Patient recruitment for the Australian Ovarian Cancer Study ceased on 30 June 2006. We will no longer be approaching patients to participate in the study, however, clinical data collection is ongoing. Access to medical records from consented participants will therefore continue through to 2010, thanks to a newly funded NHMRC project grant for collection of clinical follow-up data. This will take us close to our goal of 5-year minimum follow-up on all patients. Data analysis is currently underway and is also expected to continue over the next 5 years.
A total of 2456 women from all Australian states had consented to participate in the study of which 1859 are eligible cases. This number far exceeds our original target of 1000 cases over 3 years. Nationally, we have received a total of 1672 completed epidemiological/dietary questionnaires, 1608 blood samples and 1097 fresh tissue samples. Clinical Follow-Up has been initiated on 2358 patients, with a minimum of 5-year follow-up planned (to be completed in mid-2011). Of the eligible cases, 78% are cases of invasive cancer and 22% are low malignant potential (LMP).
Control recruitment is complete and we have recruited 1073 control women who do not have ovarian cancer and have received 1072 questionnaires and 924 blood samples, again exceeding our initial targets.
At 31 December 2010, Clinical Follow-Up forms had been received on 2359 patients nationally. This number includes patients that were recruited but subsequently found to have benign disease and were therefore not followed beyond Form 1.
The Post-Operative Data form has been completed on 100% of the total patient population recruited to date. The Primary Treatment Form, including chemotherapy details and response to treatment, has been completed on 99% of cases that have completed their primary treatment and 12, 18, 24, 30, 36, 42, 48, 54 and 60 month follow-up has been completed on 99, 98, 98, 97, 97, 96, 94, 90 and 88% of eligible cases respectively. Over 35% of AOCS cases have their ongoing treatment in a centre other than the hospital where they were initially recruited and we have implemented various strategies to ensure that cases are not ‘lost to follow-up’. Collection of clinical data from 153 centres in metropolitan, regional and rural areas across the country has meant that thus far 131 AOCS patients (7%) have been lost to follow-up.
Recruitment Information by State and/or Hospital
State |
Hospital |
Cases Recruited |
Queensland |
Royal Women’s Hospital Mater Hospital
Wesley Hospital |
521 |
Victoria |
Freemasons Hospital
Mercy Hospital
Monash Medical Centre |
326 |
New South Wales |
Royal Hospital for Women
Royal North Shore / North Shore Private
Westmead
Royal Prince Alfred
John Hunter |
425 |
South Australia |
Flinders Medical Centre
Royal Adelaide Hospital |
206 |
Tasmania |
Royal Hobart Hospital |
94 |
Western Australia |
King Edward Memorial Hospital
St John of God Hospitals |
284 |
TOTAL |
|
1858 |
Project 1 - Molecular Subtype Analysis of Ovarian Cancer
Under Construction
Project 2 - Determinants of Epithelial Ovarian Cancer - By Histologic Subtype & Tumour Behaviour
Approximately 1500 women with and 1000 women without ovarian cancer provided detailed questionnaire information for AOCS. It is well known that women who have a family history of breast or ovarian cancer have an increased risk of getting ovarian cancer themselves while women who have had several children or have used the oral contraceptive pill for several years have a lower risk. As at February 2009, key results from analysis of AOCS data had shown:
- Risk factors for fallopian tube cancer are very similar to those for ovarian cancer suggesting a shared aetiology for these two cancers. In contrast primary peritoneal cancers, which are very similar to serous ovarian cancers at the cellular level, appear to have somewhat different risk factors (Jordan et al, IJC, 2008)
- A history of endometriosis increases a woman’s risk of developing the endometrioid and clear cell subtypes of ovarian cancer while use of talcum powder in the perineal region increases risk of the serous subtype (Merritt et al, IJC 2008)
- Obesity is associated with an increased risk of some types of ovarian cancer (Olsen et al, IJC, 2008)
- Higher levels of androgens do not appear to increase a woman’s risk of ovarian cancer (Olsen et al, Endocr Rel cancer, 2008)
- Benign, borderline and frankly invasive mucinous cancers of the ovary share common risk factors suggesting that this type of ovarian cancer might develop via malignant transformation of a benign tumour (Jordan et al, Gynecol Oncol, 2007)
Ongoing analyses are investigating a range of other factors including:
- whether all pregnancies (eg singleton vs twin births, premature births, girl vs boy babies) are equally protective
- the effects of breastfeeding
- the effects of diet including consumption of meat and fish, and intake of micronutrients such as folate
We are also contributing AOCS data to international analyses that will combine data from similar studies conducted around the world to get better answers to some of these questions through the Ovarian Cancer Association Consortium (OCAC).
Project 3 - Low Risk Genes for Epithelial Ovarian Cancer
Although some high-risk ovarian cancer genes have been identified, it is likely that common low penetrance alleles exist that confer some increase in ovarian cancer risk. We have examined nine genetic variants in genes involved in hormone synthesis and DNA repair in the cases and controls from the Australian Ovarian Cancer Study. The only variant we found to be associated with ovarian cancer risk was one in the SRD5A2 gene which results in an altered amino acid. We then genotyped another variant in this gene, in an attempt to validate this finding in an independent set of cases and controls (from the UK, USA and Denmark). There was no association between the second variant and ovarian cancer risk in the validation samples, so further analyses of variants in this gene are warranted to determine whether SRD5A2 plays a role in ovarian cancer predisposition.
Clinical - Follow Up Core
Under Construction
