The ROCA Test is an innovative new test that can be used for surveillance in women who have an alteration in their BRCA 1 or BRCA 2 gene and therefore a high risk for ovarian cancer. This article delves into the intricacies of ovarian cancer, how it typically presents, evidence for family history of the disease, and what we know about some genetic causes. It also explains how the ROCA Test has become part of a clinician’s ‘tool box’ to help mitigate the risk of late-stage ovarian cancer.
About ovarian cancer
In the UK, ovarian cancer is the 6th most common cause of death due to cancer and it is important to catch it early. When ovarian cancer is caught in the earliest stage, when the cancer is confined to the ovaries, the majority of women will survive for at least 5 years. However, ovarian cancer is not easy to diagnose because the symptoms are vague e.g. abdominal pain and bloating. As a result, most women with ovarian cancer are not diagnosed until it has spread to other parts of the body, after which it is harder to treat, and few women will survive beyond 5 years.
What causes ovarian cancer?
There are several reasons why women develop ovarian cancer. Ovarian cancer is most common in older women; 8 out of 10 women with ovarian cancer will be over 50 years of age. However, ovarian cancer can develop in younger women, and often these women know one or more family members who have also developed ovarian cancer. Genetic studies have shown that in such families, alterations in one or more genes can be passed on through the generations. The most common alterations occurs in one of two genes, referred to as the BRCA 1 and BRCA 2 genes. The BRCA 1 and BRCA 2 genes are present in everyone, but in some people, they appear in a different form, and this can lead to an increased chance of developing ovarian cancer. Women with an alteration in the BRCA 1 gene can have up to a 1 in 2 chance in their lifetime of developing ovarian cancer. Women with an alteration in the BRCA 2 gene may have up to a 1 in 5 chance. Ref. Kuchenbaeker et al. JAMA 2017;317:2402–16.
Testing for a BRCA 1 and 2 alteration?
If you are concerned that ovarian cancer runs in your family, you should make an appointment with your GP, who, after an initial assessment, may refer you to a local NHS genetics service. Specialist doctors there may ask you several questions about your own personal history of cancer, and whether you have any family members who have had ovarian or breast cancer. If the doctor believes you could have an inherited alteration in the BRCA1 or BRCA2 gene, they may recommend that you have a genetic test. The test will tell them whether you have inherited an alteration in the BRCA1 or BRCA2 genes from one of your parents. (The doctor may suggest that you are also tested for alterations in a few other genes that are also known to increase your risk of ovarian cancer). You need to be over 30 years old to be recommended for genetic testing. Anyone with just one first-degree relative with breast or ovarian cancer should now be offered genetic testing in the NHS. The NHS should also offer genetic testing to any woman of Jewish descent due to her higher risk of having a BRCA gene alteration.
What are your choices if you have an alteration in your BRCA1 or BRCA2 gene?
If after being tested, the result shows that you do have an alteration in your BRCA 1 or 2 gene and as a result, you have a high risk of developing ovarian cancer, the doctors will discuss your options. The most effective way of reducing your risk of ovarian cancer would be to opt for surgery to remove your ovaries and fallopian tubes. This operation will prevent ovarian cancer from developing. It is likely that you will only be offered this procedure if you have completed your family. You are likely also to be advised about the early menopause that will result from removing your ovaries.
If you are not ready to have surgery to remove your ovaries and fallopian tubes, the doctor may offer you regular surveillance with the ROCA Test. The ROCA Test should be used every 4 months to check for any signs in the blood that may indicate ovarian cancer. There are now several clinical trials that show that regular testing with the ROCA Test can increase the chance of ovarian cancer being caught early.
If you believe the ROCA Test is something you may be able to benefit from, please contact us and we can help answer any questions you may have and put you in touch with the right people to get your ROCA journey started.