng241er11.tab3_1_1_1_5" id="hd_h_niceng241er11.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Costs <sup>[1]</sup></th><th headers="hd_h_niceng241er11.tab3_1_1_1_5" id="hd_h_niceng241er11.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect (QALYs)</th><th headers="hd_h_niceng241er11.tab3_1_1_1_5" id="hd_h_niceng241er11.tab3_1_1_2_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Cost effectiveness</th></tr></thead><tbody><tr><td headers="hd_h_niceng241er11.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng241er11.s1.ref3" rid="niceng241er11.s1.ref3">Bommer 2022</a>
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</p>
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<p>Switzerland</p>
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</td><td headers="hd_h_niceng241er11.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Minor <sup>[2]</sup></td><td headers="hd_h_niceng241er11.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Partially <sup>[3]</sup></td><td headers="hd_h_niceng241er11.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Modelling study (Markov)</p>
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<p>Female <i>BRCA</i> mutation carriers aged 40 years</p>
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<p>Time horizon: 60 years (lifetime)</p>
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<p>IS: Age-related imaging procedures and gynaecological consultations</p>
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<p>Comparators: Preventative bilateral mastectomy (PBM); preventative bilateral salpingo-oophorectomy (PBSO); PBM plus PBSO; chemoprevention with Tamoxifen (CP)</p>
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<p>Results presented for <i>BRCA1</i> and <i>BRCA2</i> carriers, separately</p>
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</td><td headers="hd_h_niceng241er11.tab3_1_1_1_5 hd_h_niceng241er11.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<i>BRCA1</i>
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</p>
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<p>IS vs</p>
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<p>CP: £2,534</p>
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<p>PBM: £14,898</p>
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<p>PBSO: £16,645</p>
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<p>PBM & PBSO: £37,787</p>
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<p>
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<i>BRCA2</i>
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</p>
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<p>IS vs</p>
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<p>CP: £3,012</p>
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<p>PBM: £13,891</p>
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<p>PBSO: £18,517</p>
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<p>PBM & PBSO: £24,240</p>
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</td><td headers="hd_h_niceng241er11.tab3_1_1_1_5 hd_h_niceng241er11.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<i>BRCA1</i>
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</p>
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<p>IS vs</p>
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<p>CP: - 0.76</p>
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<p>PBM: - 2.8</p>
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<p>PBSO: - 2.31</p>
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<p>PBM & PBSO: - 4.76</p>
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<p>
|
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<i>BRCA2</i>
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</p>
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<p>IS vs</p>
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<p>CP: - 1.33</p>
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<p>PBM: - 2.06</p>
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<p>PBSO: - 2.06</p>
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<p>PBM & PBSO: - 2.06</p>
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</td><td headers="hd_h_niceng241er11.tab3_1_1_1_5 hd_h_niceng241er11.tab3_1_1_2_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IS dominated by all other options</td><td headers="hd_h_niceng241er11.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>-The probability of IS being cost-effective at a willingness-to-pay (WTP) from £0 to £58,445/QALY gained: 0.00</p>
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<p>-Changes in ovarian cancer (OC) incidence after primary breast cancer (BC), PBSO costs, hazard ratio of PBSO, PBM costs with implant reconstruction, costs of implant replacement, utility values of IS and CP have the most effects on the incremental cost-effectiveness ratios (ICERs). However, the conclusions were unchanged.</p>
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</td></tr><tr><td headers="hd_h_niceng241er11.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
|
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<a class="bibr" href="#niceng241er11.s1.ref4" rid="niceng241er11.s1.ref4">Muller 2018</a>
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</p>
|
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<p>Germany</p>
|
|
</td><td headers="hd_h_niceng241er11.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Minor <sup>[4]</sup></td><td headers="hd_h_niceng241er11.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Partially <sup>[5]</sup></td><td headers="hd_h_niceng241er11.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Modelling study (Markov)</p>
|
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<p>Female <i>BRCA</i> mutation carriers aged 30 years</p>
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<p>Time horizon: 75 years (lifetime)</p>
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<p>IS: Half-yearly palpation and ultrasound, yearly mammography, and breast magnetic resonance imaging</p>
|
|
<p>Comparators: PBM; PBSO; PBM+PBSO at age 40; PBM+PBSO at age 30</p>
|
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</td><td headers="hd_h_niceng241er11.tab3_1_1_1_5 hd_h_niceng241er11.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>IS vs</p>
|
|
<p>PBM + PBSO at age 30: £14,585</p>
|
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<p>PBM + PBSO at age 40: £13,334</p>
|
|
<p>PBSO: £9,706</p>
|
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<p>PBM: £7,429</p>
|
|
</td><td headers="hd_h_niceng241er11.tab3_1_1_1_5 hd_h_niceng241er11.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>IS vs</p>
|
|
<p>PBM + PBSO at age 30: - 2.7</p>
|
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<p>PBM + PBSO at age 40: - 2.32</p>
|
|
<p>PBSO: - 1.75</p>
|
|
<p>PBM: - 1.31</p>
|
|
</td><td headers="hd_h_niceng241er11.tab3_1_1_1_5 hd_h_niceng241er11.tab3_1_1_2_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IS dominated by all other options</td><td headers="hd_h_niceng241er11.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>-The probability of IS being cost-effective at WTP of £45,447/QALY gained: 0.00</p>
|
|
<p>-The results were robust, including changes in cancer incidence, mortality, utility assumptions, the efficacy of surgical options, the discount rate, differentiating between ‘ovarian cancer’ (<stage 4) and ‘recurrent ovarian cancer’ (stage 4) states</p>
|
|
<p>- Only in case of a lower OC incidence or both OC and BC incidence, does PBM + PBSO at age 40 result in lower costs, but PBS + PBSO at age 30 remains the cost-effective option</p>
|
|
<p>-Assuming that the utility after prophylactic surgery increased to that of a healthy woman within a period of 25 years (base-case: 5 years), the ICER of PBM + PBSO at age 40 (vs PBM + PBSO at age 30): £6,272/QALY</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng241er11.s1.ref5" rid="niceng241er11.s1.ref5">Philpott (2023)</a>
|
|
</p>
|
|
<p>UK</p>
|
|
</td><td headers="hd_h_niceng241er11.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Potentially serious <sup>[6]</sup></td><td headers="hd_h_niceng241er11.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Directly applicable <sup>[7]</sup></td><td headers="hd_h_niceng241er11.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Modelling study (Markov)</p>
|
|
<p>Female <i>BRCA</i> mutation carriers aged 35 years</p>
|
|
<p>Time horizon: Lifetime</p>
|
|
<p>IS: The ROCA Test</p>
|
|
<p>Comparator: No surveillance (control women were assumed to have the option of undergoing risk-reducing salpingo-oophorectomy, remaining disease-free or developing ovarian cancer and entering the associated therapy)</p>
|
|
</td><td headers="hd_h_niceng241er11.tab3_1_1_1_5 hd_h_niceng241er11.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-£18,340</td><td headers="hd_h_niceng241er11.tab3_1_1_1_5 hd_h_niceng241er11.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.179</td><td headers="hd_h_niceng241er11.tab3_1_1_1_5 hd_h_niceng241er11.tab3_1_1_2_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IS dominant</td><td headers="hd_h_niceng241er11.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>-No PSA or statistical analysis for costs or QALYs, only deterministic sensitivity analyses</p>
|
|
<p>- At the ROCA Test unit cost of £585 (base case £150), the ICER of surveillance was £987/QALY gained</p>
|
|
<p>- Surveillance remained dominant when varying surveillance duration from 50-80 years</p>
|
|
<p>- Only at the early-stage (stages 1/2) cancer detection rate set at 11.5% (base case: 33.3%) the ICER of surveillance increased to £971/QALY gained</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng241er11.s1.ref6" rid="niceng241er11.s1.ref6">Yamauchi 2018</a>
|
|
</p>
|
|
<p>Japan</p>
|
|
</td><td headers="hd_h_niceng241er11.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Potentially serious <sup>[8]</sup></td><td headers="hd_h_niceng241er11.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Partially <sup>[9]</sup></td><td headers="hd_h_niceng241er11.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Modelling study (Markov)</p>
|
|
<p>Female <i>BRCA</i> mutation carriers aged 35 years</p>
|
|
<p>Time horizon: 35 years</p>
|
|
<p>IS: Undefined</p>
|
|
<p>Comparators: PBM at age 35 + PBSO at age 45; IS from age 35, PBSO at age 45; PBM at age 35</p>
|
|
<p>Results presented for <i>BRCA1</i> and <i>BRCA2</i> carriers, separately</p>
|
|
</td><td headers="hd_h_niceng241er11.tab3_1_1_1_5 hd_h_niceng241er11.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<i>BRCA1</i>
|
|
</p>
|
|
<p>IS at 35 years vs</p>
|
|
<p>PBM at age 35, PBSO at age 45: £5,345</p>
|
|
<p>IS from age 35, PBSO at age 45: £2,148</p>
|
|
<p>PBM at age 35: - £449</p>
|
|
<p>
|
|
<i>BRCA2</i>
|
|
</p>
|
|
<p>IS at 35 years vs</p>
|
|
<p>PBM at age 35: £6,637</p>
|
|
<p>PBM at age 35, PBSO at age 45: £3,226</p>
|
|
<p>IS from age 35, PBSO at age 45: - £4,155</p>
|
|
</td><td headers="hd_h_niceng241er11.tab3_1_1_1_5 hd_h_niceng241er11.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<i>BRCA1</i>
|
|
</p>
|
|
<p>IS at 35 years vs</p>
|
|
<p>PBM at age 35, PBSO at age 45: - 1.49</p>
|
|
<p>IS from age 35, PBSO at age 45: - 1.43</p>
|
|
<p>PBM at age 35: - 1.04</p>
|
|
<p>
|
|
<i>BRCA2</i>
|
|
</p>
|
|
<p>IS at 35 years vs</p>
|
|
<p>PBM at age 35: - 1.82</p>
|
|
<p>PBM at age 35, PBSO at age 45: - 0.91</p>
|
|
<p>IS from age 35, PBSO at age 45: - 0.65</p>
|
|
</td><td headers="hd_h_niceng241er11.tab3_1_1_1_5 hd_h_niceng241er11.tab3_1_1_2_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IS not cost-effective, that is for <i>BRCA1</i> PBM at age 35 plus PBSO at age 45 was dominant, and for <i>BRCA2</i> PBM at age 35 was dominant</td><td headers="hd_h_niceng241er11.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Findings robust to model inputs, including probabilities and costs. However, using lower values for some utilities for preventative surgical procedures resulted in changes in results that favoured IS, but results were not reported.</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Abbreviations: BC: Breast cancer; CP: Chemoprevention; ICER: Incremental cost-effectiveness ratio; IS: Intensified surveillance; OC: Ovarian cancer; PBM: Preventative bilateral mastectomy; PBSO: Preventative bilateral salpingo-oophorectomy; QALY: Quality-adjusted life-year; WTP: Willingness-to-pay</p></div></dd></dl><dl class="bkr_refwrap"><dt>[1]</dt><dd><div id="niceng241er11.tab3_1"><p class="no_margin">Costs were converted to UK pounds using OECD purchasing power parities (PPPs)</p></div></dd></dl><dl class="bkr_refwrap"><dt>[2]</dt><dd><div id="niceng241er11.tab3_2"><p class="no_margin">Effectiveness for preventative options from single cohort studies, some resource use data/cost data supplemented by authors’ assumptions</p></div></dd></dl><dl class="bkr_refwrap"><dt>[3]</dt><dd><div id="niceng241er11.tab3_3"><p class="no_margin">Swiss healthcare setting, QALYs estimated</p></div></dd></dl><dl class="bkr_refwrap"><dt>[4]</dt><dd><div id="niceng241er11.tab3_4"><p class="no_margin">Effectiveness for preventative options from single cohort studies, some local unit cost data</p></div></dd></dl><dl class="bkr_refwrap"><dt>[5]</dt><dd><div id="niceng241er11.tab3_5"><p class="no_margin">German healthcare setting, QALYs estimated</p></div></dd></dl><dl class="bkr_refwrap"><dt>[6]</dt><dd><div id="niceng241er11.tab3_6"><p class="no_margin">The effectiveness of ROCA, based on a single-arm trial with only a one-year follow-up, assumes that cancer downstaging results in a survival advantage. However, the evidence supporting this is limited. Additionally, some model inputs are derived from the general ovarian cancer population and these may not be generalisable to individuals with pathogenic variants. There is also limited reporting on the health economic analysis and a PSA was not performed.</p></div></dd></dl><dl class="bkr_refwrap"><dt>[7]</dt><dd><div id="niceng241er11.tab3_7"><p class="no_margin">UK study, QALYs estimated</p></div></dd></dl><dl class="bkr_refwrap"><dt>[8]</dt><dd><div id="niceng241er11.tab3_8"><p class="no_margin">Effectiveness for preventative options from single case-control and cohort studies; unclear reporting with some results not fully reported (for example the direction of deterministic sensitivity analysis results described in the text, but detailed results are not reported making it difficult to understand whether conclusions have changed); no probabilistic sensitivity analysis; unclear why the analysis did not consider lifetime horizon</p></div></dd></dl><dl class="bkr_refwrap"><dt>[9]</dt><dd><div id="niceng241er11.tab3_9"><p class="no_margin">Japanese healthcare setting, QALYs estimated</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng241er11appjtab1"><div id="niceng241er11.appj.tab1" class="table"><h3><span class="label">Table 8</span><span class="title">Excluded studies and reasons for their exclusion</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK604294/table/niceng241er11.appj.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng241er11.appj.tab1_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Andersen, M Robyn, Drescher, Charles W, Zheng, Yingye
|
|
et al. (2007) Changes in cancer worry associated with participation in ovarian cancer screening. Psycho-oncology
|
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16(9): 814–20
|
|
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/17225260" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17225260</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population in study does not match that specified in this review protocol</p>
|
|
<p>W<i>omen not at increased risk of familial ovarian cancer</i></p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Andersen, M Robyn, Karlan, Beth Y, Drescher, Charles W
|
|
et al. (2019) False-positive screening events and worry influence decisions about surgery among high-risk women. Health psychology: official journal of the Division of Health Psychology, American Psychological Association
|
|
38(1): 43–52
|
|
[<a href="/pmc/articles/PMC6738558/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6738558</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30431292" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30431292</span></a>]
|
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</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Outcomes in study do not match those specified in this review protocol<i>Secondary analysis of Karlan 2014</i></td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Auranen, Annika and Joutsiniemi, Titta (2011) A systematic review of gynecological cancer surveillance in women belonging to hereditary nonpolyposis colorectal cancer (Lynch syndrome) families. Acta obstetricia et gynecologica Scandinavica
|
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90(5): 437–44
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/21306348" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21306348</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Systematic review used as source of primary studies</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Belkic, K.L., Cohen, M., Marquez, M.
|
|
et al. (2010) Screening of high-risk groups for breast and ovarian cancer in Europe: A focus on the Jewish population. Oncology Reviews
|
|
4(4): 233–267
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Systematic review used as source of primary studies</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Bermejo-Perez, M J; Marquez-Calderon, S; Llanos-Mendez, A (2007) Effectiveness of preventive interventions in BRCA1/2 gene mutation carriers: a systematic review. International journal of cancer
|
|
121(2): 225–31
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/17471565" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17471565</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Systematic review used as source of primary studies</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Bermejo-Perez, M J; Marquez-Calderon, S; Llanos-Mendez, A (2008) Cancer surveillance based on imaging techniques in carriers of BRCA1/2 gene mutations: a systematic review. The British journal of radiology
|
|
81(963): 172–9
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/18208856" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18208856</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Systematic review used as source of primary studies</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Blyuss, Oleg, Burnell, Matthew, Ryan, Andy
|
|
et al. (2018) Comparison of Longitudinal CA125 Algorithms as a First-Line Screen for Ovarian Cancer in the General Population. Clinical cancer research : an official journal of the American Association for Cancer Research
|
|
24(19): 4726–4733
|
|
[<a href="/pmc/articles/PMC6171745/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6171745</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30084833" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30084833</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population in study does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Women with increased risk of familial ovarian cancer were excluded</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Bourne, T H, Campbell, S, Reynolds, K
|
|
et al. (1994) The potential role of serum CA 125 in an ultrasound-based screening program for familial ovarian cancer. Gynecologic oncology
|
|
52(3): 379–85
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/8157195" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8157195</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Outcomes in study do not match those specified in this review protocol</p>
|
|
<p>
|
|
<i>Outcomes reported for screening group only</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Buys, Saundra S, Partridge, Edward, Black, Amanda
|
|
et al. (2011) Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial. JAMA
|
|
305(22): 2295–2303
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/21642681" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21642681</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population in study does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Results not reported separately for the subgroup s of women with a family or personal history of ovarian cancer. Trialists contacted to ask for this subgroup data</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Debniak, Tadeusz, Gromowski, Tomasz, Scott, Rodney J
|
|
et al. (2015) Management of ovarian and endometrial cancers in women belonging to HNPCC carrier families: review of the literature and results of cancer risk assessment in Polish HNPCC families. Hereditary cancer in clinical practice
|
|
13(1): 3
|
|
[<a href="/pmc/articles/PMC4300044/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4300044</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25606063" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25606063</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Intervention in study does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>No details of surveillance protocol used for ovarian cancer</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Drescher, Charles W, Nelson, Judy, Peacock, Sue
|
|
et al. (2004) Compliance of average- and intermediate-risk women to semiannual ovarian cancer screening. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
|
|
13(4): 600–6 [<a href="https://pubmed.ncbi.nlm.nih.gov/15066925" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15066925</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Outcomes in study do not match those specified in this review protocol</p>
|
|
<p>
|
|
<i>Compliance with screening only</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Eikenboom, E.L., Van Doorn, H.C., Dinjens, W.N.M.
|
|
et al. (2021) Gynecological surveillance and surgery outcomes in dutch lynch syndrome carriers. Cancers
|
|
13(3): 1–16 [<a href="/pmc/articles/PMC7865882/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7865882</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33530354" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33530354</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Intervention in study does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Study assesses gynaecological tumours and gynaecological management in Lynch Syndrome carriers</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Eleje, George U, Eke, Ahizechukwu C, Ezebialu, Ifeanyichukwu U
|
|
et al. (2018) Risk-reducing bilateral salpingo-oophorectomy in women with BRCA1 or BRCA2 mutations. The Cochrane database of systematic reviews
|
|
8: cd012464
|
|
[<a href="/pmc/articles/PMC6513554/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6513554</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30141832" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30141832</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Intervention in study does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>RRSO is compared to general surveillance or non-RRSO - but no details of surveillance protocols are given</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Fatouros, Michael; Baltoyiannis, Georgios; Roukos, Dimitrios H (2008) The predominant role of surgery in the prevention and new trends in the surgical treatment of women with BRCA1/2 mutations. Annals of surgical oncology
|
|
15(1): 21–33
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/17940826" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17940826</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Systematic review used as source of primary studies</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Fries, Melissa H, Hailey, B Jo, Flanagan, Judith
|
|
et al. (2004) Outcome of five years of accelerated surveillance in patients at high risk for inherited breast/ovarian cancer: report of a phase II trial. Military medicine
|
|
169(6): 411–6
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/15281667" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15281667</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Comparator in study does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Does not compare surveillance to an alternative strategy</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Fry, A, Busby-Earle, C, Rush, R
|
|
et al. (2001) Prophylactic oophorectomy versus screening: psychosocial outcomes in women at increased risk of ovarian cancer. Psycho-oncology
|
|
10(3): 231–41
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/11351375" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11351375</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Non-randomised study, does not adjust for confounders in the analysis</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Gentry-Maharaj, A., Blyuss, O., Ryan, A.
|
|
et al. (2020) Multi-marker longitudinal algorithms incorporating HE4 and CA125 in ovarian cancer screening of postmenopausal women. Cancers
|
|
12(7): 1–12 [<a href="/pmc/articles/PMC7409061/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7409061</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32708856" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32708856</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population in study does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Women with increased risk of familial ovarian cancer were excluded</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Gentry-Maharaj, A, Sharma, A, Burnell, M
|
|
et al. (2013) Acceptance of transvaginal sonography by postmenopausal women participating in the United Kingdom Collaborative Trial of Ovarian Cancer Screening. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
|
|
41(1): 73–9
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/22791597" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22791597</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population in study does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Women with increased risk of familial ovarian cancer were excluded</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Gopie, Jessica P; Vasen, Hans F A; Tibben, Aad (2012) Surveillance for hereditary cancer: does the benefit outweigh the psychological burden?--A systematic review. Critical reviews in oncology/hematology
|
|
83(3): 329–40
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/22366115" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22366115</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Systematic review used as source of primary studies</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Grandi, Giovanni, Fiocchi, Federica, Cortesi, Laura
|
|
et al. (2021) The challenging screen detection of ovarian cancer in BRCA mutation carriers adhering to a 6-month follow-up program: results from a 6-years surveillance. Menopause (New York, N.Y.) 29(1): 63–72
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/34726192" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34726192</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Secondary publication of an included study that does not provide any additional relevant information</p>
|
|
<p>
|
|
<i>See Cortesi 2017</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Gronwald, Jacek, Lubinski, Jan, Huzarski, Tomasz
|
|
et al. (2019) A comparison of ovarian cancer mortality in women with BRCA1 mutations undergoing annual ultrasound screening or preventive oophorectomy. Gynecologic oncology
|
|
155(2): 270–274
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/31500890" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31500890</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design does not match that specified in this review protocol</p>
|
|
<p><i>Comparisons between groups not</i>
|
|
<i>adjusted for baseline differences</i></p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Haque, Reina, Skates, Steven J, Armstrong, Mary Anne
|
|
et al. (2020) Feasibility, patient compliance and acceptability of ovarian cancer surveillance using two serum biomarkers and Risk of Ovarian Cancer Algorithm compared to standard ultrasound and CA 125 among women with BRCA mutations. Gynecologic oncology
|
|
157(2): 521–528
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/32145911" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32145911</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Secondary publication of an included study that does not provide any additional relevant information</p>
|
|
<p>
|
|
<i>See Lentz 2020</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Henderson, J.T.; Webber, E.M.; Sawaya, G.F. (2018) Screening for ovarian cancer updated evidence report and systematic review for the US preventive services task force. JAMA - Journal of the American Medical Association
|
|
319(6): 595–606
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/29450530" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29450530</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Systematic review used as source of primary studies</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Jacobs, Ian J, Menon, Usha, Ryan, Andy
|
|
et al. (2016) Ovarian cancer screening and mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet (London, England) 387(10022): 945–956
|
|
[<a href="/pmc/articles/PMC4779792/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4779792</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26707054" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26707054</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population in study does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Women with increased risk of familial ovarian cancer were excluded</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Kobayashi, H, Yamada, Y, Sado, T
|
|
et al. (2008) A randomized study of screening for ovarian cancer: a multicenter study in Japan. Int. J. Gynecol. Cancer
|
|
18(3): 414–420
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/17645503" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17645503</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population in study does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Participants not at increased risk of familial ovarian cancer. No subgroup analysis of increased risk groups</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Lacey
|
|
Jr., J.V., Greene, M.H., Buys, S.S.
|
|
et al. (2006) Ovarian cancer screening in women with a family history of breast or ovarian cancer. Obstetrics and Gynecology
|
|
108(5): 1176–1184
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/17077240" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17077240</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Outcomes in study do not match those specified in this review protocol</p>
|
|
<p><i>Insufficient data to calculate diagnostic outcomes</i>.</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Laframboise, Stephane, Nedelcu, R, Murphy, J
|
|
et al. (2002) Use of CA-125 and ultrasound in high-risk women. International journal of gynecological cancer: official journal of the International Gynecological Cancer Society
|
|
12(1): 86–91
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/11860541" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11860541</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Outcomes in study do not match those specified in this review protocol</p>
|
|
<p>
|
|
<i>Insufficient data to calculate diagnostic outcomes</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Li, Jiaxin, Jia, Ziqi, Zhang, Menglu
|
|
et al. (2021) Cost-Effectiveness Analysis of Imaging Modalities for Breast Cancer Surveillance Among BRCA1/2 Mutation Carriers: A Systematic Review. Frontiers in oncology
|
|
11: 763161
|
|
[<a href="/pmc/articles/PMC8785233/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8785233</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35083138" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35083138</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Systematic review used as source of primary studies</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Lim, Natalie, Hickey, Martha, Young, Graeme P
|
|
et al. (2022) Screening and risk reducing surgery for endometrial or ovarian cancers in Lynch syndrome: a systematic review. International journal of gynecological cancer: official journal of the International Gynecological Cancer Society
|
|
32(5): 646–655
|
|
[<a href="/pmc/articles/PMC9067008/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9067008</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35437274" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35437274</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Outcomes in study do not match those specified in this review protocol</p>
|
|
<p><i>Insufficient data to calculate diagnostic outcomes</i>.</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Lockwood, S. and Ritzert, B. (2013) Cost-effectiveness of serum CA125 compared to transvaginal ultrasound as a screening test for ovarian cancer: A systematic review protocol. JBI Library of Systematic Reviews
|
|
11(10): 89–106
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Systematic review protocol</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Mallen, Adrianne, Soong, T Rinda, Townsend, Mary K
|
|
et al. (2018) Surgical prevention strategies in ovarian cancer. Gynecologic oncology
|
|
151(1): 166–175
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/30087058" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30087058</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Systematic review used as source of primary studies</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Marchetti, C., De Felice, F., Perniola, G.
|
|
et al. (2018) Screening program in ovarian cancer: A logical step in clinical management? A meta-analysis. Current Problems in Cancer
|
|
42(2): 235–240
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/29433824" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29433824</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Systematic review used as source of primary studies</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Menon, Usha, Gentry-Maharaj, Aleksandra, Burnell, Matthew
|
|
et al. (2021) 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. Lancet (London, England) 397(10290): 2182–2193
|
|
[<a href="/pmc/articles/PMC8192829/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8192829</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33991479" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33991479</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population in study does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Women with increased risk of familial ovarian cancer were excluded</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Menon, Usha, Gentry-Maharaj, Aleksandra, Hallett, Rachel
|
|
et al. (2009) 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). The Lancet. Oncology
|
|
10(4): 327–40
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/19282241" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19282241</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population in study does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Women with increased risk of familial ovarian cancer were excluded</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Menon, Usha, Ryan, Andy, Kalsi, Jatinderpal
|
|
et al. (2015) 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. Journal of clinical oncology : official journal of the American Society of Clinical Oncology
|
|
33(18): 2062–71
|
|
[<a href="/pmc/articles/PMC4463475/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4463475</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25964255" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25964255</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population in study does not match that specified in this review protocol</p>
|
|
<p><i>Women at increased risk of familial</i>
|
|
<i>ovarian cancer were excluded</i></p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Moller, Pal, Seppala, Toni, Bernstein, Inge
|
|
et al. (2017) Cancer incidence and survival in Lynch syndrome patients receiving colonoscopic and gynaecological surveillance: first report from the prospective Lynch syndrome database. Gut
|
|
66(3): 464–472
|
|
[<a href="/pmc/articles/PMC5534760/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5534760</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26657901" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26657901</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Intervention in study does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Colonoscopic surveillance</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Pinsky, Paul F, Yu, Kelly, Kramer, Barnett S
|
|
et al. (2016) Extended mortality results for ovarian cancer screening in the PLCO trial with median 15years follow-up. Gynecol. Oncol. 143(2): 270–275
|
|
[<a href="/pmc/articles/PMC5077651/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5077651</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27615399" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27615399</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population in study does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Results not reported separately for the subgroup of women with a family history of breast or ovarian cancer</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Ramamurthy, C.; Chertock, Y.; Hall, M.J. (2017) Randomized Controlled Trials in Hereditary Cancer Syndromes. Surgical Oncology Clinics of North America
|
|
26(4): 729–750
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/28923228" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28923228</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Systematic review used as source of primary studies</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Reade, C.J., Riva, J.J., Busse, J.W.
|
|
et al. (2013) Risks and benefits of screening asymptomatic women for ovarian cancer: A systematic review and meta-analysis. Gynecologic Oncology
|
|
130(3): 674–681
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/23822892" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23822892</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Systematic review used as source of primary studies</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Renaud, M.-C. and Le, T. (2018) No. 291-Epidemiology and Investigations forSuspected Endometrial Cancer. Journal of Obstetrics and Gynaecology Canada
|
|
40(9): e703–e711
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/30268319" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30268319</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Clinical practice guideline</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Salhab, Mohamed; Bismohun, Selina; Mokbel, Kefah (2010) Risk-reducing strategies for women carrying BRCA1/2 mutations with a focus on prophylactic surgery. BMC women’s health
|
|
10: 28
|
|
[<a href="/pmc/articles/PMC2987888/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2987888</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20961453" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20961453</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Systematic review used as source of primary studies</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Schmeler, KM, Sun, CC, Bodurka, DC
|
|
et al. (2006) Prophylactic bilateral salpingo-oophorectomy compared with surveillance in women with BRCA mutations. Obstetrics and gynecology
|
|
108(3pt1): 515–520
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/16946209" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16946209</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Analysis does not adjust for baseline differences between groups</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Sherman, Mark E, Piedmonte, Marion, Mai, Phuong L
|
|
et al. (2014) Pathologic findings at risk-reducing salpingo-oophorectomy: primary results from Gynecologic Oncology Group Trial GOG-0199. Journal of clinical oncology: official journal of the American Society of Clinical Oncology
|
|
32(29): 3275–83
|
|
[<a href="/pmc/articles/PMC4178524/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4178524</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25199754" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25199754</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Comparator in study does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Outcomes reported for RRSO group only</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Sroczynski, Gaby, Gogollari, Artemisa, Kuehne, Felicitas
|
|
et al. (2020) A Systematic Review on Cost-effectiveness Studies Evaluating Ovarian Cancer Early Detection and Prevention Strategies. Cancer prevention research (Philadelphia, Pa.) 13(5): 429–442
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/32071120" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32071120</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Systematic review used as source of primary studies</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Stewart, M.E., Knisely, A.T., Sullivan, M.W.
|
|
et al. (2019) Evaluation of screening and risk-reducing surgery for women followed in a high-risk breast/ovarian cancer clinic: it is all about the tubes in BRCA mutation carriers. Gynecologic Oncology Reports
|
|
28: 18–22
|
|
[<a href="/pmc/articles/PMC6365389/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6365389</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30775416" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30775416</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Intervention in study does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Outcomes reported for RRSO group only</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Tailor, A, Bourne, TH, Campbell, S
|
|
et al. (2003) Results from an ultrasound-based familial ovarian cancer screening clinic: a 10-year observational study. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
|
|
21(4): 378–85
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/12704748" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12704748</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Outcomes reported for screening group only</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Tschernichovsky, Roi and Goodman, Annekathryn (2017) Risk-Reducing Strategies for Ovarian Cancer in BRCA Mutation Carriers: A Balancing Act. The oncologist
|
|
22(4): 450–459
|
|
[<a href="/pmc/articles/PMC5388383/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5388383</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28314837" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28314837</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Systematic review used as source of primary studies</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Tzortzatos, Gerasimos, Andersson, Emil, Soller, Maria
|
|
et al. (2015) The gynecological surveillance of women with Lynch syndrome in Sweden. Gynecologic oncology
|
|
138(3): 717–22
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/26177554" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26177554</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Intervention in study does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Outcomes reported for screening group only</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
van Driel, Catheleine M G, de Bock, Geertruida H, Arts, Henriette J G
|
|
et al. (2015) Stopping ovarian cancer screening in BRCA1/2 mutation carriers: effects on risk management decisions & outcome of risk-reducing salpingo-oophorectomy specimens. Maturitas
|
|
80(3): 318–22
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/25600260" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25600260</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>- Outcomes in study do not match those specified in this review protocol</p>
|
|
<p>
|
|
<i>Interval cancers (not detected by screening) not reported</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Vasen, H F A, Tesfay, E, Boonstra, H
|
|
et al. (2005) Early detection of breast and ovarian cancer in families with BRCA mutations. European journal of cancer (Oxford, England : 1990) 41(4): 549–54
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/15737559" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15737559</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Outcomes in study do not match those specified in this review protocol</p>
|
|
<p>
|
|
<i>Interval cancers (not detected by screening) not reported</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Wainberg, Sara and Husted, Janice (2004) Utilization of screening and preventive surgery among unaffected carriers of a BRCA1 or BRCA2 gene mutation. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
|
|
13(12): 1989–95 [<a href="https://pubmed.ncbi.nlm.nih.gov/15598752" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15598752</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Systematic review used as source of primary studies</td></tr><tr><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Yang, Kathleen Y, Caughey, Aaron B, Little, Sarah E
|
|
et al. (2011) A cost-effectiveness analysis of prophylactic surgery versus gynecologic surveillance for women from hereditary non-polyposis colorectal cancer (HNPCC) Families. Familial cancer
|
|
10(3): 535–43
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/21538078" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21538078</span></a>]
|
|
</td><td headers="hd_h_niceng241er11.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>A theoretical population of women with Lynch Syndrome at age 30 was used for the analysis</i>
|
|
</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">RRSO: risk-reducing salpingo-oophorectomy</p></div></dd></dl></dl></div></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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