The diagnosis of ovarian cancer by pathologists: how often do diagnoses by contributing pathologists agree with a panel of gynecologic pathologists?

Article Abstract:

Accurate identification of the kind of malignancy associated with a particular ovarian cancer is essential, since metastasis (cancer spread) presents different therapeutic problems from primary ovarian cancer. To evaluate the variability in diagnoses of ovarian cancer among contributing pathologists and gynecologic pathologists, histopathological specimens were reviewed from 477 women who had been treated as part of a large, multicenter study of ovarian cancer. Of interest was the predictive value positive (PVP) of the pathologists' diagnoses, a measure of the probability that disease actually exists, given that the pathologist has said that it exists. Mathematically, the PVP is the number of true positive results divided by the sum of true and false positive reports. Diagnoses made by the pathologists who participated in the Cancer and Steroid Hormone Study (contributing pathologists) were compared with those of a panel made up of three expert gynecologic pathologists. The ovarian tumors were classified according to various criteria such as malignant/primary, malignant/metastatic, or benign. Ninety-eight percent of the diagnoses of primary ovarian cancer made by the contributing pathologists were confirmed by the panel, with a higher PVP for epithelial tumors (97 percent) than nonepithelial tumors (89 percent). The PVP was higher for cancer of low malignant potential (93 percent) than high malignant potential (85 percent). Details are presented of the main areas of disagreement between the panelists and contributing pathologists; in general, differences were most pronounced in diagnosing specific histologic types of malignancy. It appears that primary ovarian cancer is diagnosed in a consistent manner, but metastatic ovarian cancer is more likely to be incorrectly diagnosed, potentially leading to disastrous consequences for the patient. Accurate diagnosis by pathologists of the origin of an ovarian malignancy is essential to patient survival. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diagnosis, Physiological aspects, Ovarian cancer, Cytodiagnosis

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Infertility-associated endometrial cancer risk may be limited to specific subgroups of infertile women

Article Abstract:

Studies have shown a relation between infertility and cancer of the endometrium, the mucous membrane lining the inner surface of the uterus. The influence of cause of infertility on this relationship is not clear. In the United States, five to seven percent of women are infertile, and endometrial cancer is the most common cause of cancer of the female genital tract. The relation between infertility and endometrial cancer was assessed by analyzing data from the Cancer and Steroid Hormone Study, conducted by the Centers for Disease Control (CDC). This CDC study examined the relation between oral contraceptive use and the incidence of breast, ovarian, and endometrial cancers. The risk of endometrial cancer was evaluated in relation to different definitions of endometrial cancer. The study included 399 women aged 20 to 54 years with endometrial cancer and 3,040 subjects without cancer of similar age. Women who were diagnosed as infertile for at least two years were shown to have an increased risk of endometrial cancer. Women with infertility due to ovarian causes also had an increased risk of endometrial cancer. These findings suggest that the absence of ovulation, resulting in infertility, is associated with an increased risk of endometrial cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Infertility, Female, Female infertility

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Estrogen replacement therapy and the risk of endometrial cancer: remaining controversies

Article Abstract:

Administration of estrogen without concurrent progestins has been linked to endometrial cancer. In order to further clarify this relationship, data obtained from the Cancer and Steroid Hormone Study of the Centers for Disease Control were analyzed. The cases included 196 women with uterine adenocarcinoma, adenoacanthoma, adenosquamous carcinoma, and clear cell carcinoma. Random telephone interviews provided 986 control women. The study confirmed the association between estrogen replacement without progestins and increased risk for uterine cancer. Contributing risk factors include having no children, a history of high blood pressure, and obesity. The risk associated with estrogens increases with higher doses and duration of use, and the risk persists for more than six years after the estrogen therapy is terminated. In this study, women who had used oral contraceptives for over 12 months had a 60 percent reduction in endometrial cancer risk. Because of the small number of women contributing to this figure, it should be interpreted with caution. Any protective effect contributed by oral contraceptive use would be potentially very important in reducing the risk for endometrial cancer, and this effect deserves further study. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Oral contraceptives, Estrogen, Estrogens, Adenocarcinoma

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