ovarian cancer screening n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
OVARIAN CANCER SCREENING : PowerPoint Presentation
Download Presentation
OVARIAN CANCER SCREENING :

Loading in 2 Seconds...

play fullscreen
1 / 58

OVARIAN CANCER SCREENING : - PowerPoint PPT Presentation


  • 428 Views
  • Uploaded on

OVARIAN CANCER SCREENING :. Edward J. Pavlik University of Kentucky Ovarian Cancer Screening Research Program July 26, 2011. CANCER SCREENING: Definitions.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'OVARIAN CANCER SCREENING :' - osmond


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
ovarian cancer screening
OVARIAN CANCER SCREENING:

Edward J. Pavlik University of Kentucky Ovarian Cancer Screening Research Program

July 26, 2011

cancer screening definitions
CANCER SCREENING:Definitions
  • Cancer Screening: The act of testing for a condition in a population that is presumed to be asymptomatic when detection will result in the possibility of cure or extending life.Predicting disease is present before it is evident.
  • Cancer Diagnostic Workup: The act(s) of testing when clinical evidence or symptoms indicate that a condition is present and cancer must be ruled out as an explanation for this condition.
perspectives ovarian screening
Perspectives --- Ovarian Screening
  • What are current perceptions about screening?
  • Why screen for ovarian cancer?
  • How good is transvaginal ultrasound screening?
  • What do women want?
  • What about costs?
perceptions screening
Perceptions --- Screening

What are current perceptions about screening?

What do we mean by “perceptions?”

perspectives ovarian screening1
Perspectives --- Ovarian Screening

What are current perceptions about ovarian screening?

My doctor does it

The PAP test does it

I don’t need it

I don’t want to talk about it

It doesn’t work

My insurance doesn’t pay for it

My doctor didn’t tell me about it

slide6

The Holy Grail: distinguishing benign from malignant ovarian tumors with precision high enough and cost low enough to please everyone: the Kentucky ovarian cancer screening experience with 37,200+ women and 230,000+ screens.

perspectives ovarian screening2
Perspectives --- Ovarian Screening

Why screen for ovarian cancer?

uk ovarian screening program
UK Ovarian Screening Program

Ovarian Screening Video

perspectives ovarian screening3
Perspectives --- Ovarian Screening

How good is transvaginal ultrasound screening?

3 tvs vs pelvic exam
#3. TVS vs Pelvic Exam

TVS is significantly more accurate (p< 0.001)

Ueland, DePriest, DeSimone, Pavlik, Lele, Kryscio, van Nagell JR Jr.

The accuracy of examination under anesthesia and transvaginal sonography in evaluating ovarian size. Gynecol Oncol. 2005 Nov;99(2):400-3.

4 performance tvs vs mammography
#4. Performance: TVS vs Mammography

TVSperforms similarly tomammography &MRI

van Nagell JR Jr, DePriest PD, Ueland FR, DeSimone CP, Cooper AL, McDonald, JM, Pavlik EJ, Kryscio RK. Ovarian Cancer Screening With Annual Transvaginal Sonography. Cancer 2007; 109: 1887-1196

Humphrey LL, Hefland M, Chan BKS, Woolf, SH. Breast Cancer Screening: A Summary of the Evidencefor the U.S. Preventive Services Task Force. Annals of Internal Med. 137: E347, 2002 (Multi-study report)

Elmore JG, Armstrong K, Lehman CD, Fletcher SW. Screening for Breast Cancer. JAMA 293: 1245, 2005

Lehman CD, Gatsonis C, Kuhl CK, Hendrick RE, Pisano ED, Hanna L, Peacock S, Smazal SF, Maki DD, Julian TB, DePeri ER, Bluemke DA, Schnall MD. MRI Evaluation of the Contralateral Breast in Women with Recently Diagnosed Breast Cancer. N. Engl. J. Med. 2007; 356:1295

4 performance tvs vs mammography1
#4. Performance: TVS vs Mammography

TVSscreening results in improved survival

2 what women want

http://ovarianscreening.info

#2 What Women Want

I realize that the risk of ovarian cancer is a lot lower than breast cancer and I:A. Feel that ovarian cancer is still a concern or threat to me 647 =97%B. Feel that my chances of getting ovarian cancer are too low to be concerned with. 22 = 3%

When I am near or at age 50, I feel strongly that I would:1. Probably be undecided about ovarian cancer screening 10 = 2% 2. NOT want to participate in ovarian cancer screening 5 = 1% 3. Might consider ovarian cancer screening 91 = 18% 4. Would definitely want to participate in ovarian cancer screening 413 = 80%

2 what women want1

http://ovarianscreening.info

#2 What Women Want

For what I am paying for medical insurance, my insurance should:1. Pay for ovarian screening no matter what the cost 488 = 70%

2. Pay up to $500 for ovarian screening 50 = 7%

3. Pay up to $250 for ovarian screening 44 = 6%

4. Pay up to $150 for ovarian screening 48 = 7%

5. Pay up to $100 for ovarian screening 25 = 4%

6. Pay up to $50 for ovarian screening 13 = 2%

7. Not pay for ovarian screening 27 = 4%

2 what women want2

http://ovarianscreening.info

#2 What Women Want
  • If my medical insurance would NOT pay for ovarian cancer screening, I consider the risk of ovarian cancer to be sufficient to pay for screening out of my own pocket so that I might:
  • Pay for ovarian screening no matter what the cost 162 = 23%
  • Pay up to $500 for ovarian screening 56 = 8%
  • Pay up to $250 for ovarian screening 100 = 14%
  • Pay up to $150 for ovarian screening 131 = 19%
  • Pay up to $100 for ovarian screening 122 = 18%
  • Pay up to $50 for ovarian screening 110 = 16%
  • I do not consider the risk of ovarian cancer to be worth paying for screening myself or would never pay for anything that my medical insurance would not pay for. 12 = 2%
5 cost number of recovered screens
#5. Cost & Number of Recovered Screens

SR: “Screens Recovered” at $25**/screen

Over 2000 screens can be paid for by preventing a single IIIc cancer and over 500 screens by chemotherapy alone!

* Current Women’s Health Reviews 5, 44-50 (2009)

**Pavlik EJ, van Nagell JR Jr, DePriest PD, Wheeler L, Tatman JM, Boone M, Sollars S, Rayens MK, Kryscio RK. Participation in transvaginal ovarian cancer screening: compliance, correlation factors, and costs.Gynecol Oncol. 1995 Jun;57(3):395-400

5 costs screens
#5. Costs & Screens

ASSUMPTION: IIIC expense is if all 68 detected malignancies progressed to IIIC.

Cases that can be stopped from progressing to a IIIC expense can pay for a large number of TVS screens.

5 costs relativity
#5. Costs & Relativity

$25/screen is within the Co-Pay

5 costs relativity1
#5. Costs & Relativity

$25/screen is less than Styling

summary of perspectives
Summary of Perspectives
  • Women want ovarian screening
  • TVS outperforms manual PE
  • TVS performs as well as mammography
  • TVS ovarian screening has reasonable cost
ovarian cancer
Ovarian Cancer
  • 2011: 21,990new cases/yr; 2011: 15,460 deaths
  • Fifth leading cause of cancer death among women
  • Leading cause of death among gynecologic malignancies
  • 5 yr survival: Stage I - ~ 90% Stage III/IV - 20%
  • Prevalence- 50/100,00 in women > 50 yrs.
  • 75% cases diagnosed with advanced disease
delay in diagnosis
Delay in Diagnosis
  • Retrospective review of 277 pts.
  • On average patients sought medical attention 9 months after onset of symptoms
  • On average patients received pelvic exam 9 months after seeking medical attention
  • Gilda Radner, Ella Grasso, Madeline Kahn, Liz Tilberis, Cassandra Hanis-Brosnan, Coretta Scott King, Patsy Ramsey, Loretta Young, Dinah Shore, Jessica Tandy, Lauro Nyro, Joan Hackett, Dixie Lee, Rosalind Franklin (discoverer of DNA), Sandy Dennis; Bess Myerson & Carol Channing are survivors

Sackett, et. al., Clinical Epid., Boston: Little, Brown & Co., 1985

http://en.wikipedia.org/wiki/Ovarian_cancer#Notable_victims_of_ovarian_cancerhttp://www.wect.com/Global/story.asp?S=5466000

symptoms tests
Symptoms & Tests

Out of 100 women with symptoms, only 1 will have OvCa.Symptoms occur in women without OvCa 60-1500 times more than the incidence of OvCa.OVA1 is an FDA-cleared blood test that uses results of 5 biomarkers, with an algorithm to indicate the probability of malignancy of an ovarian mass. It is not a screening or stand alone test.

transvaginal sonography tvs2
Transvaginal Sonography (TVS)
  • Echos not degraded in air-space @ ovary
  • Easy to perform
  • Well-accepted
  • Relatively cost-effective (~$25/screen)
  • Acceptable sensitivity
unresolved issues
Unresolved Issues
  • Who should be screened? (Who decides?)
  • What is the optimal screening interval?
  • What is the optimal screening algorithm?
  • How should the screening be done?
disease prevention is related to education
Disease Prevention Is Related To Education

“The one social factor that researchers agree is consistently linked to longer lives in every country where it has been studied is education. It is more is more important than race; it obliterates any effects of income.”

And, health economists say, those factors that are popularly believed to be crucial — money and health insurance, for example, pale in comparison.

http://www.nytimes.com/ref/health/newage_index.html

finding more information googled 07 21 2011

http://ovarianscreening.info

Finding More InformationGoogled 07/21/2011

Women's Health Care - Ovarian Cancer Screening - UK HealthCare

ukhealthcare.uky.edu/WomensHealth/ovariancancer.asp

Feb 4, 2010 – Early detection is vital to surviving ovarian cancer. The UK Markey Cancer Center Ovarian Screening Program was started in 1987 and provides ...►

Ovarian Screening Program

ovarianscreening.info/

Apr 4, 2011 – Free ovarian cancer screening for women is performed using transvaginal ultrasound as a protocol to reduce mortality due to ovariancancer.

Ovarian Screening Program

ovarianscreening.info/Faceswithafuture.htm

Apr 4, 2011 – Ovarian Cancer. Screening Program. Ovarian Cancer ...

Ovarian Screening Memorials - Ovarian Screening Program

ovarianscreening.info/Memorials.html

Apr 4, 2011 – The Monroe County Extension Homemakers have initiated ...

Show more results from ovarianscreening.info

Ovarian cancer screening : Cancer Research UK : CancerHelp UK

cancerhelp.cancerresearchuk.org/.../ovarian.../ovari... - United Kingdom

Nov 1, 2010 – Over the next 5 years the researchers in the study will look at whether an ovarian screening programme using these tests could help to...

first global thoughts on cancer screening in general
First:Global Thoughts on Cancer Screening in general

Edward J. Pavlik, Director

University of Kentucky

Ovarian Cancer Screening Research Program

July 26, 2011

cancer screening definitions1
CANCER SCREENING:Definitions
  • Cancer Screening: The act of testing for a condition in a population that is presumed to be asymptomatic when detection will result in the possibility of cure or extending life.Predicting disease is present before it is evident.
  • Cancer Diagnostic Workup: The act(s) of testing when clinical evidence or symptoms indicate that a condition is present and cancer must be ruled out as an explanation for this condition.
perception vs preconception wh at is reality
Perception vs Preconception: What Is Reality?

Do you stop?

Do you slow down?

Do you speed up to get through before it turns red?

perception vs preconception wh at is reality1
Perception vs Preconception: What Is Reality?

Colorado Law

STEADY YELLOW LIGHT: A red light is about to appear.

Stop unless you are already within the intersection.

Indiana Law

STEADY YELLOW LIGHT: means that the right-of-way is ending.

Kentucky Law

STEADY YELLOW LIGHT means stop if you can do so safely. A vehicle may

clear an intersection on a red light, if the vehicle entered the intersection while the signal was yellow; but it is against the law to enter an intersection after the light turns red.

Ohio Law

STEADY YELLOW LIGHT: clearance of vehicle within intersection.

perspective wh at is reality
Perspective What Is Reality?

Is the glass half empty?

Is the glass half full?

What other quantitative relationship applies?

perspective wh at is reality1
Perspective What Is Reality?

Are too few medical services provided in the USA?

Could more medical services be provided?

Are the number of medical services that could be provided too great for payer resources in the USA?

Screening = a medical service

perspective what is reality
Perspective What Is Reality?

What quantitative relationship applies?Is this a full cup?Is this a full half cup?

Is this a way of adjusting services (contents) to perception? (i.e. a consumer can get all the services a medical plan provides by restricting the plan)

perspective what is reality1
Perspective What Is Reality?

Types of Service Plan Restrictions:1. Age eligibility2. Pre-existing conditions3. PSA & consequences4. Breast screening (40-50)

Ways of adjusting services

perspective what is reality2
Perspective What Is Reality?

It ALL has to work!

Sometimes half isn’t good enough!

cancer screening definitions2
CANCER SCREENING:Definitions
  • Cancer Screening: The act of testing for a condition in a population that is presumed to be asymptomatic when detection will result in the possibility of cure or extending life.Predicting disease is present before it is evident.
  • Cancer Diagnostic Workup: The act(s) of testing when clinical evidence or symptoms indicate that a condition is present and cancer must be ruled out as an explanation for this condition.
cancer screening
CANCER SCREENING:

Visual Bias / Context

cancer screening science1
CANCER SCREENING:Science

Visual Bias / Selective Attention ---1

Task Orientation & Awareness:

The Elephant In The Room

cancer screening1
CANCER SCREENING:

Visual Bias / Selective Attention ---1

Did you see Carmen Sandiego?

cancer screening science2
CANCER SCREENING:Science

Visual Bias / Selective Attention ---2

Task Orientation & Awareness:

Multiple Events

cancer screening science3
CANCER SCREENING:Science

Visual Bias / Selective Attention ---3

Task Orientation & Awareness:

Tracking Multiples

cancer screening science4
CANCER SCREENING:Science

Four Questions That Must Be Answered

1. How good is the test when disease is there?

Ability to identify true disease = Sensitivity

Sensitivity = TP/(TP+FN)

2. How good is the test when disease is not there?

Ability to identify the absence of disease

= Specificity = TN/(TN+FP)

cancer screening science5
CANCER SCREENING:Science

Four Questions That Must Be Answered

3. How many of those that are positive really have the disease?

% of positive subjects who have disease =

Positive Predictive Value= TP/(TP+FP)

4. How many of those that are negative really do not have the disease?

% of negative subjects who do not have the disease =

Negative Predictive Value = TN/(TN+FN)

cancer screening screened population features
1. Disease has a high enough Prevalence to justify screening

2. Medical care available if screening test is positive

3. Patient is willing & able to undergo further evaluation

CANCER SCREENING:Screened Population Features
cancer screening role of education
CANCER SCREENING:Role of Education

What do you have to be able to do?

cancer screening role of education1
CANCER SCREENING:Role of Education

What do you have to be able to do?