The National Ovarian Cancer Prevention and Early Detection Study [CAS 7210] among women at increased genetic risk of ovarian cancer (GOG-199) is the cornerstone of CGBs intervention studies research portfolio. Developed and chaired by Dr. Greene, it is a non-randomized natural history study of risk-reducing salpingo-oophorectomy (RRSO) versus a novel ovarian cancer screening strategy (the ROCA algorithm) [NCI Protocol #02-C-0268]. This study closed to new patient enrollment in November 2006, having accrued 2605 high-risk women (1029 surgery arm;1576 screening arm). Prospective follow-up ends in November 2011. Accomplishments to date include: (1) successfully completing subject accrual;(2) completing the research-based BRCA1/2 mutation testing for the 1,500 mutation-unknown study participants (including both full sequencing and testing for large deletions, rearrangements);(3) completing the central pathology review of 1037 RRSO samples;(4) publishing a report detailing the rationale and design of the study, along with baseline characteristics of the women in each cohort;(5) developing a preliminary model of the factors which influence the choice of RRSO versus screening;(6) contributing 1576 screening subjects to a pooled analysis (with the Cancer Genetics Network: total = 4,000 subjects) of determinants of baseline CA-125 levels and of the performance characteristics of the ROCA algorithm (manuscript nearing completion);(7) creating a unique biospecimen repository for future translational research;and (8) negotiating a collaboration between GOG and CIMBA under which DNA and clinical data from our 1400 mutation carriers are being contributed to multiple pooled candidate gene association studies of breast cancer risk, and two genome-wide association studies (GWAS), one for each BRCA gene. Seven published and 1 submitted manuscripts have resulted from this collaboration, including several high-impact findings (e.g., a common genetic variant at 9p22.2 modifies ovarian cancer risks in BRCA1 and BRCA2 carriers the first new BRCA-related ovarian cancer modifier identified [J Natl Cancer Inst] and a genome-wide association study identified a 19p13 locus that modifies the risk of breast cancer in BRCA1 mutation carriers and which is also associated with estrogen receptor-negative and triple-negative breast cancer in the general population [Nature Genetics]). Data from another dozen candidate SNPs are in various stages of analysis and manuscript preparation. Ancillary analyses are now underway related to (1) a detailed description of the characteristics of the eligible analytic study cohort;(2) histopathology findings from baseline RRSO surgical pathology material, emphasizing the fallopian tube mucosa;(3) testing/validation of the medical decision-making model related to choice between surgery and screening;and (4) a description of baseline quality of life by study arm. A collaborative study of the p53 molecular signature, a putative molecular precursor to fallopian tube carcinoma, is in development, and we are implementing plans to extend active follow-up of the entire cohort for an additional 5 years. The Breast Imaging Pilot Study in Women from BRCA Mutation-Positive Families [CAS 7040] reached its accrual goal of 200 women from BRCA1/2 mutation-positive families;prospective follow-up ends in February 2010 (NCI Protocol 01-C-0009). Analysis of baseline mammographic density (MD) has revealed no differences between mutation carriers and low-risk women. Analyses of MRI volume in carriers versus non-carriers and correlations between with MD are nearing completion. Our digitized mammographic images are being used to evaluate various novel imaging characteristics that may prove to be better predictors of breast cancer risk than standard MD. We have described the results of BDL in the largest cohort of BRCA mutation carriers yet reported, and quantified the tolerability of the BDL procedure. Our experience has led us to abandon BDL as a research/risk stratification tool. DNA samples from mutation-positive BI participants have been contributed to our collaboration with CIMBA. Based on pilot data documenting that femtogram quantities of estrogen metabolites are detectable in both NAF and BDL fluid, a larger study comparing estrogen levels in sample trios (serum, BDL, NAF) from the same individuals is underway. We have published a series of psychosocial analyses based on this cohort;current efforts target life issues in young mutation carriers, and the impact of ambiguous screening test results on patient mood and screening behavior.A Phase II Randomized Trial of Icosahedron Acid versus Standard Care to Prevent Post-RRSO Osteopenia/Osteoporosis (GOG-215) targets one of the major complications of RRSO-related premature menopause, i.e., significant bone loss, increased risk of osteoporosis and fracture. This study is currently open at 50 sites nationwide, and has enrolled 100 participants to date. A Pilot Study of a 3-month Intervention for Increasing Physical Activity in Sedentary Women at Risk of Breast Cancer reached its accrual goal. It asked whether a physician recommendation for increasing physical activity along with the use of a pedometer will be effective in increasing physical activity in a sedentary population of women at increased breast cancer risk [NCI Protocol #04-C-0276]. A publication describing study design and recruiting strategies has appeared, and a manuscript describing its results is in preparation.

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Skates, Steven J; Greene, Mark H; Buys, Saundra S et al. (2017) Early Detection of Ovarian Cancer using the Risk of Ovarian Cancer Algorithm with Frequent CA125 Testing in Women at Increased Familial Risk - Combined Results from Two Screening Trials. Clin Cancer Res 23:3628-3637
Loud, Jennifer T; Murphy, Jeanne (2017) Cancer Screening and Early Detection in the 21st Century. Semin Oncol Nurs 33:121-128
Young, Jennifer Louise; Werner-Lin, Allison; Mueller, Rebecca et al. (2017) Longitudinal cancer risk management trajectories of BRCA1/2 mutation-positive reproductive-age women. J Psychosoc Oncol 35:393-408
Sherman, Mark E; Drapkin, Ronny I; Horowitz, Neil S et al. (2016) Rationale for Developing a Specimen Bank to Study the Pathogenesis of High-Grade Serous Carcinoma: A Review of the Evidence. Cancer Prev Res (Phila) 9:713-20
Greene, Mark H; Mai, Phuong L (2015) The fallopian tube: from back stage to center stage. Cancer Prev Res (Phila) 8:339-41
Portnoy, David B; Loud, Jennifer T; Han, Paul K J et al. (2015) Effects of false-positive cancer screenings and cancer worry on risk-reducing surgery among BRCA1/2 carriers. Health Psychol 34:709-17
Gierach, Gretchen L; Li, Hui; Loud, Jennifer T et al. (2014) Relationships between computer-extracted mammographic texture pattern features and BRCA1/2 mutation status: a cross-sectional study. Breast Cancer Res 16:424
Mai, Phuong L; Loud, Jennifer T; Greene, Mark H (2014) A major step forward for BRCA1/2-related cancer risk management. J Clin Oncol 32:1531-3
Loud, Jennifer T; Gierach, Gretchen L; Veenstra, Timothy D et al. (2014) Circulating estrogens and estrogens within the breast among postmenopausal BRCA1/2 mutation carriers. Breast Cancer Res Treat 143:517-29
Werner-Lin, Allison; Hoskins, Lindsey M; Doyle, Maya H et al. (2012) 'Cancer doesn't have an age': genetic testing and cancer risk management in BRCA1/2 mutation-positive women aged 18-24. Health (London) 16:636-54

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