The goal of any screening program is to find the disease early enough, usually meaning early stage, such that the chances for cure are improved. We have that sort of screening for cervical cancer and, to an extent, for breast cancer. Cervical cancer screening can actually detect PRE-cancer, in which case cure is almost inevitable. Mammograms can detect very small tumors which are most often stage I. What about ovarian cancer screening?

Unfortunately we have no reliable way to detect Stage I ovarian cancer, and certainly can't find pre-cancer. CA125 and ultrasound screening have really been disappointing. "Early" symptoms usually become noticeable when the cancer is already past stage I, especially with the more common and more aggressive types of ovarian cancer. There is always a heart-warming story here and there but, in most cases, screening for Stage I cancer is not very effective with our current tools. New tools are being developed and that is exciting, but are there any other ways we can approach this problem?

Researchers from Johns Hopkins have recently proposed that we refocus a little on finding cancer when it is "low volume" rather than "low stage". That means finding it when surgery can usually remove essentially all of the visible disease, even if it has spread beyond the ovary. This surgery becomes more and more difficult as the volume goes up, but when visible cancer is removed the chances that chemo can lead to a cure is markedly improved. The researchers suggest that the more aggressive and more common "type II" cancers have different genetic alterations than the less common and less aggressive "type I" ovarian cancers.

This proposal and "typing" is new. So much more research is required. However, the concept has significant possibilities. Focusing on these genetic alternations, and finding ways to exploit them, can give us both a new way to detect the more aggressive ovarian cancers and new avenues for targeted biological therapies.