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A multidisciplinary team of researchers from the Ï㽶ÊÓƵ Health Centre (MUHC) and the universities of Sherbrooke, Laval, Quebec, McGill and Calgary have launched a multi-centre study designed for early identification of women at risk of ovarian cancer (OC).

The study, known as "DOVE – Detecting OVarian Cancer Earlier," is the initiative of gynecological oncologist Dr Lucy Gilbert of the Ï㽶ÊÓƵ Health Centre (MUHC). Gilbert and a team of gynecological oncologists, family practitioners, general gynecologists, mathematicians, epidemiologists and scientists from centres across Canada have combined their medical expertise to defeat this disease. Although ovarian cancer is considered "the silent killer," there are numerous studies that show that women with ovarian cancer are symptomatic but unfortunately, because the signs are vague and non-specific in nature, they are ignored by women and their doctors.

"Ovarian cancer is the fourth leading cause of cancer death in women and deadliest of the gynecological cancers," says Dr. Lucy Gilbert, the principal investigator in the study. "The statistics are alarming and a reliable assessment tool to detect this disease early and while it is treatable (in stage 1 of the disease) must be developed without delay. We owe this to women and the DOVE team is determined to work on achieving this goal," she explains.

Of the 2,400 women newly diagnosed each year more than 75% will die from the disease. Four women die per day in Canada from ovarian cancer because most are diagnosed in the advanced stages of the disease (stages 2 and 3). However, if the cancer is detected early (at stage 1) more than 80% will survive.

"By the time women present to us with ovarian cancer over 60% are already at stage three and four – very advanced stages of the cancer," says gynecological oncologist Dr. Prafull Ghatage of Calgary's Tom Baker Cancer Centre. "Even with heroic efforts at surgery followed by the best available chemotherapy combination we are able to achieve long-term survival in only about 20%."

"Screening women without clearly defined/recognized symptoms is not recommended by the Canadian Task Force on the Periodic Health Examination and the U.S. Preventive Services Task Force because it results in unnecessary major surgery and has the potential to do more harm than good," says Dr Michel Roy of University of Laval. "In the DOVE trial we are working with women who have indications of OC to clearly profile a cluster of symptoms from the 70 or so non-specific symptoms that would identify women with a high likelihood of having the disease," adds Roy, who is the president of the Regroupement des Gynécologues-Oncologues du Québec.

Dr Martin Dawes, Chair of Family Medicine at McGill and director of Family Medicine at the MUHC, explains, "The challenge for doctors who first see the patient is to identify those who do need urgent investigations from those who do not." The DOVE study is designed to further ensure that the predictive tool we recommend to family doctors and general gynecologists profiles ovarian cancer as precisely as possible, so the system is neither swamped by over-investigating, nor is there undue delay in identifying women with cancer. "The only way to defeat this deadly disease is if primary, secondary and tertiary care services work as real partners," he emphasizes.

Epidemiologists Dr. Marie-Elise Parent of Institut Armand-Frappier, University of Quebec, and Dr. James Hanley of Ï㽶ÊÓƵ will be instrumental in ensuring that the predictive tool is refined and tested in three phases to ensure that it profiles early ovarian cancer as precisely as possible. "In Phase I we will identify an accurate symptom profile and develop a reliable diagnostic tool to detect ovarian cancer. In phase II we will refine and validate this tool and by phase three, we will be able to take the prediction tool and apply it to the community to fast-track women with suspected OC," says Dr. Duarte-Franco, the trial coordinator.

In addition to identifying women with OC symptoms early, the DOVE trial will also allow scientists to compare large numbers of cancer patients with controls, identifying not just the clinical or symptom profiles of women with ovarian cancer, but also their molecular biology profile. Dr. Michel Tremblay, Director of the McGill Cancer Centre, and his team will work on identifying genetic and proteomic markers that may allow detection of the disease even before symptoms set in.

About the Ï㽶ÊÓƵ Health Centre (MUHC)
The Ï㽶ÊÓƵ Health Centre (MUHC) is a comprehensive academic health institution with an international reputation for excellence in clinical programs, research and teaching. The MUHC is a merger of five teaching hospitals affiliated with the Faculty of Medicine at Ï㽶ÊÓƵ — the Montreal Children's, Montreal General, Royal Victoria, and Montreal Neurological Hospitals, as well as the Montreal Chest Institute. Building on the tradition of medical leadership of the founding hospitals, the goal of the MUHC is to provide patient care based on the most advanced knowledge in the health care field, and to contribute to the development of new knowledge.

For more information on the DOVE study please contact: Dr. Eliane D. Franco at 514-398-2278.