towards an improved prognosis

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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, president of the cooperative group Gineco, which brings together researchers around therapeutic trials devoted to gynecological cancers. She is also national coordinator of the rare ovarian cancer care network.

So far, researchers have failed to identify biological markers of ovarian tumors and, for lack of a sufficiently fine medical imaging technique, the screening campaigns are failures. A preventive ablation can be proposed to genetically predisposed women, the most important risk factor (the others being obesity, the absence of pregnancy, and the precocity of the periods).

Inappropriate support

After diagnosis, surgery is the first treatment. “Its quality has a major impact on the prognosis of the patient, there should be no residue of the diseaseinsists Professor Marcos Ballester, head of the gynecological and breast surgery department of the Diaconesses-Croix-Saint-Simon hospital group in Paris. This involves trained practitioners, capable of carrying out 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 progress, and the use of molecules such as anti-angiogenics, which fight against the proliferation of blood vessels in the breast tumors.

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

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A decree, published in Official newspaper in April – and applicable from June 2023 –, specifies that a place of care may be approved to perform this type of surgery by justifying a minimum of twenty procedures per year. This decision is part of the reform of authorizations for cancer care by health establishments, 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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