Mercedes Castiel

Pre- and postmenopausal high-risk women undergoing screening for ovarian cancer: anxiety, risk perceptions, and quality of life.

OBJECTIVE Recommendations for women at high risk of ovarian cancer include prophylactic salpingo-oophorectomy (PSO) or screening with transvaginal ultrasonography (TVUS) and CA125 levels. The best strategy for improving survival and maintaining quality of life in high-risk women is not known. Premenopausal women may be more reluctant than postmenopausal women to undergo PSO. However, the risk of false-positive screening results may be more likely in premenopausal women, posing potential psychological risk for those enrolled in high-risk ovarian cancer surveillance programs. We sought to determine whether anxiety, depression, perception of ovarian cancer risk, and false-positive test frequency differed between high-risk premenopausal and postmenopausal women initiating ovarian cancer screening. METHODS High-risk women aged > or = 30 years enrolling in a TVUS plus CA125 ovarian cancer screening study completed standard QOL (SF-36), cancer-specific anxiety (IES), depression (CES-D), and ovarian cancer risk perception measures. CA125 > 35 and TVUS showing solid or complex cystic ovarian masses were considered abnormal. Abnormal tests were repeated after 4-6 weeks. Persistently abnormal tests prompted a search for malignancy. Tests that normalized on repeat were considered false positive. RESULTS One hundred forty-seven high-risk women, median age 46 (range, 30-78), 78 premenopausal and 69 postmenopausal, had > or = 1 TVUS/CA125/outcome assessment. Premenopausal women were more likely than postmenopausal women to consider themselves at higher risk of ovarian cancer compared with women their age (P < 0.001) and compared with women with similar family histories (P < 0.001). Mean personal perception of lifetime risk of ovarian cancer among premenopausal women was 37% (range, 0-90%) versus 26% (range, 0-60%) among postmenopausal women (P = 0.02). While general QOL and depression scores were similar, 38% of premenopausal women reported high anxiety versus 27% of postmenopausal women (P = 0.03). Thirty percent of women required repeat CA125 or TVUS after first screening; 10.8% of premenopausal women versus 4.6% of postmenopausal women required repeat CA125; and 23.3% of premenopausal and 20.6% of postmenopausal women required repeat TVUS. One postmenopausal woman with persistently rising CA125 >100 had negative mammography, colonoscopy, and dilation and curettage/bilateral salpingo-oophorectomy. All other abnormal tests normalized on repeat. Two premenopausal women withdrew due to anxiety following false-positive CA125 results. Five women (2 premenopausal, 3 postmenopausal) with normal TVUS/CA125 screening tests elected PSO, with benign findings. CONCLUSION Premenopausal women perceive their ovarian cancer risk to be higher, report greater ovarian cancer risk-related anxiety, and are more likely to have false-positive screening results than postmenopausal women. Few high-risk women elect PSO in the short term. Knowledge of the frequency of false-positive screening results and psychosocial outcomes is important for high-risk women choosing strategies for managing ovarian cancer risk.

Ovarian carcinoma screening in women at intermediate risk : Impact on quality of life and need for invasive follow-up

Women with family histories suggestive of an increased risk of ovarian carcinoma who have not had a deleterious BRCA1 or BRCA2 mutation identified are commonly suggested to consider ovarian carcinoma screening with transvaginal ultrasound and/or assessment of CA 125 levels. Limited information is available regarding the impact of this approach on either quality of life (QOL) or need for invasive follow‐up in this group of women.

Brain cancer and sexual health: A case report

OBJECTIVE Cancer patients often encounter sexual concerns during the diagnosing, treatment, and recovery phase of their illness. However, the sexual concerns of these patients are often overlooked. Brain cancer patients are no exception to this oversight. METHODS A case report of a 39-year-old patient with a history of high-grade anaplastic astrocytoma presented to the Sexual Health Program at the Memorial Sloan-Kettering Cancer Center complaining of vaginal discharge and several months of amenorrhea. Although the patient was administered extensive aggressive antineoplastic treatments, her disease rapidly progressed. RESULTS Despite the patients terminal illness she continued to have normal sexual thoughts, feelings, and desires; however, she had difficulty discussing these issues with her partner and caregiver, who was her mother. An examination by the sexual medicine gynecologist noted no clinical signs of genital infections; however, there was minimal vaginal atrophy. Her sexual health laboratory evaluation was extensively abnormal. Her treatment consisted of intravaginal non-hormonal moisturizers and vaginal lubricants, counseling, and sexual education. The patient successfully engaged in sexual contact with her partner by the third counseling session. SIGNIFICANCE OF RESULTS Almost all oncology patients have sexual concerns during or following cancer treatment. These patients should be referred to comprehensive sexual health programs for treatment, if available.

Treatment of menorrhagia in women undergoing hematopoietic stem cell transplantation

Summary:The management of uterine bleeding in female transplant patients over a 3-year period at our institution was reviewed. A total of 33 females who had undergone allogeneic hematopoietic stem cell transplant were identified as having received gynecologic consultation for the diagnosis of menorrhagia. Hormone therapy achieved a resolution of symptoms in 32 (97%) of the patients, and 26 (79%) required only one hormone regimen. Following resolution of symptoms, transition to standard-dose oral contraceptive pills as maintenance therapy prevented recurrent menorrhagia due to high circulating estrogen levels. Alternatives for patients who are unable to tolerate oral administration and those with hepatotoxicity are also discussed.

Abstract P2-12-05: Limited Absorption of Low Dose 10µg Intravaginal 17-β Estradiol (Vagifem®) in Postmenopausal Women with Breast Cancer on Aromatase Inhibitors

Background: Aromatase inhibitors (AIs) are used to treat postmenopausal women with hormone-receptor positive (HR+) breast cancer (BC). AIs block the peripheral conversion of androgens to estrogen (E), resulting in sub-physiologic levels of E that may lead to profound urogenital atrophy. Atrophic vaginitis in BC survivors is prevalent and its management is complex. An observational study (n = 6) demonstrated elevated estradiol levels in 5/6 women on AIs after 2 weeks (wks) of treatment with 25µg 17-β Estradiol (Vagifem ®), which raised questions regarding the safety of intravaginal estradiol in women with HR+ BC. However, the small sample size limited definitive conclusions, yet underscored the need for a clinical trial to evaluate concurrent use of AIs and intravaginal estradiol. In addition, a lower dose 17-β Estradiol (10µg) is now available and effectively treats healthy women with atrophic vaginitis. We hypothesized that the 10µg dose is effective and may have less systemic absorption than the 25µg dose. This is the first study to evaluate the 10µg dose in BC pts on AI therapy. Methods: A prospective longitudinal IRB-approved study was performed at MSKCC in postmenopausal women with stage I-III HR+ BC on adjuvant letrozole or anastrozole for at least 3 months and had urogenital atrophy. Patients on exemestane were not eligible due to cross-reactivity with the assay. All women were initiated on 10µg intravaginal 17- β estradiol (Vagifem®). Serial estradiol/FSH levels were measured at baseline and wks 2, 7, 12, 18 & 24; we used a highly sensitive estradiol radioimmunoassay, ESTR-US-CT, from Cisbio US, Inc. Estradiol/FSH levels were checked approximately 12 hrs after insertion, chosen to measure peak absorption. The primary endpoint was change in systemic estradiol level from baseline to wk 12. Patients also completed the Female Sexual Function Index (FSFI) and Menopausal Symptom Checklist (MSCL) at baseline and wks 12 & 24. Results: 26 pts have been treated and 18 are currently evaluable for the primary endpoint at wk 12. Wilcoxon signed rank test showed no statistically significant difference between baseline and wk 12 estradiol levels (p = 0.49) or FSH levels (p = 0.28). The median change in estradiol from baseline to wk 12 was 0.3 with a range from −3 to 14.6 (p = .49). Twelve wk results are anticipated for 6 additional pts on study; however 2 pts withdrew before wk 12. Based on the Wilcoxon signed rank test, estradiol levels were not elevated at wks 2 (n = 17) or 7 (n = 16) when compared to baseline. Graphical analysis showed a relationship with increasing estradiol coinciding with decreasing FSH, as physiologically expected. All patients reported being less bothered by menopausal symptoms on the MSCL from baseline to wk 12. Improvement in sexual function/FSFI scores was noted in all sexually active women. Conclusion: Treatment with intravaginal 10µg 17- β estradiol (Vagifem ®) did not elevate wks 2, 7 or 12 estradiol. It also provided relief of vaginal and menopausal symptoms and improvement in sexual function in postmenopausal women with HR+ BC on adjuvant AIs. This is consistent with findings in the general population. Updated data from this study will be presented for all patients treated on study. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-12-05.