8th November 2022
Following comments from some of our members, UKCGG Council wanted to highlight the publication of the results of the ALDO study in The Journal of Medical Genetics, 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 (bmj.com) , which we have heard about for a number of years through UKCGG meetings and which has involved a number of UK Genetics Centres.
This NHS pilot surveillance programme invited BRCA1 and BRCA2 carriers who had not undertaken risk-reducing bilateral salpingo-oophorectomy (RRBSO) for a ROCA blood test every four months and further tests were organised as necessary depending on the ROCA results. Whilst based on small numbers the study confirms previous research that although this approach cannot prevent ovarian cancer, in women who defer BSO, it may facilitate detection of ovarian cancer at earlier stages, resulting in less complex surgery and reduced need for pre-op chemotherapy. Whilst the results of the study are encouraging, along with the authors of the paper, UKCGG would still recommend that RRBSO is the gold standard management for women at increased risk, as the only proven way to minimise risk of ovarian cancer. Surveillance should not be considered a safe alternative to risk-reducing surgery.
In addition, the UKCGG would encourage recruitment of eligible women to the PROTECTOR trial Information for health professionals - Protector as this gives them the opportunity of undergoing bilateral salpingectomy with delayed oophorectomy. This approach is likely to provide some protection against ovarian cancer with less impact on hormonal function than RRBSO, and hence may be an option which women previously declining BSO would be willing to accept.