towards an improved prognosis

Human papillomavirus particles, colored transmission electron micrograph (TEM).  The particles (virions) of the human papillomavirus (HPV) consist of a protein capsid (orange) containing DNA (deoxyribonucleic acid), the genetic material of the virus.
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With 5,200 new cases and 3,200 deaths each year according to the National Cancer Institute (INCa), ovarian cancer is the eighth female cancer in France. It is a pathology with a poor prognosis, with an overall five-year survival rate of 43% – compared to 63% for cervical cancer and 88% for breast cancer.

This cancer is asymptomatic in the early stage, so “75% of women are diagnosed at an advanced stage when cancer cells reach the peritoneum [membrane entourant les organes abdominaux] »explains Professor Isabelle Ray-Coquard, oncologist at the Léon-Bérard Center in Lyon, chairman of the collaborative group Gineco, which brings together researchers around therapeutic trials dedicated to gynecological cancers. She is also national coordinator of the rare ovarian cancer network.

So far, researchers have failed to identify biological markers for ovarian tumors and in the absence of a sufficiently fine medical imaging technique, the screening campaigns are failures. A preventive ablation can be suggested to genetically predisposed women, the main risk factor (the others are obesity, absence of pregnancy and haste of the rules).

Inappropriate support

After diagnosis, surgery is the first treatment. “Its quality has a great influence on the prognosis of the patient, there should be no remnants of the diseaseinsists Professor Marcos Ballester, head of the gynecology and breast surgery department at the Diaconesses-Croix-Saint-Simon hospital group in Paris. This involves trained practitioners who are able to perform resections of organs affected by the disease outside the gynecological sphere. »

From twelve months in the 1980s to more than thirty-six months today, overall survival has clearly progressed thanks to surgical advances and the use of molecules such as anti-angiogenic agents, which fight the proliferation of blood vessels in breast tumors.

Problem, GPs without expertise continue to operate. How many are they? The general direction for the provision of care (DGOS) did not answer us on this point. “Inadequate care still exists and represents a real loss of opportunity for women »laments Professor Ballester, as condemned by a column published in the The world in 2016.

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A decree, published in Official newspaper in April – and valid from June 2023 – specifies that a nursing home can be approved to carry out this type of operation by justifying a minimum of twenty interventions per year. This decision is part of the reform of health institutions’ approvals of cancer treatment, driven by the former Minister of Health Agnès Buzyn, in 2018, and is in line with the recommendations of the European Society of gynecological oncology published as early as 2016.

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